基于倾向性评分匹配的T4a期胃癌腔镜辅助与开腹手术近期疗效的对比分析OACSTPCD

Objective:To explore the short-term efficacy of laparoscopic assisted D2 radical surgery for T4a stage gastric cancer.Methods:Using propensity score matching,the data of patients diagnosed with T4a stage gastric adenocarcinoma and undergoing D2 lymph node dissection from Jan.2014 to Dec.2020 were analyzed.They were divided into the open group(n=362)and the laparosco-pic group(n=134).The data were 1:1 matched by propensity score matching,with the matching tolerance set to 0.03.Finally,134 cases were obtained from each of the two groups.The two groups were compared in terms of the surgical conditions,postoperative complications,changes in postoperative inflammatory indicators,and 2-year overall survival rate.Results:After propensity matching,the baseline data of the two groups were comparable(P>0.05).There was no statistically significant difference between the two groups in the time of first postoperative feeding,postoperative hospital stay,and complications(P>0.05).The surgical time[240(203.75,256.25)min vs.140(120,190)min,P<0.05],intraoperative bleeding volume[200(100,300)mL vs 200(200,300)mL,P<0.05],the number of lymph node dissection[20.5(17,27.25)vs.16(10,23),P<0.05],incision length[5(5,6)cm vs.12(10,15)cm,P<0.05],postoperative venting time[4(3,6)d vs.5(3,6)d,P<0.05],postoperative ambulation time[2(2,3)d vs 3(2,3)d,P<0.05]showed statistically significant differences.There was no statistically significant difference in preoperative neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,and lymphocyte-monocyte ratio between the two groups(P>0.05);there was no statistically significant difference in postoperative platelet-lymphocyte ratio.After operation,the neutrophil-lymphocyte ratio in the laparoscopic group was lower than that in the open group,and the lymphocyte-monocyte ratio was higher than that in the open group,and the difference was statistica-lly significant.The postoperative 2-year overall survival rates of the open and laparoscopic groups were 53.3%and 48.3%,respectively,with no statistically significant difference(P=0.211).Conclusions:For T4a stage gastric cancer,the complication rate and 2-year sur-vival rate of laparoscopic surgery are comparable to open surgery,but laparoscopic surgery has the advantages of few trauma,aesthetics,and quick postoperative recovery.