Background: Whether the surgical case order is an important factor affecting the short- and long-term outcomes of patients with GC has always been a concern. This study aimed to compare the short- and long-term outcomes of different surgical case orders METHODS: We included patients who underwent laparoscopy-assisted radical gastrectomy at the Union Hospital of Fujian Medical University (Fuzhou, China) between January 2016 and December 2017. In total, 1235 patients (No.1 (n=497), No.2 (n=426), and Other groups (n=312)) were included in the propensity score matching (PSM, 1:1:1).

Results: After PSM, there were no significant differences in clinicopathological characteristics between the No.1, No.2, and the Other groups. The operative duration in the Other group was significantly longer than that in groups No.1 and No.2. The volume of blood loss in the No.2 and the Other group was significantly higher than that in the No.1 group. Kaplan-Meier survival analysis revealed similar five-year overall survival (OS) and disease-free survival (DFS) rates among the three groups. Multivariate Cox regression analysis showed that surgical case order was not independent risk factors for 5-year OS and DFS. Further analysis showed no significant difference in the 5-year OS and DFS among patients with different surgical case orders, regardless of age, pT stage, or range of gastrectomy (P > 0.05).

Conclusions: In high-volume centers, different surgical case orders can only affect operative time and intraoperative bleeding but not short- or long-term outcomes. Surgeons should reasonably schedule surgeries to provide better medical services and to improve patient motivation and care.

Keywords: Gastric cancer; Laparoscopy; Long-term prognosis; Surgical case order; Surgical outcomes.

Copyright © 2025 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.

背景：

胃癌（GC）患者的手术顺序是否是影响短期和长期预后的关键因素一直是一个关注点。本研究旨在比较不同手术顺序的短期和长期结果。
方法：我们纳入了2016年1月至2017年12月期间在中国福建医科大学附属协和医院接受腹腔镜辅助根治性胃切除术的患者。总共纳入了1235名患者（No.1组(n=497)，No.2组(n=426)和其他组(n=312))，并进行倾向评分匹配(PSM, 1:1:1)。

结果：

在PSM后，No.1、No.2和其它组之间没有显著的临床病理特征差异。与其他组相比，No.1和No.2组的操作时间较短。与No.1组相比，No.2和其他组出血量较多。Kaplan-Meier生存分析显示三组之间的5年总生存率(Overall Survival, OS)和无病生存率(Disease-Free Survival, DFS)相似。多变量Cox回归分析表明手术顺序不是独立影响5年OS和DFS的风险因素。进一步的分析发现，无论年龄、pT分期或胃切除范围如何，不同手术顺序患者的5年OS和DFS均没有显著差异（P > 0.05）。

结论：

在高量中心内，不同的手术顺序仅会影响操作时间和术中出血量，但不会影响短期或长期预后。外科医生应合理安排手术以提供更好的医疗服务，并提高患者的动机和护理质量。

关键词：

胃癌；腹腔镜；长期预后；手术顺序；手术结果。