Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy

Ji, Lin; Huang, Chang‐Ming; Zheng, Chao‐Hui; Li, Ping; Xie, Jian‐Wei; Wang, Jia-Bin; Lü, Jun; Chen, Qi‐Yue; Ma, Lin; Tu, Ru‐Hong

doi:10.1007/s00464-015-4429-x

Cited by 36 publications

(23 citation statements)

References 36 publications

(29 reference statements)

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“…There was significant heterogeneity among studies ( p = 0.13; I 2 = 51%), so we used a random-effect model here(Fig 2). Five studies [6,7,13,14,17] reported harvested lymph nodes, meta-analysis confirmed that TG procedure could retrieve more lymph nodes than DG (MD = 4.33, 95% CI = 2.34–6.31, p <0.0001) (Fig 2). …”

Section: Resultsmentioning

confidence: 78%

“…The flow diagram of reviews shows the detailed process of selection (Fig 1). Finally, 11 studies [6,7,9–17] involving 5447 patients (2418 by TG vs 3029 by DG) were included for our analysis which included Laparoscopy-assisted and open gastrectomy for gastric cancer (Table 3). The baseline characteristics between both groups were shown in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…Three articles [6,13,17] reported blood loss and four studies [6,7,13,17]reported operation time. Meta-analyses showed that DG took obviously shorter operative time than TG procedure (MD = 50.73, 95% CI: 12.75–88.72, p = 0.009), heterogeneity was observed ( p <0.00001; I 2 = 96%), so we used a random-effect model for this analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Data regarding hospital stay were provided in four studies [6,7,12,17] involving 2559 patients, meta-analysis showed that there was no significant difference in the length of hospital stay between TG and DG group (MD = 0.76, 95% CI:-0.26–1.79, p = 0.15) (Fig 3). …”

Section: Resultsmentioning

confidence: 99%

“…However, the distal subtotal gastrectomy and total gastrectomy for centuries, there has been controversy about the choice of the best surgical procedure for the distal half of gastric cancer which is usually resection by the distal subtotal gastrectomy in china[5]. Although total gastrectomy can maximumly reduce gastric remnant cancer[6], it leads to the postoperative limited diet, dysphagia, dry mouth, and reflux symptoms which will affect the patient's quality of life [7]. Whether distal subtotal gastrectomy and total gastrectomy is the same in perioperative period, complications and long-term survival rate or not, different studies have different results.…”

Section: Introductionmentioning

confidence: 99%

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Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

Zhang²,

Wang

et al. 2016

PLoS ONE

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Background/AimsTotal gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer.MethodologyA search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis.ResultsTen retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90–2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31–51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26–1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34–6.31, p<0.0001). According to different postoperative complications, we performed subgroup analysis, subgroup analysis revealed that patients in TG group tended to have a higher rate of postoperative intra-abdominal abscess than DG procedure (RR = 3.41, 95% CI = 1.21–9.63,p<0.05). No statistical differences were found in leakage, intestinal obstruction, postoperative bleeding, anastomotic stricture and wound infection between the two groups (p>0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0.85–0.97,p = 0.006).ConclusionBased on current retrospective evidences, we found that in spite of similar postoperative mortality, TG for distal gastric cancer provided a high risk of five-year Overall Survival rate. DG procedure can be a recommendation for distal gastric cancer, whereas due to lack of high quality RCTs in multicenter and the relatively small sample size of long-term outcomes, further comparative studies are still needed.

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Section: Resultsmentioning

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

Zhang²,

Wang

et al. 2016

PLoS ONE

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Safety and Efficacy of Indocyanine Green Tracer-Guided Lymph Node Dissection During Laparoscopic Radical Gastrectomy in Patients With Gastric Cancer

