Clinical Outcome and Clinicopathological Characteristics of Recurrence after Laparoscopic Gastrectomy for Advanced Gastric Cancer

Abstract

Background: Although laparoscopic gastrectomy has been recognized as a treatment of early gastric cancer, the indication for laparoscopic gastrectomy with D2 lymph node dissection has remained controversial. D2 lymph node dissection is considered to be feasible for advanced gastric cancer in some high-volume institutions specifically trained for the laparoscopic procedure. This study was undertaken to determine the clinical outcome and clinicopathological characteristics of patients who showed recurrence following laparoscopic gastrectomy for advanced gastric cancer. Methods: From August 1999 through February 2009, among 805 patients who underwent laparoscopic gastrectomy associated with regional lymph node dissection, a total of 209 patients undergoing gastrectomy associated with lymph node dissection who consequently obtained complete resection for advanced gastric cancer were subjected to the retrospective analysis to evaluate clinical outcome. Results: The mean period of postoperative observation was 1,068 days. The final stages of the 209 cases were as follows: 83 in IB, 56 in II, 46 in IIIA, and 24 in IIIB. The 5-year survival rate was 89.1% in stage IB, 93.1% in stage II, 52.5% in stage IIIA, and 46.5% in stage IIIB, respectively. A total of 27 patients (12.9%) had recurrence. Postoperative recurrence of gastric carcinoma occurred in peritoneal dissemination in 13 patients, liver in 7, distant lymph nodes in 6, ovary in 3, lung in 2, skin in 1, and meninges in 1 patient. There were neither port-site metastases nor locoregional recurrence. Conclusion: The characteristics and the rate of postoperative recurrence after laparoscopic gastrectomy for advanced gastric cancer were not greatly different from those of the open conventional procedure. Although further observation is required to finally conclude long-term survival, laparoscopic radical gastrectomy may possibly be indicated for patients with advanced gastric cancer.

Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study

“…In our series, the majority of tumors were located in the proximal and middle-third of the stomach. This recurrence rate is slightly higher than those observed by Yoshimura et al [44] and Song et al [42] of 12.9 and 13% respectively in a series of 209 and 231 patients who underwent curative laparoscopic gastrectomy for advanced cancer respectively. Memon et al [37] in a meta-analysis of randomized control trials also found no statistical difference in tumor recurrence between each group [13% in the LG and 12.5% in the OG; odds ratio (OR), 1.08].…”

Robot-Assisted Surgery for Gastric Cancer: Experience at Our Institute

“…Whereas the D2 LND is an essential procedure for the treatment of gastric cancer [14,15], laparoscopic gastrectomy with this type of LND is technically difficult and is performed only in limited institutes. As we reported previously, D2 LND has been performed laparoscopically in our institute [20][21][22][23] . From our experiences, the da Vinci surgical system has the potential to make complex procedures, such as gastrectomy with D2 LND, easier than with the laparoscopic technique.…”

Experimental Study on Sustained-release 5-Fluorouracil Implantation in Canine Peritoneum and Para-aortic Abdominalis

“…However, with a good penetration in the interstitial space and cell membrane, and a certain affinity with tumour tissue, 5-Fu usually enters into the cells through passive diffusion according to a concentration gradient, and can form a higher drug concentration locally and maintain a long time . The literature has revealed that 5-Fu wrapped with adjuvant has a good effect in intraperitoneal chemotherapy of gastric cancer (Yoshimura et al, 2011). Besides, the efficacy of 5-Fu is positively associated with its action duration (Hu et al, 2013;Yoney et al, 2013).…”