Laparoscopic-assisted Versus Open D2 Gastrectomy for Advanced Gastric Cancer in Highly Selective Patients

Abstract

Objectives: The feasibility and efficacy of laparoscopic-assisted D2 gastrectomy (LAD2G) for advanced gastric cancer (AGC) remain controversial. We conducted a prospective cohort study to provide a comprehensive comparison of LAD2G and open D2 gastrectomy (OD2G) for AGC. Materials and Methods: Between April 2016 and December 2017, patients with clinical stage T2-4aN0-3M0 gastric cancer were enrolled and assigned to either LAD2G or OD2G group. The primary endpoint was short-term surgical and chemotherapy outcomes. The postoperative pain and perioperative anxiety were compared as the secondary endpoint to indicate perioperative life quality. Results: A total of 110 patients in LAD2G group and 238 patients in OD2G group were included. The 2 groups showed similar number of retrieved lymph nodes (29.85±6.52 vs. 30.60±5.37, P=0.069) and postoperative morbidity (21.01% vs. 21.82%, P=0.888). A total of 84.4% of patients in LAD2G group and 75.6% in OD2G group received adjuvant chemotherapy (AC) (P=0.069). The mean time interval to AC was shorter in LAD2G group (34±13.74 vs. 40.78±18.78 d, P<0.001). Furthermore, LAD2G was superior to OD2G in terms of earlier postoperative recovery, faster relief of postoperative pain, and lower postoperative anxiety. Conclusions: LAD2G is feasible for AGC in experienced centers. Patients after LAD2G tended to have earlier initiate of AC. LAD2G could provide more rapid postoperative recovery and relief of postoperative pain, along with lower postoperative anxiety.

Factors connected with anxiety and other neuropsychiatric symptoms in advanced gastric cancer

“…We have observed that the risk of neuropsychiatric symptoms increases with age (Kato et al, 2016;Hwang et al, 2018;Honda et al, 2018;Huang et al, 2019;Shim et al, 2019). This can be explained by the reduced adaptability of older people to new hospital conditions and the form of stress response.…”

“…Optimal analgesia and adaptation of pharmacotherapy to patient needs is very important in home and hospice treatment, and thus minimises the risk of emergency hospitalisation. This is very important because the severity of pain and anxiety is important determinants of quality of life (Hong & Tian, 2014;Huang et al, 2019).…”

Comparative Analysis of Clavien–Dindo Grade and Risk Factors of Complications after Dual-Port Laparoscopic Distal Gastrectomy and Hand-Assisted Laparoscopic Gastrectomy

“…The Clavien–Dindo classification system is currently the most definitive criterion internationally for evaluating the postoperative complications including gastric cancer [ 23 ]. This study provided the basis for preventing complications after radical gastrectomy by comparing the impact of two surgical methods on the severity of postoperative complications and analyzing the risk factors of postoperative complications.…”