To investigate the clinical effect of Open Total Gastrectomy (OTG) combined with D2 lymph node dissection and Laparoscopic total gastrectomy (LATG) combined with D2 lymph node dissection in advanced gastric cancer in the upper and middle part.

From January 2014 to June 2017, the data of 88 cases of advanced gastric cancer in the upper and middle parts were retrospectively analyzed. Total gastrectomy and D2 lymph node dissection were performed in all patients. According to the different operation, they were divided into Laparoscopic group (LATG group, 37 cases) and open group (OTG group, 51 cases). SPSS19.0 was used for statistical analysis. The intraoperative and postoperative indicators, VAS scores , tumor standard substances were expressed as (±s), and compared with independent t test. After operation, the free survival rate, the total survival rate and the incidence of postoperative complications were compared with χ² test, P<0.05 was P<0.05 was considered statistically significant.

The results showed that the LATG group had better operative time, intraoperative bleeding volume, first exhaust time, first eating time, intraoperative incision length, post operative hospitalization time, total incidence of complications (5.4% vs. 21.6%), intraoperative related indicators, post operative rehabilitation indicators, VAS scores of 1 week and, 3 month of VAS, CA125, CA199, CEA levels after operation than OTG group (P<0.05). There was no significant difference in the number of lymph node dissections between the two groups (P>0.05). As of December 2018, there was no significant difference in 1 year tumor free survival rate and overall survival rate between the two groups (P>0.05).

LATG combined with D2 lymph node dissection is a safe surgical method for the treatment of advanced gastric cancer in the upper and middle part, It has the advantages of less bleeding, shorter incision, quicker recovery, lower pain and lowwe postoperative complications..

Stomach neoplasms; Laparoscopes; Laparotomy; Gastrectomy; Lymph node excision; Comparative effectiveness research