Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer without serosal invasion: a case control study

Abstract

BackgroundThe application of laparoscopic surgery for advanced gastric cancer (AGC) remains questionable on account of technical difficulty of D2 lymphadenectomy, and there has been few large-scale follow-up results regarding the oncological adequacy of laparoscopic surgery compared with that of open surgeries for AGC. The aim of this study is to evaluate technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer without serosal invasion.MethodsFrom January 2008 to December 2012, 1114 patients with gastric cancer underwent D2 gastrectomy, including 336 T2 and T3 patients in term of depth of invasion. Of all 336 patients, 224 underwent LAG, while open gastrectomy (OG) performed on the other 112 patients. The comparison was based on the clinicopathologic characteristics, surgical outcome, and follow-up results.ResultsThere are not significant differences in clinicopathological characteristics between the two groups (P > 0.05). The operation time and first ambulation time was similar in the two groups. However, estimated blood loss, bowel function recovery time and duration of hospital stay were significantly less in the LAG group. No significant difference in morbidity and mortality was found between the LAG group and OG group (11.1% vs. 15.3%, P = 0.266; 0.9% vs. 1.8%, P = 0.859). The mean number of resected lymph nodes (LNS) between the LAG group and OG group was similar (30.6 ± 10.1 vs. 30.3 ± 8.6, P = 0.786). Furthermore, the mean number of removed LNS in each station was not significantly different in the distal gastrectomy and total gastrectomy (P > 0.05). No statistical difference was seen in 1 year survival rate (91.5% vs. 89.8% P > 0.05) and the survival curve after surgery between the LAG group and OG group.ConclusionLaparoscopy-assisted D2 radical gastrectomy is feasible, effective and has comparative oncological efficacy compared with open gastrectomy for advanced gastric cancer without serosal invasion.

Totally Laparoscopic Distal Gastrectomy with D2 Lymphadenectomy and Billroth II Gastrojejunostomy for Gastric Cancer: Short- and Medium-term Results of 139 Consecutive Cases from a Single Institution

“…As the technique has matured in recent years, some researchers have reported that not only was the overall number of lymph nodes that could be retrieved laparoscopically similar to that of laparotomy, but also that the specific lymph nodes such as No. 7, 8a, 9, 11p, 12a and 14v retrieved were also similar to that of laparotomy, which were once considered difficult to dissect under laparoscope 36,37.…”

Interest of Laparoscopy for “En Bloc” Resection of Primary Malignant Sacral Tumors by Combined Approach

“…They reported no statistical difference on rates of positive resection margins. Chen et al 21 concerning gastrectomy for advanced gastric cancers have shown similar surgical duration between laparoscopy and open resection. Blood loss and duration of hospital stay were signifi cantly less using laparoscopy for gastric resection.…”

Minimally Invasive Gastric Surgery

“…Chen et al in 2012 (29) evaluated 224 patients who underwent LAG and 112 for the OG. The clinicopathological characteristics were similar as well as the number of lymph nodes of harvested (30.6 ± 10 vs. 30.3 ± 8.6 p = 0.786).…”

“…No difference was noted in the incidence of morbidity and mortality. Survival was similar for both groups (91.5% vs. 89.8% p > 0.05) (29). Hamabe (30) included 66 patient in the LAG and 101 in the OG.…”