This study aimed to evaluate the surgical outcome and quality of life (QoL) of totally laparoscopic total gastrectomy (TLTG) compared with laparoscopy-assisted total gastrectomy (LATG) in patients with clinical stage I gastric cancer. From 2012 to 2018, EGC patients who underwent TLTG (n = 223), including the first case with intracorporeal hemi-double stapling, were matched to those who underwent LATG (n = 114) with extracorporeal circular stapling, using 2:1 propensity score matching (PSM). Prospectively collected morbidity was compared between the TLTG and LATG groups in conjunction with the learning curve. The European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires QLQ-C30, STO22, and OG25 were prospectively surveyed during postoperative 1 year for patient subgroups. After PSM, grade I pulmonary complication rate was lower in the TLTG group (n = 213) than in the LATG group (n = 111) (0.5% vs. 5.4%, P = 0.007). Other complications were not different between the groups. The learning curve of TLTG was overcome at the 26th case in terms of the comprehensive complication index. The TLTG group after learning curve showed lower grade I pulmonary complication rate than the matched LATG group (0.5% vs. 4.7%, P = 0.024). Regarding postoperative QoL, the TLTG group (n = 63) revealed less dysphagia (P = 0.028), pain (P = 0.028), eating restriction (P = 0.006), eating (P = 0.004), odynophagia (P = 0.023) than the LATG group (n = 21). Multivariate analyses for each QoL item demonstrated that TLTG was the only common independent factor for better QoL. TLTG reduced grade I pulmonary complications and provided better QoL in dysphagia, pain, eating, odynophagia than LATG for patients with clinical stage I gastric cancer.

中文翻译：

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完全腹腔镜全胃切除术和腹腔镜辅助全胃切除术的术后发病率和生活质量：倾向评分匹配分析

本研究旨在评估完全腹腔镜全胃切除术 (TLTG) 与腹腔镜辅助全胃切除术 (LATG) 在临床 I 期胃癌患者中的手术结果和生活质量 (QoL)。从2012年到2018年，接受TLTG的EGC患者（n = 223），包括第一例体内半双钉吻合术，与接受体外圆形吻合术的LATG（n = 114）患者，使用2：1倾向评分匹配（PSM）。结合学习曲线，比较了 TLTG 和 LATG 组之间前瞻性收集的发病率。欧洲癌症研究与治疗组织 (EORTC) 的 QoL 问卷 QLQ-C30、STO22 和 OG25 在术后 1 年内针对患者亚组进行了前瞻性调查。在 PSM 之后，TLTG 组（n = 213）的 I 级肺部并发症发生率低于 LATG 组（n = 111）（0.5% 对 5.4%，P = 0.007）。其他并发症在各组之间没有差异。在综合并发症指数方面，第 26 例克服了 TLTG 的学习曲线。学习曲线后的 TLTG 组的 I 级肺部并发症发生率低于匹配的 LATG 组（0.5% vs. 4.7%，P = 0.024）。在术后 QoL 方面，TLTG 组（n = 63）显示的吞咽困难（P = 0.028）、疼痛（P = 0.028）、进食限制（P = 0.006）、进食（P = 0.004）、吞咽痛（P = 0.023）少于LATG 组（n = 21）。每个 QoL 项目的多变量分析表明，TLTG 是改善 QoL 的唯一共同独立因素。TLTG 减少了 I 级肺部并发症，并在吞咽困难中提供了更好的 QoL，