Laparoscopic-assisted radical gastric cancer surgery
The incidence rate of gastric cancer ranks second among all cancers in China, and its morbidity and mortality rate ranks first, and the annual incidence of new gastric cancer in China accounts for 40% of the total cases worldwide. Radical resection of tumor and standardized lymph node dissection through surgery, combined with preoperative and postoperative MDT comprehensive treatment, is the only method that can effectively cure gastric cancer at present. Traditional open surgery for radical resection and lymph node dissection of gastric cancer is a very mature procedure. In recent years, with the continuous progress and development of minimally invasive laparoscopic surgery technology, laparoscopic gastric cancer surgery is also becoming more and more mature, gradually expanding from treating early gastric cancer to progressive gastric cancer. Since the stomach has rich blood supply and complex anatomical levels, and standardized lymph node dissection is an important factor to improve the prognosis of gastric cancer, the technical requirements for surgeons are higher than those for laparoscopic colorectal cancer. In recent years, besides completing laparoscopic hepatobiliary and pancreatic surgery, laparoscopic radical surgery for gastric cancer has been further developed, and laparoscopic hepatobiliary and pancreatic surgery techniques have been integrated into radical surgery for gastric cancer, and standard radical treatment for gastric cancer, D2 lymph node dissection and hilar lymph node dissection have been completed, etc. Now we will briefly introduce some relevant information about laparoscopic radical surgery for gastric cancer.
I. Indications and contraindications of laparoscopic radical gastric cancer surgery
1.Surgical indications
(1) Recognized indications for laparoscopic gastric cancer surgery.
(1) Those whose gastric tumor infiltration depth is within T2.
(ii) other malignant tumors such as gastric malignant interrogative stromal tumor and lymphoma.
③to perform the exploration and staging of gastric cancer.
④ short-circuit surgery for advanced gastric cancer.
⑤ Those who are considered to be stage I, II or IIIa in the preoperative and intraoperative staging examination of gastric cancer.
(2) Indications for comprehensive consideration according to patient’s specific condition.
(i) Those whose tumor invades the plasma membrane layer, but the invaded area of plasma membrane is <10 cm2.
(2) Gastric cancer with liver or abdominal metastasis requiring palliative gastrectomy.
2. Contraindications for surgery
(1) Gastric cancer with large invasion of plasma membrane layer, or tumor diameter >10 cm, or lymph node metastasis fusion and encirclement of important blood vessels and/or extensive infiltration of tumor and surrounding tissues.
(2) Severe abdominal adhesions, severe obesity, emergency surgery for gastric cancer and poor heart and lung function are relatively contraindicated; those with poor general condition which cannot be corrected despite preoperative treatment; those with serious heart, lung, liver and kidney diseases which cannot tolerate surgery.
2.Laparoscopic radical gastric cancer surgery methods and types
Surgical methods.
(1) Total laparoscopic gastric surgery: the resection and anastomosis of the stomach are done under laparoscopy, which is technically demanding and the operation time is relatively long, but for cancer in the upper part of the stomach and the lower part of the esophagus is involved, total laparoscopic esophagogastric/jejunal anastomosis has advantages over small incisional adjuvant anastomosis.
(2) Laparoscopic-assisted gastric surgery: gastric freeing and lymph node dissection are done laparoscopically, and gastric resection or anastomosis is done through small incisions in the abdominal wall, which is the most used surgical modality at present.
(3) Hand-assisted laparoscopic gastric surgery: during laparoscopic surgery operation, the hand is inserted into the abdominal cavity through a small incision in the abdominal wall to assist in the operation to complete the surgery.
Types of surgery.
(1) laparoscopic radical resection of distal gastric cancer.
(2) Laparoscopic proximal gastric cancer radical surgery.
(3) laparoscopic radical total gastrectomy for gastric cancer.
(4) laparoscopic gastrectomy combined with adjacent organ resection.
3.Advantages and disadvantages of laparoscopic radical gastric cancer surgery compared with traditional open surgery
Compared with traditional open surgery, laparoscopic radical gastric cancer surgery can effectively reduce surgery-related trauma and stress reactions, significantly reduce the amount of surgical bleeding, reduce surgical side injuries, and promote rapid recovery of patients.
4. Complications associated with laparoscopic radical gastric cancer surgery
Complications of laparoscopic gastric cancer surgery are mainly divided into 3 types.
(1) Complications related to laparoscopic instruments and operations. (1) Complications related to laparoscopic instruments and operations, including pneumoperitoneum needle puncture errors, “Trocar” injury to abdominal organs, subcutaneous emphysema or hypercapnia, and other problems common to all laparoscopic procedures.
(2) Systemic complications associated with gastric cancer surgery, including lung infection, urinary tract infection, and abnormal liver and kidney function.
(3) Abdominal complications directly related to gastric cancer surgery. The most common ones include abdominal bleeding, anastomotic fistula or stenosis, pancreatic leakage, small bowel obstruction, lymphatic leakage, etc.
In summary, we can see that there is no significant difference between laparoscopic radical gastric cancer treatment and open radical gastric cancer treatment in terms of long-term prognosis and five-year survival. However, laparoscopic radical gastric cancer treatment has obvious advantages over conventional open radical gastric cancer treatment in terms of postoperative complications and rapid postoperative recovery of patients.
Lower special liver segment resection, hemihepatectomy, total laparoscopic pancreatic body and tail resection with preservation of spleen, total laparoscopic radical treatment of gastric cancer, laparoscopic-assisted radical treatment of gastric cancer, total laparoscopic radical treatment of colorectal cancer and total laparoscopic splenectomy have been performed with less injury, faster recovery and satisfactory results compared with traditional surgery.