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Purpose : Although the use of laparoscopic gastrectomy for gastric cancer has been widespread, it has remained controversial whether it can be applied for the patients with advanced gastric cancer. Th...e aim of this study was to clarify the safety and usefulness of totally laparoscopic gastrectomy for patients with advanced gastric cancer. Patients and Methods : Totally laparoscopic gastrectomy was applied for a total of 38 patients with pStage IB-III advanced gastric cancer at our institute. The surgical and long-term results were analyzed in those patients. Results : Twenty-seven patents underwent distal gastrectomy and 11 patients underwent total gastrectomy. The mean number of dissected lymph nodes was 41 (range, 16-87). The mean length of the operation and amount of blood loss was 324 min and 123 ml, respectively. Two cases of postoperative bleeding were noted, while neither anastomosis-related complications nor in-hospital death was observed. The follow-up period after surgery was 8-72 months. Postoperative recurrence was observed in 6 patients (peritoneal dissemination : 3 patients, pleural dissemination : 1 patient, liver metastasis : 1 patient, ovarian metastasis : 1 patient). The overall survival rates at 1, 3 and 5 years were 94.7%, 76.3% and 76.3%, respectively. Conclusion : Totally laparoscopic gastrectomy is safe and can lead to satisfactory long-term outcomes in cases of advanced gastric cancer. Prospective controlled studies are warranted to confirm our findings.
【目的】胃癌に対する腹腔鏡下手術は広く普及したが，進行胃癌に対する適応の是非に関しては議論の余地がある．本研究の目的は，進行胃癌に対する完全腹腔鏡下胃切除術の有用性を明らかにすることである．【対象・方法】当科において完全腹腔鏡下胃切除術が施行されたIB 期-III 期進行胃癌症例38 例の手術成績と予後を検討した．【結果】幽門側胃切除27例，胃全摘11例が施行された．郭清リンパ節個数は平均41 個(16-87 個)であった．平均出血量123ml，平均手術時間324分，術後合併症として出血を2例に認めたが，吻合部関連合併症および在院死は認めなかった．観察期間は8-72ヶ月で，再発は6例に認めた(腹膜播種3 例，胸膜播種1 例，卵巣転移1 例，肝転移1 例)．全生存率は1 年94.7％，3 年・5 年76.3％であった．【結語】進行胃癌に対する腹腔鏡下胃切除術は安全に施行可能であり，予後も良好である．これらの結果を検証するための，前向き比較試験が必要である．続きを見る
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