Background

Totally laparoscopic gastrectomy (TLG), which involves a complete intracorporeal gastric transection and the creation of an anastomosis, has been gradually adopted. However, a potential limitation of intracorporeal transection is the lack of tactile feedback, and whether this limitation influences oncological outcomes is unclear. The aim of this study is to evaluate the short- and long-term oncological safety of TLG using endoscopy-guided intracorporeal gastric transection for clinical stage (cStage) I gastric cancer.

Methods

A total of 1875 consecutive patients who underwent laparoscopic gastrectomy for cStage I gastric cancer between January 2007 and March 2015 were enrolled in this study. Marking clips were preoperatively placed and a transection line was determined by perceiving it tactually in laparoscopy-assisted gastrectomy (LAG) or endoscopically in TLG. After propensity score matching, 1366 patients (683 each for LAG and TLG groups) were selected to primarily test the non-inferiority of TLG to that of LAG for relapse-free survival (RFS).

Results

In the propensity-matched population, the 5-year RFS rates of the LAG and TLG groups were 94.3% (95% confidence interval (CI) 92.2–95.8%), and 95.6% (95% CI 93.8–96.9%), respectively. The hazard ratio (TLG/LAG) was 0.77 (95% CI 0.48–1.24, P for non-inferiority < 0.01). There were no significant differences in the recurrence profiles. The incidence of the remnant of marking clips or tumor tissue did not differ (LAG: 1.0% vs. TLG: 1.9%, P = 0.177).

Conclusions

TLG using preoperative markings and intraoperative endoscopic guidance provides cStage I gastric cancer patients with comparable oncological outcomes to the conventional method.

中文翻译：

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全腹腔镜胃切除术与腹腔镜辅助胃切除术治疗临床Ⅰ期胃癌的短期和长期肿瘤学结果

背景

全腹腔镜胃切除术（TLG），包括完整的体内胃横断和吻合口，已逐渐被采用。然而，体内横断的一个潜在限制是缺乏触觉反馈，这种限制是否会影响肿瘤学结果尚不清楚。本研究的目的是评估 TLG 的短期和长期肿瘤学安全性，使用内镜引导的体外胃横断术治疗临床分期 (cStage) I 期胃癌。

方法

共有 1875 名在 2007 年 1 月至 2015 年 3 月期间因 cStage I 胃癌接受腹腔镜胃切除术的连续患者被纳入本研究。在术前放置标记夹，并通过在腹腔镜辅助胃切除术 (LAG) 中触觉感知或在 TLG 中通过内窥镜感知来确定横断线。在倾向得分匹配后，选择了 1366 名患者（LAG 组和 TLG 组各 683 名），主要测试 TLG 与 LAG 在无复发生存期（RFS）方面的非劣效性。

结果

在倾向匹配人群中，LAG 和 TLG 组的 5 年 RFS 率分别为 94.3%（95% 置信区间 (CI) 92.2–95.8%）和 95.6%（95% CI 93.8–96.9%） . 风险比 (TLG/LAG) 为 0.77（95% CI 0.48-1.24，非劣效性P < 0.01）。复发曲线没有显着差异。残留标记夹或肿瘤组织的发生率没有差异（LAG：1.0% vs. TLG：1.9%，P  = 0.177）。

结论

TLG 使用术前标记和术中内窥镜引导为 cStage I 胃癌患者提供与传统方法相当的肿瘤学结果。