Total and subtotal laparoscopic gastrectomy for adenocarcinoma

Pugliese, Raffaele; Maggioni, Dario; Sansonna, Fabio; Scandroglio, Ildo; Ferrari, Giovanni; Lernia, Stefano Di; Costanzi, Andrea; Pauna, J.; Martini, Paolo De

doi:10.1007/s00464-005-0409-x

Cited by 103 publications

(123 citation statements)

References 33 publications

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“…In a randomized trial, Huscher et al [21] reported mortality and [29,30]. The mortality and morbidity rates in the current study were 0 and 4%, respectively, and less than those observed in our historical series of open surgeries.…”

Section: Discussioncontrasting

confidence: 65%

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

et al. 2011

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Background Laparoscopy-assisted gastrectomy (LAG) is an advanced surgery that requires the mastery of complex surgical skills. We evaluate the feasibility of LAG with systemic lymph node dissection when participating surgeons have sufficient knowledge and experience to conduct open surgery for gastric cancer and basic laparoscopic skills. Methods All operations were performed by two Japan Surgical Society board-certified attending surgeons who had performed over 50 conventional gastrectomies and 30 laparoscopic cholecystectomies. The surgeons went through an established program, including training at the wet and dry laboratories. In addition, surgeries for the first 10 cases were assisted by an expert surgeon with experience of [300 cases. To be eligible for the LAG procedure, patients had to have a preoperative diagnosis of T1, N0 and M0 gastric carcinoma. The morbidity rate was used as the study endpoint. Variables such as operating time, intraoperative blood loss and number of retrieved lymph nodes were evaluated as complementary surgical endpoints. These variables were compared between the first 25 cases and the latter 25 cases.Results A total of 50 patients who were scheduled to undergo LAG were prospectively enrolled between 2005 and 2008. Morbidity rate was 4% (2/50), with one case due to intestinal injury and one case due to an intra-abdominal abscess. Complications related to laparoscopy were observed in 2% (1/50), with one case of mesenteric injury. The conversion rate to laparotomy was 6% (3/50). However, there were no serious consequences in converted cases. The operating time was 263.7 ± 45.0 min. The intraoperative blood loss was 94.5 ± 106.5 g. The total number of regional lymph nodes retrieved was 34.7 ± 12.2. A significant improvement in the blood loss was only noted after the first 25 procedures. All patients are alive and disease-free after a median follow-up of 38.8 months. Conclusion An adequate training program, including site visits by expert surgeons, in conjunction with basic laparoscopy skills and solid backgrounds in open gastrectomy from the perspective of the trainees are currently key to the successful and safe implementation of LAG. Whether the procedure is oncologically feasible remains to be confirmed by long-term follow-up.

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Section: Discussioncontrasting

confidence: 65%

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

et al. 2011

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“…Francescutti and colleagues 27 have reported the only previous Canadian experience, but they included patients with benign lesions as well as those with malignant ones. All comparative studies have reported decreased or similar early postoperative morbidity with LAG ranging from 0% to 26%, [15][16][17][26][27][28][29]31 which compares with our results. Other benefits of the laparoscopic ap proach, including decreased time to ambulation and resumed diet, decreased consumption of analgesia and a shorter length of stay, have been reported in these studies.…”

Section: Discussionsupporting

confidence: 88%

“…Others reported no difference between the laparoscopic and open approaches. 15,16,[26][27][28][29][30][31]33 In a meta-analysis of RCTs comparing laparoscopic and open approaches for early gastric cancer, Ohtani and colleagues 9 concluded that there was a lesser number of LNs with laparoscopy. Debate is still ongoing about the extent of the lymphadenectomy and the number of LNs needed in the specimen.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre

Christou

2013

cjs

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Background:The Eastern experience has reported the safety of laparoscopic assisted gastrectomy (LAG) for gastric cancer. Its use in Western countries is still debated owing to concerns about its oncologic equivalence to open gastrectomy (OG). We sought to review and compare their operative outcomes and oncologic specimen quality (number of harvested lymph nodes and surgical margins) for gastric adenocarcinoma (GA). Methods:We reviewed the charts of all patients undergoing LAG (2007( ) and OG (2000 for GA in a single institution. Several surgeons performed the OGs, whereas 1 fellowship-trained laparoscopic surgeon performed LAGs. The primary outcome was quality of the surgical specimen, assessed by the number of harvested lymph nodes (LNs) and margin status. Secondary outcomes were perioperative events. Data were analyzed as intention to treat. Results:We retrieved 60 cases (47 OGs, 13 LAGs). The conversion rate was 23%. Conclusion:Laparoscopic assisted gastrectomy is a challenging but safe and feasible procedure in experienced hands. It offers the same radical resection as OG regarding negative margins and LN retrieval. Long-term follow-up is warranted.Contexte : La gastrectomie assistée par laparoscopie (GAL) a été démontrée dans des études orientales comme sécuritaire dans le traitement de l'adénocarcinome gastrique (AG). En occident, l'équivalence oncologique de la GAL avec la gastrectomie ouverte (GO) demeure cependant controversée. Cette étude vise à comparer le devenir postopératoire et la qualité des spécimens oncologiques de ces interventions, dans le traitement de l'AG. (2007)(2008)(2009)(2010) ou GO (2000GO ( -2010 pour AG dans un seul centre hospitalier ont été revus. Différents chirurgiens ont réalisé les GO. Toutes les GAL ont été réalisées par un seul chirurgien sur-spécialisé en chirurgie laparoscopique. Le critère d'évaluation principal était la qualité du spécimen chirurgical évaluée par le nombre de ganglions lymphatiques (GL) prélevés et le statut des marges de résection. Le critère d'évaluation secondaire était la morbidité postopératoire. Les données ont été analysées en fonction de l'intention de traiter. Méthodes : Tous les dossiers de patients opérés par GALRésultats : Soixante cas ont été inclus (47 GO, 13 GAL). Le taux de conversion s'est établi à 23 %. Le temps opératoire moyen était plus long de 115 minutes, et les pertes sanguines moyennes moindres de 425 mL (p < 0,001 dans les 2 cas) pour la GAL que pour la GO. Une moyenne de 14,4 (écart-type [ET] 9,8) et 11,2 (ET 8,2) GL ont été prélevés respectivement pour la GO et la GAL (p = 0.29). On a obtenu des marges négatives pour tous les patients. La durée moyenne du séjour ne différait pas (GAL 19 j c. GO 18,9 j; p = 0,91). Les complications majeures (12,7 % c. 23,1 %; p = 0,39) et la mortalité post-opératoires (2,1 % c. 7,7 %; p = 0,32) étaient similaires. Conclusion :La gastrectomie assistée par laparoscopie est une intervention complexe, mais peut être réalisée de manière sécuritaire en des mains expertes. Elle offre un spécimen onc...

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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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Total and subtotal laparoscopic gastrectomy for adenocarcinoma

Cited by 103 publications

References 33 publications

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre

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

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