Traditional surgical incision for gastric cancer

Gastric cancer is one of the most frequent cancers in China. With the progress of medical examination and the improvement of people's awareness of self-care, the proportion of early gastric cancer is increasing. In recent years, minimally invasive surgery technology has gradually matured, and minimally invasive surgery represented by laparoscopy has gradually become one of the important directions of surgical treatment of gastric cancer.

However, it is still a thorny problem for doctors and patients whether to choose laparoscopic or open surgery for early gastric cancer resection.

Cognitive misunderstanding brings treatment problems.

Many patients believe that whether laparoscopic surgery or open surgery, surgical safety is the first. Patients also expect surgeons to remove lesions, thoroughly clean lymph nodes and minimize the risk of recurrence. Some patients even think that the larger the incision, the greater the operating space and room for the surgeon. Therefore, when laparoscopic surgery is recommended, many patients always want to know, "Is it safe? Is it clean? " , and even refused directly.

Not only do patients have cognitive misunderstandings, but some primary doctors also believe that laparoscopic surgery may not be able to completely deal with the lesions. These misunderstandings directly lead to a large gap in the proportion of minimally invasive surgery for early gastric cancer in China compared with countries such as Japan and South Korea.

High-quality research confirms the safety problem.

Recently, a national multi-center study answered the above questions. This multicenter randomized controlled clinical study comparing the safety of laparoscopic surgery and open radical total gastrectomy in the treatment of gastric cancer was led by the gastric cancer surgery team of Zhongshan Hospital affiliated to Fudan University, and was completed in conjunction with 12 well-known domestic hospitals and Fudan University School of Public Health for 2 1 month.

Professor Sun from Zhongshan Hospital affiliated to Fudan University said that laparoscopic total gastrectomy is a subject to be studied. Compared with laparoscopic distal gastrectomy, laparoscopic total gastrectomy has higher technical requirements, and the difficulty and risk of reconstruction are far greater than that of distal gastrectomy.

Specifically, the main purpose of this study is to compare the safety of laparoscopic total gastrectomy (LTG) and traditional open total gastrectomy (OTG) in the treatment of stage I clinical gastric cancer. The study lasted from 20 17 to September 20 18, and 227 patients were recruited. The final follow-up time was 20 18 10 months.

The main end points and evaluation methods of the study include evaluating the incidence and mortality of complications within 30 days after LTG and OTG operations, and the non-inferiority threshold is 10%. The secondary purpose is to evaluate the recovery process and postoperative hospitalization time of patients.

The study finally included ***2 14 patients with clinical stage I gastric cancer, and randomly divided them into laparoscopic total gastrectomy group (105 cases) and traditional open total gastrectomy group (109 cases). The average age of laparoscopic group was 59.8 years old, and that of open surgery group was 59.4 years old. Most of the patients in both groups were men (more than 70%).

After comparing the data of the two groups, the researchers found that there was no significant difference in the incidence of total complications, postoperative complications and mortality between the two groups, but the amount of bleeding in abdominal surgery was significantly less than that in open surgery.

In order to ensure the safety of patients and the quality of research, in this clinical study, all participating doctors have two hard indicators besides being well trained.

First, the doctors involved in the study must complete at least 50 cases of laparoscopic radical gastrectomy and 50 cases of open radical gastrectomy.

Second, unedited surgical videos must be directly submitted to the third-party evaluation organization-China Laparoscopic Gastrointestinal Surgery Research Group (class), and sent to the same surgeon for blind evaluation.

Only by meeting the above two requirements can you be eligible to participate in this study.

The research results have been recognized by international peers.

Sun introduced that because this study is a safety study of laparoscopic total gastrectomy, a comprehensive and accurate record of complications is the key to ensure the quality of the study. In the past, the data of retrospective or single-center prospective clinical studies in China generally had low or incomplete incidence of complications, which became one of the main reasons for being questioned in international communication.

Sun said that due to the lack of high-level clinical evidence, the safety of laparoscopic total gastrectomy (LTG) in treating gastric cancer is still uncertain. However, the significance of this study is that China scholars have proved the safety of both with the highest level of evidence-based evidence in the world for the first time. Sun stressed that for patients with clinical stage I gastric cancer, experienced surgeons can perform laparoscopic radical total gastrectomy as safely as open surgery, and the safety of the two operations is equivalent. This study also laid a foundation for expanding the application scope of laparoscopic surgery in the field of gastric cancer surgery in the future.