Short term outcomes of laparoscopic double-channel reconstruction for proximal gastric cancer: propensity score matching analysis

doi:10.3877/cma.j.issn.1674-0793.2021.02.004

Abstract

Abstract:

Objective

To explore the application value of proximal gastric cancer through the short-term clinical outcomes of laparoscopic proximal gastrectomy with double-channel anastomosis (PG) in the treatment of upper gastric cancer.

Methods

A retrospective cohort study was performed. Clinical data of 84 patients who underwent laparoscopic upper gastric tumor resection in Huangshan People’s Hospital from May 2017 to April 2020 were retrospectively collected. Propensity matching analysis was used to compare the short clinical outcomes of PG and laparoscopic total gastrectomy with Roux-en-Y anastomosis (TG) for upper gastric tumors.

Results

There were 19 cases of PG and 65 cases of TG. After 11 propensity matching, they were divided into group PG and group TG, with 19 patients in each group. The data of the two groups were evenly distributed. Compared with group TG, group PG had no significant increase in postoperative complications, length of hospital stay, and hospitalization expenses, but the first exhaust time was significantly earlier, and the albumin level and body weight recovery were better at3 months after operation (t=2.660, P=0.012; Z=-2.669, P=0.008). Group PG did not significantly increase the risk of serious postoperative complications (P=0.486), whereas it might potentially reduce postoperative gastrointestinal reactions.

Conclusion

Compared with TG, PG is safe and feasible in the short term clinical outcome, and helps to restore the patients’ nutritional status.

Key words: Stomach neoplasms, Laparoscopes, Gastroenterostomy, Double-channel anastomosis

Yanbin Ji, Jianming Cui, Jian Liu, Weiqing Zheng, Jian Ren. Short term outcomes of laparoscopic double-channel reconstruction for proximal gastric cancer: propensity score matching analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(02): 95-99.

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References 19

[1]	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015 [J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[2]	Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501[J]. J Clin Oncol, 2004, 22(14): 2767-2773.
[3]	Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted BillrothⅠgastrectomy[J]. Surg Laparosc Endosc, 1994, 4(2): 146-148.
[4]	Park YK, Yoon HM, Kim YW, et al. Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer: results from a randomized phase multicenter clinical trial (COACT 1001)[J]. Ann Surg, 2018, 267(4): 638-645.
[5]	Wang Z, Xing J, Cai J, et al. Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: A multicenter randomized controlled trial[J]. Surg Endosc, 2019, 33(1):33-45.
[6]	中华人民共和国卫生部医政司. 胃癌诊疗规范（2011年版）[J/CD]. 中国医学前沿杂志（电子版）, 2012, 4(5): 62-71.
[7]	Smith RJ, Bryant RG. Metal substitutions incarbonic anhydrase: A halide ion probe study[J]. Biochem Biophys Res Commun, 1975, 66(4): 1281-1286.
[8]	Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation[J]. J Chronic Dis, 1987, 40(5): 373-383.
[9]	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6 336 patients and results of a survey[J]. Ann Surg, 2004, 240(2): 205-213.
[10]	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition)[J]. Gastric Cancer, 2021, 24(1): 1-21.
[11]	Sugoor P, Shah S, Dusane R, et al. Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary[J]. Langenbecks Arch Surg, 2016, 401(5): 687-697.
[12]	Rosa F, Quero G, Fiorillo C, et al. Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach: A propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer-GIRCG)[J]. Gastric Cancer, 2018, 21(5): 845-852.
[13]	Chen YC, Lu L, Fan KH, et al. Proximal gastrectomy versus total gastrectomy for adenocarcinoma of the esophagogastric junction: A Meta-analysis[J]. J Comp Eff Res, 2019, 8(10):753-766.
[14]	徐泽宽，王林俊，李博文. 腹腔镜胃癌手术进展及展望[J]. 中国实用外科杂志, 2020, 40(2): 185-190.
[15]	杨潇，李琛. 早期胃癌近端胃切除术后消化道重建方式的比较[J]. 外科理论与实践, 2019, 24(6): 560-564.
[16]	张琬昕，张小桥. 腹腔镜与开腹进展期胃癌全胃切除术远期疗效的Meta分析[J]. 腹腔镜外科杂志, 2020, 25(3): 189-194.
[17]	吴永彪，梁秀健，闫慧明. 腹腔镜下胃切除术治疗进展期胃癌近期及远期疗效的Meta分析[J/CD]. 中华普通外科学文献（电子版）, 2019, 13(5): 412-420.
[18]	Jung DH, Lee Y, Kim DW, et al. Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer[J]. Surg Endosc, 2017, 31(10): 3961-3969.
[19]	刘选文，李金秋，刘通，等. 双通道吻合技术在早期胃癌腹腔镜近端胃切除术消化道重建中的应用价值[J]. 腹腔镜外科杂志, 2020, 25(1): 21-24, 29.

