WANG Ze, CHEN Lin. Comparative analysis of complications after 2D laparoscopy, 3D laparoscopy or open radical gastrectomy[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(3): 301-305. DOI: 10.3969/j.issn.2095-5227.2021.03.013
Citation: WANG Ze, CHEN Lin. Comparative analysis of complications after 2D laparoscopy, 3D laparoscopy or open radical gastrectomy[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(3): 301-305. DOI: 10.3969/j.issn.2095-5227.2021.03.013

Comparative analysis of complications after 2D laparoscopy, 3D laparoscopy or open radical gastrectomy

Funds: Supported by the Beijing Science and Technology Project (Z161100000516237)
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  • Corresponding author:

    CHEN Lin. Email: chenlinbj@vip.sina.com

  • Received Date: December 29, 2020
  • Available Online: October 18, 2021
  •   Background  Laparoscopy-assisted radical gastric cancer surgery has become the main method of gastric cancer surgery today. With the development of imaging technology, 3D laparoscopy emerges after 2D and has gradually been used in clinics, but is laparoscopic surgery better than open surgery, is 3D more advantageous than 2D laparoscopy? This study is to explore this issue.
      Objective  To compare the difference of postoperative complications after 2D laparoscopic, 3D laparoscopic and open radical gastric cancer surgery.
      Methods  Clinical data about patients who underwent 2D laparoscopic, 3D laparoscopy or open radical gastric cancer surgery from January 1, 2018 to January 1, 2020 in the First Medical Centre of Chinese PLA General Hospital were retrospectively analyzed. All included patients were preoperatively diagnosed with primary gastric cancer and confirmed without distant metastasis, and they were confirmed with R0 resection by postoperative pathology. Patients without complete medical records were excluded. The postoperative complications among open group, 2D laparoscopic group and 3D laparoscopic group were analyzed and compared. One-way ANOVA was used to analyze continuous variables, while χ2 test or Fisher's exact test was chosen to compare categorical variables.
      Results  A total of 1 743 patients (1 324 males and 419 females) were included in this study, aged from 21 to 88 (59.7 ± 11.2) years. There were 400 cases (315 males and 85 females, 198 cases with age over 65 years) in open group, 589 cases (443 males and 146 females, 284 cases with age over 65 years) in 2D laparoscopic group and 754 cases (566 males and 188 females, 303 cases with age over 65 years) in 3D laparoscopic group. No statistically significant difference was found in the baseline data and some operative or postoperative data among three groups, such as gender, family history of tumors and preoperative radio chemotherapy, combined organ resection, surgical procedures or tumor stage (all P>0.05). The incidence of postoperative complications among open group, 2D laparoscopic group and 3D laparoscopic group were 9.8% (39/400), 14.8% (87/589) and 11.4% (86/754), respectively (P=0.042). The incidence of anastomotic leakage was significantly higher in the 2D laparoscopic group and 3D laparoscopic group than that in the open group (4.8% [28/589] and 3.8%[29/754] vs 1.3%[5/400], P=0.012). The incidence of anastomotic bleeding in open group was lower than that of 2D laparoscopic group and 3D laparoscopic group (0.3%[1/400] vs 1.7%[10/589] and 0.4% [3/754], P=0.017]. In view of Clavien-Dindo classification, III b complications occurred more common in open group (3.8% [15/400] vs 2D 1.2% [7/589] and 3D 1.2% [9/754], P=0.003).
