Clinical efficacy of total laparoscopic proximal gastrectomy for cancer
Objective To analyze the clinical efficacy of total laparoscopic proximal gastrectomy and esophagogastric anastomosis to provide a new surgical method for the treatment of early proximal gastric cancer.Methods The clinical data of 80 patients with early gastric cancer who underwent proximal gastrectomy in the Department of General Surgery,the First Medical Center of Chinese PLA General Hospital from January 2019 to June 2021 were retrospectively analyzed.According to different surgical methods,the patients were divided into two groups:a total laparoscopic proximal gastrectomy group(n=36)and a laparoscopic-assisted proximal gastrectomy group(n=44).The perioperative conditions,long-term complications,and survival status were compared between the two groups.Results The length of surgical incision[(59.9±4.7)mm vs.(119.7±8.3)mm,P<0.001],first exhaust time[(58.2±15.3)h vs.(66.8±16.4)h,P=0.019]and postoperative hospital stay[(7.6±1.1)d vs.(9.2±1.3)d,P<0.001]of total laparoscopic proximal gastrectomy group were significantly shorter than those of laparoscope-assisted proximal gastrectomy group.The duration of operation[(186.9±16.4)min vs.(154.0±17.2)min,P<0.001]of total laparoscopic proximal gastrectomy group was significantly longer than that of laparoscopic-assisted proximal gastrectomy group.There were no significant differences in intra-operative hemorrhage,number of lymph nodedissection and first liquid diet feeding time between the two groups(P>0.05),and no early complications requiring surgical intervention occurred.The incidence of reflux esophagitis in the total laparoscopic proximal gastrectomy group was less than that in laparoscope-assisted proximal gastrectomy group[16.7%(6/36)vs.38.6%(17/44),P=0.031].There was no significant difference in gastric motility,residual gastritis,anastomosis stenosis and anastomotic ulcer between the two groups(P>0.05).Conclusion Total laparoscopic proximal gastrectomy and esophagogastric anastomosis have the characteristics of good safety,rapid postoperative recovery and anti-reflux,being worthy of clinical popularization.
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