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Title: [Comparison of clinical efficacy between proximal gastrectomy with double tract reconstruction and total gastrectomy with Roux-en-Y reconstruction for proximal gastric cancer].
Author: Fan JY, Qian F, Liu JJ, Liu JY, Wu B, Wu YX, Yu PW.
Journal: Zhonghua Wei Chang Wai Ke Za Zhi; 2019 Aug 25; 22(8):767-773. PubMed ID: 31422616.
Abstract:
Objective: To compare the clinical efficacy of proximal gastrectomy with double tract reconstruction (PG-DT) and total gastrectomy with Roux-en-Y reconstruction (TG-RY) for proximal gastric cancer. Methods: The retrospective study was conducted. Clinicopathological data of 132 patients with proximal gastric cancer confirmed by pathology who underwent PG-DT (n=51) or TG-RY (n=81) by the same surgeon team in Southwest Hospital of Army Military Medical University between January 2006 and December 2016 were collected. Patients with preoperative neoadjuvant therapy, non-R0 resection and non-adenocarcinoma confirmed by pathology were excluded. Observation indicators included intraoperative (operation time and blood loss); postoperative (time to flatus, hospital stay, total complications, metastasis of lymph nodes around distal side of stomach from cases undergoing TG-RY), follow-up (long-term hemoglobin level, incidence of anemia, and survival) parameters. Survival analysis was conducted using the Kaplan-Meier method, and Log-rank test was used to compare survival difference between two groups. Results: No statistically significant differences were found between two groups in the baseline data, including age, gender, BMI, hemoglobin level before operation, postoperative TNM stage, tumor size and histological differentiation between two groups (all P>0.05). There were no significant differences between PG-DT and TG-RY in intraoperative blood loss [200 (200) ml vs. 200 (195) ml, Z=-1.860, P=0.063], time to flatus [(2.7±1.0) days vs. (2.6±1.1) days, t=0.225, P=0.823], postoperative hospital stay [10(3) days vs. 10 (4) days, Z=-0.449, P=0.654] and morbidity of perioperative complications [5.9% (3/51) vs. 8.6% (7/81), χ(2)=0.081, P=0.775]. Compared with the TG-RY group, PG-DT group had longer total operative time [294 (97) minutes vs. 255 (71) minutes, Z=-3.148, P=0.002]. The hemoglobin data of 42 patients with PG-DT and 56 patients with TG-RY were collected 1 year after operation. The incidence of anemia in PG-DT group was lower than that of TG-RY group [64.2%(27/42) vs. 82.1% (46/56), χ(2)=4.072, P=0.045], and PG-DT group had higher level of hemoglobin than TG-RY group [(114.4±16.3) g/L vs. (106.6±15.0) g/L, t=2.435, P=0.017]. There were 4 cases (4/81, 4.9%) with metastasis of lymph nodes around distal side of stomach in TG-RY group. All of these 4 tumors were T4 in depth and were more than 5 cm in diameter. The median follow-up period was 26 (1 to 110) months. One-year, 3-year and 5-year survival rates were 93.2%, 65.3% and 55.0% in PG-DT group, and 85.8%, 63.8% and 47.2% in TG-RY group, respectively without significant difference (χ(2)=0.890, P=0.345). Conclusions: Compared with TG-RY, PG-DT has the same safety and feasibility for proximal gastric cancer. Although the operative time is a little longer than TG-RY, PG-DT has advantages in improving the postoperative hemoglobin level. 目的： 比较胃上部癌行根治性近端胃切除双通道重建（PG-DT）和根治性全胃切除Roux-en-Y重建（TG-RY）两种手术方式的临床疗效。 方法： 采用回顾性队列研究方法。根据以上标准，收集2006年1月至2016年12月期间陆军军医大学附属西南医院全军普通外科中心同一治疗组收治的经病理确诊为胃上部癌患者的临床病理资料，排除术前接受新辅助治疗、未能达到R(0)切除以及术后病理为非腺癌者。共132例患者纳入研究，根据手术方式的不同分为PG-DT组（51例）和TG-RY组（81例）。观察指标包括：手术情况（手术时间、术中出血量）、术后情况（术后首次排气时间、术后住院天数、术后总并发症、TG-RY组远端胃周淋巴结转移情况）以及随访（术后远期血红蛋白水平和术后贫血发生率）和生存情况。采用Kaplan-Meier法绘制生存曲线并计算生存率，并用log-rank检验进行组间比较。 结果： 两组患者基线资料的比较，差异无统计学意义（均P>0.05），具有可比性。PG-DT组和TG-RY组术中出血量[M（QR）：200（200）ml比200（195）ml，Z=-1.860，P=0.063]、术后首次排气时间[（2.7±1.0）d比（2.6±1.1）d，t=0.225，P=0.823]、术后住院天数[M（QR）：10（3）d比10（4）d，Z=-0.449，P=0.654]以及围术期并发症发生率[5.9%（3/51）比8.6%（7/81），χ(2)=0.081，P=0.775]的比较，差异均无统计学意义（均P>0.05）。与TG-RY组比较，PG-DT组手术时间较长[M（QR）：294（97）min比255（71）min，Z=-3.148，P=0.002]，但术后1年血红蛋白水平明显更高[（114.4±16.3）g/L比（106.6±15.0）g/L，t=2.435，P=0.017]，术后1年贫血发生率更低[64.3%（27/42）比82.1%（46/56），χ(2)=4.072，P=0.045]。TG-RY组81例患者中，有4例（4.9%）患者出现第4d、5、6组淋巴结转移，均为T(4)期且肿瘤直径>5 cm。全组中位随访26（1~110）个月，PG-DT组患者术后1年、3年、5年生存率分别为93.2%、65.3%和55.0%，TG-RY组分别为85.8%、63.8%和47.2%；两组总生存率比较，差异无统计学意义（χ(2)=0.890，P=0.345）。 结论： 胃上部癌行PG-DT手术安全性与TG-RY相当，且术后发生贫血概率更低，是胃上部癌较为合理的手术方式之一。.

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