      Conclusion  Open radical gastrectomy has no significant difference in types of complications compared with laparoscopic surgeries. However, the incidence of complication in laparoscopic surgery is higher than that of open radical gastrectomy. Patients undergoing laparoscopic surgery are more prone to have postoperative anastomotic leakage, and patients in 2D laparoscopic surgery group are more prone to have postoperative anastomotic bleeding, while open radical gastrectomy usually requires reintervention of general anesthesia.
  • [1]
    Berríos-Torres SI,Umscheid CA,Bratzler DW,et al. Centers for disease control and prevention guideline for the prevention of surgical site infection,2017[J]. JAMA Surg,2017,152(8): 784-791. doi: 10.1001/jamasurg.2017.0904
    [2]
    李前进,董永辉,赵福岩. 食管贲门癌术后胃排空障碍的影响因素[J]. 海南医学,2020,31(20): 2674-2676. doi: 10.3969/j.issn.1003-6350.2020.20.025
    [3]
    刘祥,王城,武步强. 胰十二指肠切除术后胃排空障碍的诊疗进展[J]. 中国普外基础与临床杂志,2020,27(5): 641-645.
    [4]
    张裕. 导致腹部手术后胃排空障碍相关因素临床分析[J]. 系统医学,2019,4(17): 39-41.
    [5]
    Deng Y, Huang S, Huang M, et al. Gastrocolic ligament lymph-node dissection may increase the incidence of delayed gastric emptying after colon cancer surgery with D3 lymph- adenectomy[J/OL]. https://doi.org/10.1007/s00595-020-02200-6.
    [6]
    周晓峰,杜华劲,高学健,等. 结肠癌根治术后并发症的Clavien-Dindo分级及其危险因素分析[J]. 局解手术学杂志,2020,29(7): 553-557.
    [7]
    张剑锋. 腹腔镜与开腹胃癌根治术治疗进展期胃癌的临床对比研究[J]. 医学食疗与健康,2021,19(2): 45-46.
    [8]
    黄文场,苏亦斌,练玉杰,等. 腹腔镜胃癌根治术与开腹胃癌根治术治疗远端进展期胃癌的效果比较[J]. 中外医学研究,2021,19(2): 54-56.
    [9]
    黄志良,束一鸣,许斌华,等. 全腹腔镜与腹腔镜辅助全胃切除术治疗胃癌临床观察[J]. 社区医学杂志,2020,18(24): 1652-1655.
    [10]
    Jiao J,Liu SZ,Chen C,et al. Comparative study of laparoscopic radical gastrectomy and open radical gastrectomy[J]. J Minim Access Surg,2020,16(1): 41-46. doi: 10.4103/jmas.JMAS_155_18
    [11]
    Chen QY,Xie JW,Zhong Q,et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer:a randomized clinical trial[J]. JAMA Surg,2020,155(4): 300-311. doi: 10.1001/jamasurg.2019.6033
    [12]
    胡祥. 日本胃癌外科临床研究和治疗新动向[J]. 中国实用外科杂志,2020,40(8): 905-908.
    [13]
    孙益红. 早期胃癌行腹腔镜和开腹全胃切除术RCT研究(CLASS-02)进展[J]. 中国实用外科杂志,2019,39(5): 433-436.
    [14]
    Zhang K,Xi H,Wu X,et al. Ability of serum C-reactive protein concentrations to predict complications after laparoscopy-assisted gastrectomy:a prospective cohort study[J]. Medicine (Baltimore),2016,95(21): e3798.
    [15]
    Hu YF,Huang CM,Sun YH,et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer:a randomized controlled trial[J]. J Clin Oncol,2016,34(12): 1350-1357. doi: 10.1200/JCO.2015.63.7215
    [16]
    Espiritu PN,Agarwal G,Luchey A,et al. mp50-04 a novel method of stratification of complication of radical cystectomy using the comprehensive complication index[J]. J Urol,2014,191(4): e495.
    [17]
    Kim DJ,Lee JH,Kim W. Comparison of the major postoperative complications between laparoscopic distal and total gastrectomies for gastric cancer using Clavien-Dindo classification[J]. Surg Endosc,2015,29(11): 3196-3204. doi: 10.1007/s00464-014-4053-1
    [18]
    杨天池,王孟龙. 采用Clavien-Dindo分级系统分析不同肝移植术式对肝衰竭患者术后早期严重并发症的影响[J]. 中华肝脏外科手术学电子杂志,2019,8(6): 489-492. doi: 10.3877/cma.j.issn.2095-3232.2019.06.006
    [19]
    张能云,王金波,张晶晶,等. 老年患者行腹腔镜直肠癌根治术后并发症的Clavien-Dindo分级及相关因素分析[J]. 全科医学临床与教育,2019,17(10): 926-928.
    [20]
    杨奕,王伟,彭承宏. Clavien-Dindo分级系统在消化外科的应用现状及前景[J]. 外科理论与实践,2019,24(2): 175-178.

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