الفهرس 
Dedication
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Abstract
Gastric cancer (GC) is one of the important causes of morbidity and mortality worldwide. In Egypt, GC is the 12th most common cancer representing 1.6% of the total cancers. During the last two decades, laparoscopic gastrectomy has shown a lot of popularity and efficacy, mainly from far east countries. but in low- and middle-income countries still challenging, due to the high cost of the equipment and the relative low incidence of cases. This study aims to assess the short-term outcomes of laparoscopic versus open gastrectomy in gastric cancer patients. Patients and methods: This randomized controlled trial conducted at general surgery department of Assiut University Hospital (one of the largest tertiary centers in Egypt that serves most of upper Egypt patients) in the period from January 2017 to December 2018 including all gastric cancer patients admitted in Assiut university hospital during this period. Patients were diagnosed by upper endoscopy and biopsy, where the tumor is considered surgically resectable by MSCT abdomen (IV oral contrast) (T1-3, N0-1, M0). All patients with infiltrating or metastatic cancer, peritoneal deposits, or surgically unfit patient and those who refused to be recruited in our study were excluded. After diagnosis and assessment of eligibility, patients were randomized into two groups; group A, underwent OG and group B, underwent LG. Random assignment was done by sealed envelope technique. All patients signed an informed consent after full explanation of the risks and benefits of the surgery being planned for them. Demographic details, peri-operative data such as operative time, estimated intra-operative blood loss, postoperative complications, length of hospital stay, clinicopathological TNM stage (according to the International Union Against Cancer staging) and follow-up data were evaluated. Results: During study period 73 patients were admitted to the department of general surgery at Assiut university hospital having gastric cancer and assessed for eligibility for possibility of curative resection. Twenty-seven patients were excluded as they were not meeting the eligibility criteria or refusing to be recruited in the study. The remaining 46 patients were randomized, 23 patients for open gastrectomy OG (group 1) and 23 for LG laparoscopic gastrectomy (group 2). After assignment, 4 patients refused to complete the study (early withdrawal); one from OG group and three from LG group. Locally advanced cases received palliative resection and were excluded from both groups. The study ended up with a total of 36 patients (20 for OG and 16 for LG). Although there was no statistical difference between the two groups in the clinicopathological data we noticed the following; The mean age of recruited patients was 52.5 ± 11.4 years old, (24 male and 12 female). As regard the tumor, was more distally located (69.4%), differentiated (86.1%) , all were adenocarcinoma and 55.6% TNM stage II. . The mean operative time was 260.6± 46.7 minutes in LG and 191.0 ± 24.7 minutes in OG group (p-value < 0.001). Blood loss was more in OG 372.5 ± 125.1 ml compared to 296.6 ± 124.2 ml in LG with p-value = 0.077,and number of harvested LNs was more in OG 21.0 ± 6.5 compared to LG 16.8 ± 6.5 (p-value =0.064).Intra-operative organ injury occurred in one case of open group (1/20) ( injury to the middle colic artery that leaded to colonic ischemia that required resection with primary anastomosis and one case of laparoscopic group ( 1/16) (where pleural injury occurred that was dealt with by simple repair that was air tight and there was no need for intercostal tube insertion ) with p value =0.871. Postoperative follow-up for 30 days showed the following results, Postoperative hospital stay was more among OG 8.0 ± 4.1 days than LG 6.9 ± 2.6 days (p-value =0.361). Postoperative pain score was higher in OG group (p< 0.001). Time to first flatus were 2.4 ±0.51days in OG and 2.5 ± 0.52 days in LG with p value=0.773 (Table 3). Post-operative Complications were more among OG (4/20) (4 cases; 1 anastomotic leak {total gastrectomy}, 2 luminal bleedings and 1 chest infections) compared to two cases (2/16) LG group 2 cases of anastomotic leaks {one total and one distal gastrectomy}. Anastomotic leakages were low output and managed successively by conservation in both groups. In cases which developed luminal bleeding; in both cases the bleeding was not significant (bleeding less than 100 ml/h) not required any emergency procedure. There was no mortality in LG group compared to one patient of OG group (died by massive pulmonary embolism).