变量		倾向性评分匹配前				倾向性评分匹配后
变量		PG组	TG组	χ²值	P值	PG组	TG组	χ²值	P值
例数		19	65			19	19
性别
	男	17	47	-	0.219	17	17	-	1.000
	女	2	18			2	2
年龄(岁)
	≥65	11	39	0.027	0.869	10	10	0.106	1.000
	<65	8	26			9	9
存在营养不良风险
	是	6	32	1.849	0.174	6	6	0.000	1.000
	否	13	33			13	13
ASA分级
	Ⅰ/Ⅱ	18	62	-	1.000	17	18	-	1.000
	Ⅲ	1	3			2	1
组织分化程度
	高/中	8	17	1.790	0.181	8	8	0.000	1.000
	低	11	48			11	11
低蛋白血症
	有	5	17	0.000	0.989	1	3	-	0.604
	无	14	48			18	16
Charlson合并症指数(分)
	0/1	17	60	-	0.654	17	16	-	1.000
	≥2	2	5			2	3
术前贫血
	有	7	27	0.135	0.714	7	7	0.000	1.000
	无	12	38			12	13
T分期
	1/2	8	14	3.217	0.073	8	6	0.452	0.501
	3/4	11	51			11	13
N分期
	0/1	14	22	9.528	0.002^a	14	12	0.487	0.485
	2/3	5	43			5	7

变量		倾向性评分匹配前				倾向性评分匹配后
变量		PG组	TG组	χ²值	P值	PG组	TG组	χ²值	P值
例数		19	65			19	19
性别
	男	17	47	-	0.219	17	17	-	1.000
	女	2	18			2	2
年龄(岁)
	≥65	11	39	0.027	0.869	10	10	0.106	1.000
	<65	8	26			9	9
存在营养不良风险
	是	6	32	1.849	0.174	6	6	0.000	1.000
	否	13	33			13	13
ASA分级
	Ⅰ/Ⅱ	18	62	-	1.000	17	18	-	1.000
	Ⅲ	1	3			2	1
组织分化程度
	高/中	8	17	1.790	0.181	8	8	0.000	1.000
	低	11	48			11	11
低蛋白血症
	有	5	17	0.000	0.989	1	3	-	0.604
	无	14	48			18	16
Charlson合并症指数(分)
	0/1	17	60	-	0.654	17	16	-	1.000
	≥2	2	5			2	3
术前贫血
	有	7	27	0.135	0.714	7	7	0.000	1.000
	无	12	38			12	13
T分期
	1/2	8	14	3.217	0.073	8	6	0.452	0.501
	3/4	11	51			11	13
N分期
	0/1	14	22	9.528	0.002^a	14	12	0.487	0.485
	2/3	5	43			5	7

组别	清扫淋巴结数目(枚)^a	术前白蛋白(g/L)^b	术后首次排气时间(d)^a	术后并发症^c[例(%)]	术后住院时间(d)^a	出院时白蛋白(g/L)b	出院时体重下降(kg)^a	总住院费用(元)^a	术后3个月白蛋白(g/L)^b	术后3个月体质量下降(kg)^a
PG组	23(19, 24)	37.52±4.37	2(2, 3)	5(26.3)	14(11, 16)	33.44±3.37	3(1, 4.5)	46 746.59(41 932.52~49 572.54)	40.10±4.94	4(2, 5)
TG组	25(18, 31)	37.37±3.83	3(3, 4)	5(26.3)	14(12, 15)	33.5±3.07	3(2, 5)	43 419.18(39 247.17, 52 074.17)	35.89±4.81	9(4, 10.5)
统计值	-1.043	0.111	-2.342	0	-0.089	-0.055	-1.001	-0.686	2.660	-2.669
P值	0.311	0.913	0.019	1.000	0.929	0.956	0.317	0.493	0.012	0.008

组别	清扫淋巴结数目(枚)^a	术前白蛋白(g/L)^b	术后首次排气时间(d)^a	术后并发症^c[例(%)]	术后住院时间(d)^a	出院时白蛋白(g/L)b	出院时体重下降(kg)^a	总住院费用(元)^a	术后3个月白蛋白(g/L)^b	术后3个月体质量下降(kg)^a
PG组	23(19, 24)	37.52±4.37	2(2, 3)	5(26.3)	14(11, 16)	33.44±3.37	3(1, 4.5)	46 746.59(41 932.52~49 572.54)	40.10±4.94	4(2, 5)
TG组	25(18, 31)	37.37±3.83	3(3, 4)	5(26.3)	14(12, 15)	33.5±3.07	3(2, 5)	43 419.18(39 247.17, 52 074.17)	35.89±4.81	9(4, 10.5)
统计值	-1.043	0.111	-2.342	0	-0.089	-0.055	-1.001	-0.686	2.660	-2.669
P值	0.311	0.913	0.019	1.000	0.929	0.956	0.317	0.493	0.012	0.008

组别	例数	胃肠道反应	术后并发症					严重并发症
组别	例数	胃肠道反应	吻合口漏/狭窄/胃瘫	吻合口/腹腔出血	低蛋白血症	肺部/腹腔感染	心血管疾病	严重并发症
PG组	19	1	0	3	1	1	1	0
TG组	19	6	0	2	3	2	0	2
P值		0.090	-	1.000	0.604	1.000	1.000	0.486

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