Objective:To compare the safety and long-term efficacy of totally laparoscopic total gastrectomy(TLTG),laparo-scopic-assisted total gastrectomy(LATG),and open total gastrectomy(OTG)in enhanced recovery after surgery.Methods:The clini-cal data of patients who underwent TLTG,LATG and OTG for gastric cancer from Jan.2017 to Dec.2021 were retrospectively collected.Results:A total of 1 447 patients were enrolled,including1 184 males(81.82%)and263 females(18.18%)with an average age of(60.7±9.7)years.There were 194 cases in the TLTG group,249 cases in the LATG group,and 1 004 cases in the OTG group.There was no significant difference in gender,age,body mass index,and other baseline data among the three groups(P>0.05).Theamount of blood loss in the TLTG group was the least,followed by the LATG group,which was smaller than the OTG group[(102.4±9.5)mL vs.(136.8±9)mL vs.(171.2±5.4)mL],and the difference was statistically significant(P<0.001).The hospital stay in the LATG group and the OTG group[(7.3±0.2)d vs.(7.4±0.1)d]was longer than that in the TLTG group[(6.6±0.2)d],and the difference was statistically significant(P=0.043).The cost of surgery in the TLTG group and the LATG group was significantly higher than that of the OTG group[(84 193.8±951.7)yuan vs.(84 444.8±1 343.2)yuan vs.(76 849.6±728.3)yuan,P<0.001].The number of dissected lymph nodes in the TLTG group was more than that in the LATG group and the OTG group[(30.5±0.6)vs.(28.2±0.4)vs.(25.9±0.3),P=0.011].The number of positive lymph nodes in the TLTG group was more than the other two groups with a signifi-cant difference(P=0.002).There were 78 cases of postoperative complications(5.4%),including 11 cases in grades Ⅰ and Ⅱ(0.8%),32 cases in gradeⅢ(2.2%),4 cases in gradeⅣ(0.3%),and 7 cases in gradeⅤ(case fatality rate 0.5%)according to Clavien-Dindo classification.The total incidence of postoperative complications in the TLTG group,LATG group,and OTG group was 5.2%(10/194),4.0%(10/249),and 5.8%(58/1 004),respectively,and there was no significant difference among the groups(P=0.200).Survival analysis showed that patients in the OTG group had shorter overall and disease-free survival.Multivariate logistic regression analysis showed that age over 60,OTG,postoperative complications and later T stage or N stage were independent risk factors for the survival of patients after radical total gastrectomy.Conclusions:The safety of TLTG,LATG,and OTG is consistent,and laparo-scopic surgery may improve patients'overall survival.
维普
万方数据