Comparison on the efficacy between laparoscopic distal subtotal gastrectomy and total gastrectomy on gastric cancer

Abstract

Objective To compare the clinical efficacy of laparoscopic distal subtotal gastrectomy and total gastrectomy on gastric cancer. Methods The clinical data of 300 patients with gastric cancer undergoing laparoscopic radical gastrectomy in Shanxi Provincial Cancer Hospital from January 2015 to January 2018 were retrospectively analyzed. Of them, 100 patients who underwent distal subtotal gastrectomy were included in distal gastrectomy group, and 200 patients who underwent total gastrectomy were included in total gastrectomy group. The surgical related indexes (surgical duration, intraoperative blood loss, total number of lymph nodes dissection), related indexes of postoperative recovery (postoperative analgesic frequency, postoperative intestinal exhaust time, first ambulation time, postoperative hospital stay) and occurrence of perioperative complications (abdominal hemorrhage, wound infection, respiratory tract infection, fever, intestinal obstruction) were observed and compared between the two groups. And the levels of serum tumor markers including carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), neuron-specific enolase (NSE), and serum high-sensitivity C-reactive protein (hs-CRP) were recorded before surgery and at 1 day after surgery. Results The surgical duration, intraoperative blood loss, the number of lymph nodes dissection, postoperative analgesic frequency, postoperative intestinal exhaust time, first ambulation time and postoperative hospital stay in distal gastrectomy group were significantly less than those in total gastrectomy group (all P 0.05). There was no perioperative death in the two groups, and there was no statistically significant difference in the total incidence rates of abdominal bleeding, wound infection, respiratory tract infection, fever or intestinal obstruction between the two groups (P>0.05). Conclusions Two kinds of laparoscopic surgeries are safe and effective in the treatment of gastric cancer, and they can improve the serum tumor markers and inflammatory factors levels. The total gastrectomy has more number of lymph nodes dissection, but the distal gastrectomy has better condition in indexes of intraoperative blood loss and postoperative recovery than total gastrectomy. Key words: Laparoscopic surgery; Distal gastrectomy; Total gastrectomy; Gastric cancer