et al. 2020

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IMPORTANCEThe application of indocyanine green (ICG) imaging in laparoscopic radical gastrectomy is in the preliminary stages of clinical practice, and its safety and efficacy remain controversial.OBJECTIVE To investigate the safety and efficacy of ICG near-infrared tracer-guided imaging during laparoscopic D2 lymphadenectomy in patients with gastric cancer. DESIGN, SETTING, AND PARTICIPANTSPatients with potentially resectable gastric adenocarcinoma (clinical tumor stage cT1-cT4a, N0/+, M0) were enrolled in a prospective randomized clinical trial at a tertiary referral teaching hospital between November 2018 and July 2019. Patients were randomly assigned to the ICG group or the non-ICG group. The number of retrieved lymph nodes, rate of lymph node noncompliance, and postoperative recovery data were compared between the groups in a modified intention-to-treat analysis. Statistical analysis was performed from August to September 2019. INTERVENTIONSThe ICG group underwent laparoscopic gastrectomy using near-infrared imaging after receiving an endoscopic peritumoral injection of ICG to the submucosa 1 day before surgery. MAIN OUTCOMES AND MEASURES Total number of retrieved lymph nodes.RESULTS Of 266 participants randomized, 133 underwent ICG tracer-guided laparoscopic gastrectomy, and 133 underwent conventional laparoscopic gastrectomy. After postsurgical exclusions, 258 patients were included in the modified intention-to-treat analysis, which comprised 129 patients (86 men and 43 women; mean [SD] age, 57.8 [10.7] years) in the ICG group and 129 patients (87 men and 42 women; mean [SD] age, 60.1 [9.1] years) in the non-ICG group. The mean number of lymph nodes retrieved in the ICG group was significantly more than the mean number retrieved in the non-ICG group (mean [SD], 50.5 [15.9] lymph nodes vs 42.0 [10.3] lymph nodes, respectively; P < .001). Significantly more perigastric and extraperigastric lymph nodes were retrieved in the ICG group than in the non-ICG group. In addition, the mean total number of lymph nodes retrieved in the ICG group within the scope of D2 lymphadenectomy was also significantly greater than the mean number retrieved in the non-ICG group (mean [SD], 49.6 [15.0] lymph nodes vs 41.7 [10.2] lymph nodes, respectively; P < .001). The lymph node noncompliance rate of the ICG group (41 of 129 patients [31.8%]) was lower than that of the non-ICG group (74 of 129 patients [57.4%]; P < .001). The postoperative recovery process was comparable, and no significant difference was found between the ICG and non-ICG groups in the incidence (20 of 129 patients [15.5%] vs 21 of 129 [16.3%], respectively; P = .86) or severity of complications within 30 days after surgery.CONCLUSIONS AND RELEVANCE Indocyanine green can noticeably improve the number of lymph node dissections and reduce lymph node noncompliance without increased complications in patients undergoing D2 lymphadenectomy. Indocyanine green fluorescence imaging can be performed for routine lymphatic mapping during laparoscopic gastrectomy, especially t...

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Impact of anastomotic leak on long-term survival in patients undergoing gastrectomy for gastric cancer

Kamarajah

Navidi

Griffin

et al. 2020

British Journal of Surgery

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Background: The impact of anastomotic leak (AL) on long-term outcomes after gastrectomy for gastric adenocarcinoma is poorly understood. This study determined whether AL contributes to poor overall survival. Methods: Consecutive patients undergoing gastrectomy in a single high-volume unit between 1997 and 2016 were evaluated. Clinicopathological characteristics, oncological and postoperative outcomes were stratified according to whether patients had no AL, non-severe AL or severe AL. Severe AL was defined as anastomotic leakage associated with Clavien-Dindo Grade III-IV complications. Results: The study included 969 patients, of whom 58 (6⋅0 per cent) developed AL; 15 of the 58 patients developed severe leakage. Severe AL was associated with prolonged hospital stay (median 50, 30 and 13 days for patients with severe AL, non-severe AL and no AL respectively; P < 0⋅001) and critical care stay (median 11, 0 and 0 days; P < 0⋅001). There were no significant differences between groups in number of lymph nodes harvested (median 29, 30 and 28; P = 0⋅528) and R1 resection rates (7, 5 and 6⋅5 per cent; P = 0⋅891). Cox multivariable regression analysis showed that severe AL was independently associated with overall survival (hazard ratio 3⋅96, 95 per cent c.i. 2⋅11 to 7⋅44; P < 0⋅001) but not recurrence-free survival. In sensitivity analysis, the results for patients who had neoadjuvant therapy then gastrectomy were similar to those for the entire cohort. Conclusion: AL prolongs hospital stay and is associated with compromised long-term overall survival.

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Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy

Abstract: The study findings suggest that LTG is an oncologically safe procedure for AGC yields comparable surgical outcomes. A well-designed phase III trial can be carried out to provide valuable evidence for the oncologic safety of LTG for the treatment of AGC.

Cited by 36 publications

References 36 publications

Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

Safety and Efficacy of Indocyanine Green Tracer-Guided Lymph Node Dissection During Laparoscopic Radical Gastrectomy in Patients With Gastric Cancer

Impact of anastomotic leak on long-term survival in patients undergoing gastrectomy for gastric cancer

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