Preliminary analysis of the promotion effect of laparoscopic standardized surgical treatment for gastric cancer in regional medical centers in Shanghai.
10.3760/cma.j.cn441530-20220412-00144
- Author:
Xiao Dong SHEN
1
;
Ming XU
2
;
Chang SU
1
;
Min YE
3
;
Wei LI
4
;
Zhen Xi YANG
5
;
Jiang HAN
6
;
Zhi Qi ZHANG
7
;
Hong Gang XIANG
8
;
Lin Hai YU
9
;
Peng SUN
10
;
Wen Hai HUANG
11
;
Bo Wen XIE
12
;
Ying Xin GUAN
12
;
Zeng Hao CAI
12
;
Wenpeng ZHANG
13
;
Lu ZANG
12
Author Information
1. Department of General Surgery, Minhang Hospital, Fudan University, Shanghai 201199, China.
2. Department of General Surgery, Pudong Hospital, Fudan University, Shanghai 201399, China.
3. Department of General Surgery, Pudong Hospital, Fudan University, Shanghai 201399, China Department of General Surgery, Shanghai Pudong New District Punan Hospital, Shanghai 200125, China.
4. Department of General Surgery, Shanghai Putuo District Central Hospital, Shanghai 200062, China.
5. Department of General Surgery, Shanghai Seventh People's Hospital, Shanghai 200137, China.
6. Department of General Surgery, Shanghai Pudong New District Zhoupu Hospital, Shanghai 201318, China.
7. Department of General Surgery, Shanghai Fourth People's Hospital, Shanghai 200081, China.
8. Department of General Surgery, Shanghai Pudong New District People's Hospital, Shanghai 201299, China.
9. Department of General Surgery, Shanghai Songjiang Fangta Hospital of Traditional Chinese Medicine, Shanghai 201699, China.
10. Department of General Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200050, China.
11. Department of General Surgery, Jinshan Hospital, Fudan University, Shanghai 201508, China.
12. Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
13. Department of General Surgery, Luwan Branch of Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200020, China.
- Publication Type:Journal Article
- MeSH:
China;
Gastrectomy/methods*;
Hospitals;
Humans;
Laparoscopy;
Lymph Node Excision/methods*;
Postoperative Complications/etiology*;
Retrospective Studies;
Stomach Neoplasms/pathology*;
Treatment Outcome
- From:
Chinese Journal of Gastrointestinal Surgery
2022;25(8):708-715
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To explore the promotion effect of laparoscopic standardized surgery for gastric cancer observational in some regional medical centers in Shanghai. Methods: A retrospective cohort study was carried out. Eleven regional medical centers in Shanghai received the promotion program of laparoscopic standardized surgery for gastric cancer, which was led by Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Shanghai Minimally Invasive Surgery Center) from January to December 2020. Clinicopathological data of gastric cancer patients treated at these 11 regional medical centers before and after the promotion program were collected. Inclusion criteria were as follows: patients undergoing laparoscopic distal gastrectomy or total gastrectomy; gastric cancer confirmed by pathology; without distant metastasis or peritoneal metastasis. Patients who did not undergo laparoscopic D2 radical resection, or received neoadjuvant chemotherapy before surgery, or without complete clinical data were excluded. Patients undergoing laparoscopic surgery from January to December 2019 were included in the pre-promotion group (46 cases). Patients undergoing laparoscopic surgery from January to December 2021 were included in the post-promotion group (102 cases). In addition, patients undergoing laparoscopic surgery at Ruijin Hospital from January 2021 to December were included in the control group (138 cases). The baseline data, perioperative measurements postoperative complications, and pathological results of the three groups were analyzed and compared. Results: There were no significant differences in baseline characteristics among the three groups (all P>0.05). Compared with the pre-promotion group, the operation time in post-promotion group was significantly shorter [(207.3±36.0) minutes vs. (254.2±47.1) minutes, t=7.038,P<0.001], and the number of harvested lymph node was significantly more (24.4±12.2 vs. 18.9±5.5, t=2.900, P=0.004). However, there were no significant differences in the extent of resection, time to fluid intake, and postoperative hospital stay between the two groups (all P>0.05). Compared with the control group, the operation time [(207.3±36.0) minutes vs (172.6±26.0) minutes, t=8.281, P<0.001], time to fluid intake [(6.3±3.2) days than (5.5±3.0) days, t=2.029, P=0.044], and the postoperative hospital stay [(14.3±5.6) days vs. (10.1±4.8) days, t=6.036, P<0.001] in the post- promotion group were still longer. Total gastrectomy was less common in the post-promotion group compared with the control group [18 cases (17.6%) vs. 41 cases (29.7%), χ2=7.380, P=0.007]. However, there was no significant difference in the number of harvested lymph node between the two groups (P>0.05). The morbidity of postoperative complication in the post-promotion group (9.8%, 10/102) was significantly lower than that in the pre-promotion group (23.9%, 11/46) (χ2=5.183, P=0.023), while above morbidity was not significantly different between the post-promotion group and the control group [9.8% vs. 6.5% (9/138), χ2=0.867, P=0.352]. Conclusion: After the promotion of laparoscopic standardized surgery for gastric cancer in regional medical centers, the standardization degree of surgery has been improved, and the morbidity of postoperative complication decreases. Laparoscopic standardized surgery for gastric cancer can be promoted to more regional medical centers.
