Morbidity and Mortality of Laparoscopic Gastrectomy Versus Open Gastrectomy for Gastric Cancer

Kim, Hyung‐Ho; Hyung, Woo Jin; Cho, Gyu Seok; Kim, Min Chan; Han, Sang Uk; Kim, Wook; Ryu, Seung Wan; Lee, Hyuk Joon; Song, Kyo Young

doi:10.1097/sla.0b013e3181cc8f6b

Cited by 677 publications

(236 citation statements)

References 17 publications

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“…After reading the full texts of the remaining papers, 24 studies were removed as they only reported the outcomes of LG for AGC whereas no controlled or matched cases treated by OG were available. Among the remaining articles, 19 studies [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] were excluded because EGC cases were mixed with AGCs in the cohort studies and data on AGCs were not extractable. Eight studies were further deleted for the following reasons: 2 studies were ongoing randomized controlled trials (RCTs) that only described study design and patient enrollment criteria without results reported [56,57]; 2 studies had overlapped enrollments with former research [58,59]; 1 study reported incomplete data that were not suitable for analysis [60]; and 3 studies discussed other issues irrelevant to the topic of this meta-analysis [61][62][63].…”

Section: Resultsmentioning

confidence: 99%

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Quan

Huang

et al. 2015

Gastric Cancer

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Background Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. Methods Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. Results Overall, 26 studies were included in this metaanalysis. LG had some advantages over OG, including shorter hospitalization (WMD, -3.63, 95 % CI, -4.66 to -2.60; P \ 0.01), less blood loss (WMD, -161.37, 95 % CI, -192.55 to -130.18; P \ 0.01), faster bowel recovery (WMD, -0.78, 95 % CI, -1.05 to -0.50; P \ 0.01), and earlier ambulation (WMD, -0.95, 95 % CI, -1.47 to -0.44; P \ 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.49, 95 % CI, -1.78 to 0.81; P = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P \ 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. Conclusions For AGCs, LG appeared comparable with OG in short-and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.

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Section: Resultsmentioning

confidence: 99%

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Quan

Huang

et al. 2015

Gastric Cancer

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“…POPF = postoperative pancreatic fistula. 14 The majority of complications can be resolved with conservative management. However, some major complications need active interventions including reoperation.…”

Section: Discussionmentioning

confidence: 99%

37. Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery

Park

Jung

et al. 2014

European Journal of Surgical Oncology (EJSO)

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Purpose: Postoperative pancreatic fistula is a dreadful complication after gastric cancer surgery. The purpose of this study is to evaluate the actual incidence and risk factors of postoperative pancreatic fistula after curative gastrectomy for gastric cancer. Results: Overall, the postoperative pancreatic fistula rate was 3.3% (30/900) (1.5% in laparoscopic gastrectomy versus 6.9% in open gastrectomy, P<0.001). Patients who underwent D2 lymphadenectomy, total gastrectomy, splenectomy or distal pancreatectomy showed higher postoperative pancreatic fistula rates (4.7%, 13.8%, 13.6%, or 57.1%, respectively, P<0.001). Patients with postoperative pancreatic fistula had higher morbidity (46.7% versus 13.1%, P<0.001), delayed gas out (4.9 days versus 3.8 days, P<0.001), belated diet start (5.8 days versus 3.5 days, P<0.001) and longer postoperative hospital stay (13.7 days versus 6.8 days, P<0.001). On the multivariate analysis, total gastrectomy (odds ratio 9.751, 95% confidence interval: 3.348 to 28.397, P<0.001), distal pancreatectomy (odds ratio 7.637, 95% confidence interval: 1.668 to 34.961, P=0.009) and open gastrectomy (odds ratio 2.934, 95% confidence interval: 1.100 to 7.826, P=0.032) were the independent risk factors of postoperative pancreatic fistula. Conclusions: Laparoscopic gastrectomy had an advantage over open gastrectomy in terms of the lower postoperative pancreatic fistula rate. Total gastrectomy and combined resection, such as distal pancreatectomy, should be performed carefully to minimize postoperative pancreatic fistula in gastric cancer surgery.

