Impact of bilateral subcostal rooftop incision combined double lifting retractor on recent surgical outcomes of obese patients with advanced gastric cancer

L.-M. Qian, J.-M. Huang

Gastrointestinal Surgery of the People’s Hospital of Jiangyin, Jiangyin, China. qqllmm2003@163.com

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• Surgery

OBJECTIVE: To investigate the impact of bilateral subcostal rooftop incision under bilateral costal margins combined double lifting retractors on the recent surgical outcome of obese patients with advanced gastric cancer.

PATIENTS AND METHODS: We retrospectively analyzed the clinical data of 138 obese patients with gastric cancer under radical gastrectomy. The patients were divided into two groups, the MI group (n=68) and RI group (n=70). Patients in MI group were treated by midline incision via upper abdomen combined single double lifting retractor technology while the patients in RI group were treated by roof incision under bilateral costal margins under combined double lifting technology. The abdomen entering and closing time, the operation time, bleeding volume, blood transfusion rate, postoperative drainage volume, postoperative hospitalization time, postoperative detected number of perigastric lymph node, postoperative pain score, postoperative complications and short-term survival between the two groups were compared and analyzed.

RESULTS: The average abdominal entering and closing time of RI group were slightly longer than MI group, but the average total operation time of RI group was shorter than MI group. The average bleeding volume was 98.4 ± 46.8 ml, the postoperative intraperitoneal drainage was 24 h (123.8 ± 69.0 ml), 48 h (101.9±36.7 ml), 72 h (45.1±24.6 ml), and the postoperative hospitalization time was 12.9 ± 2.5 d, and the incidence of postoperative complications was 17.1%, all of which were less than MI group. The difference on the average total detected number of perigastric lymph node between the two groups was not statistically significant. 129 cases (93.5%) were followed up for 12 to 36 months, and the difference on survival curve between the two groups was not statistically significant (p>0.05).

CONCLUSIONS: Bilateral subcostal rooftop incision was favorable for exposing the stomach, adjacent organs and large vessels, convenient for operation and would not affect the postoperative recovery, so it was a good choice for obese patients with gastric cancer.

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