Abstract:
Objective To explore the clinical application of hand-assisted laparoscopic D2 radical gastrectomy (HALG) for the treatment of gastric cancer. Methods We retrospectively analyzed the clinical data of 60 patients with gastric cancer who were treated in the Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University from January 2018 to December 2020, among which 20 patients underwent hand-assisted laparoscopic surgery, 20 underwent traditional open surgery, and 20 underwent laparoscopic assisted surgery. The differences in operative time, blood loss, incision length, postoperative discharge time, duration of first time to get out of bed after surgery, length of hospital stay, number of dissected lymph nodes and other indicators among the three groups were analyzed. Results All of the 60 operations were completed successfully. Results of the three groups showed that the operation time of the hand-assisted laparoscopic group and the laparoscopic assisted group were significantly longer than that of the traditional group [(239.7±22.2)min, (251.9±33.2)min, (184.1±37.2)min, F=26.309, P < 0.001], but there was no significant difference in the operation time between the hand-assisted laparoscopic group and laparoscopic assisted group (P > 0.05). The blood loss of the hand-assisted laparoscopic group and the laparoscopic assisted group were significantly less than that of the traditional group (F=68.984, P < 0.001), and the blood loss of the hand-assisted laparoscopic group was shorter than that of the laparoscopic assisted group (P < 0.05). The incision length of the hand-assisted laparoscopic group and the laparoscopic assisted group were significantly smaller than that of the traditional group (F=675.937, P < 0.001), but there was no significant difference between the hand-assisted laparoscopic group and the laparoscopic assisted group (P > 0.05). Postoperative exhaust time, length of hospital stay and duration of first time to get out of bed after surgery of the hand-assisted laparoscopic group and the laparoscopic assisted group longer than that of the traditional group (all P < 0.001), but there was no significant difference between the hand-assisted laparoscopic group and the laparoscopic assisted group (all P > 0.05). There was no significant difference in numbers of lymph nodes dissected among the 3 groups (F=0.582, P=0.562). Conclusion Hand-assisted laparoscopic D2 radical gastrectomy (HALG) combines the advantages of both open and laparoscopic-assisted radical gastrectomy. Compared with OG and LAG, HALG shows great advantages in lower requirements for assistants, less manpower, smaller incision, less intraoperation blood loss, quicker postoperative recovery and fewer complications. In conclusion, the HALG is a safe and feasible surgery.