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“…As secondary outcomes, the investigators planned to compare progression-free survival, morbidity/mortality, quality of life, immune/inflammatory response, and cost. An interim report that evaluates the safety of the trial was published in 2010, and there was no significant difference on morbidity and mortality between LDG and ODG groups (18). Patient recruitment was completed in 2012 and long-term outcomes are awaited.…”

Section: Laparoscopic Gastrectomy Versus Open Gastrectomymentioning

confidence: 99%

“…To date, eight randomized controlled trials (RCT) that compared LG and open gastrectomy (OG) have been published (12)(13)(14)(15)(16)(17)(18)(19). In all of these studies except one, patients who underwent laparoscopic distal gastrectomy (LDG) were compared to those who underwent open distal gastrectomy (ODG), and patients who underwent total gastrectomy were excluded.…”

Section: Laparoscopic Gastrectomy Versus Open Gastrectomymentioning

confidence: 99%

Minimally invasive surgery for gastric cancer

Güner

Hyung

2014

UCD

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The interest in minimally invasive surgery (MIS) has rapidly increased in recent decades and surgeons have adopted minimally invasive techniques due to its reduced invasiveness and numerous advantages for patients. With increased surgical experience and newly developed surgical instruments, MIS has become the preferred approach not only for benign disease but also for oncologic surgery. Recently, robotic systems have been developed to overcome difficulties of standard laparoscopic instruments during complex procedures. Its advantages including threedimensional images, tremor filtering, motion scaling, articulated instruments, and stable retraction have created the opportunity to use robotic technology in many procedures including cancer surgery. Gastric cancer is one of the most common causes of cancer-related deaths worldwide. While its overall incidence has decreased worldwide, the proportion of early gastric cancer has increased mainly in eastern countries following mass screening programs. The shift in the paradigm of gastric cancer treatment is toward less invasive approaches in order to improve the patient's quality of life while adhering to oncological principles. In this review, we aimed to summarize the operative strategy and current literature in laparoscopic and robotic surgery for gastric cancer.Key Words: Gastric cancer, gastrectomy, minimally invasive surgery, laparoscopy, robotics INTRODUCTIONFollowing the first report of laparoscopic cholecystectomy, the interest in minimally invasive surgery (MIS) has rapidly increased, and this approach has been introduced for various surgical procedures.When compared to open surgery, MIS is known by its several advantages such as reduced invasiveness, less pain, rapid recovery and improved cosmetic outcomes. However, its safety and feasibility for oncological surgery is still under debate (1). Nevertheless, with the increasing experience of surgeons and the adaptation of newly developed surgical instruments such as endoscopic stapling or sealing devices, MIS has become the widely preferred approach even for cancer surgery that consists of more complicated procedures compared to surgeries of benign diseases. In the last decade, the technical disadvantages that are faced during conventional laparoscopy have been reduced to minimum with the introduction of robotic technology. Its advantages like three-dimensional images, tremor filtering, motion scaling, articulated instruments, and stable retraction have created the opportunity to use robotic technology in many surgical specialties including cancer surgery (2).Gastric cancer is still a major health problem and one of the leading causes of cancer-related death despite its decreasing incidence worldwide. In some eastern countries, following the advances in diagnostic instruments and increased use of mass-screening programs, the incidence of early gastric cancer (EGC) has risen to 60% (3). Following the favorable outcomes that were reported for EGC, surgeons became interested in improving the quality of life, in ad...

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Morbidity and Mortality of Laparoscopic Gastrectomy Versus Open Gastrectomy for Gastric Cancer

Abstract: There was no significance difference in the morbidity and mortality between the 2 groups. Therefore, we conclude that this trial is safe and is thus ongoing.

Cited by 677 publications

References 17 publications

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

37. Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery

Minimally invasive surgery for gastric cancer

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