Totally Laparoscopic Gastric Resection with Extended Lymphadenectomy for Gastric Adenocarcinoma

Guzman, Eduardo A.; Pigazzi, Alessio; Lee, Byrne; Soriano, Perry; Nelson, Rebecca A.; Paz, I. Benjamin; Trisal, Vijay; Kim, Joseph; Ellenhorn, Joshua D. I.

doi:10.1245/s10434-009-0508-3

Cited by 59 publications

(68 citation statements)

References 32 publications

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“…As regards lymphadenctomy, the mean number of retrieved lymph nodes reported by Asian authors after laparoscopic D2 dissection ranges from 23 to 49, 18 whereas it ranges from 15 to 35 in Western observational studies. 5,[7][8][9][29][30][31] Our outcomes, with a mean number of 30.0 examined lymph nodes, are comparable with these previously reported results and, importantly, are in line with Western criteria (number of lymph nodes harvested > 25) regarding adequate D2 dissection and thus surgical quality for advanced gastric cancer. 38 In conclusion, within the limitations of a nonrandomized analysis, our study contributes to the Western experience by demonstrating both the safety and oncologic efficacy of the laparoscopic approach to the resection of gastric adenocarcinoma.…”

Section: Cianchi Et Alsupporting

confidence: 90%

“…The surgery-related complications and mortality rates in our study were comparable to those of the open approach and also acceptable if compared with previously published Western reports. 5,8,[28][29][30] One of our major complications was duodenal stump leakage. We had 2 (4.9%) patients with this complication, with one death due to septic complications.…”

Section: Discussionmentioning

confidence: 99%

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Totally Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Matched Cohort Study

Cianchi

Qirici²,

Trallori³

et al. 2013

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: The role of laparoscopic surgery for the treatment of gastric cancer is still controversial, particularly in terms of oncologic efficacy. The aim of this study was to compare short-term outcomes of laparoscopic and open resection for gastric cancer at a single Western institution. Subjects and Methods: This study was designed as a matched cohort study from a prospective gastric cancer database. Forty-one patients undergoing laparoscopic gastrectomy for gastric cancer between June 2008 and January 2012 were matched with 41 patients undergoing open gastrectomy in the same time period. Patient pairing was done according to age, gender, type of gastrectomy (subtotal or total), and tumor stage via a randomized statistical method. The short-term outcomes and oncologic adequacy of the laparoscopic and open procedures were compared. A D2 lymph node dissection was performed in the majority of patients in both groups. Results: The two study groups were similar with respect to patient and tumor characteristics. Laparoscopic procedures were associated with a decreased blood loss (118.7 versus 312.4 mL, P < .005), incidence of surgeryunrelated complications (3 versus 9 patients, P < .05), and duration of hospital stay (8.1 versus 11.5 days, P < .05) but increased operative time for both subtotal (223.5 versus 158.2 minutes, P < .001) and total (298.1 versus 185.5 minutes, P < .001) gastrectomies. The mean number of retrieved lymph nodes after D2 dissection was similar: 30.0 for laparoscopic and 29.7 for open patients. Conclusions: Within the limitations of a nonrandomized analysis, this study shows that the laparoscopic approach is a safe and oncologically adequate option for the treatment of gastric cancer, which compares favorably with open gastrectomy in short-term outcomes.

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Section: Cianchi Et Alsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Totally Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Matched Cohort Study

Cianchi

Qirici²,

Trallori³

et al. 2013

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…TLDG was defined as a method to intracorporeally perform both the resection and anastomosis using the laparoscopic technique [2,3,4,5]. TLDG has several advantages over LADG, including smaller wounds, a lower degree of invasiveness, and a better feasibility for secure ablation [2].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Delta-Shaped Anastomoses in Totally Laparoscopic Distal Gastrectomy

et al. 2011

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Background: Delta-shaped (DS) anastomosis is a new reconstruction method for totally laparoscopic distal gastrectomy (TLDG) using a linear stapler. We evaluated the feasibility of using this method for TLDG. Methods: A retrospective analysis was performed in 114 patients who underwent TLDG with DS anastomosis. Twenty-four patients reconstructed with a Roux-en-Y (RY) anastomosis during the same period were analyzed as control subjects. Results: The patient characteristics of DS and RY anastomoses were slightly different in terms of tumor location and extent of lymph node dissection, since this was not a prospective comparative study. Blood loss, postoperative complication rate and postoperative hospital stay were not different between the two groups. There was only 1 case of anastomotic leakage, and no case of anastomotic stricture after DS anastomosis. The length of the operation using DS anastomosis was significantly shorter than for RY anastomosis. The rates of body weight loss were not significantly different at 1 year after the operation. Conclusions: Although this was a small retrospective analysis, DS anastomosis was feasible, required a shorter operation time, and had no associated complications. This method can therefore be recommended as a standard procedure for TLDG.

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“…Important to this series was the observation that all laparoscopic resections had negative resection margins and adequate number of lymph nodes retrieved for accurate staging. There was no statistically significant difference in the number of lymph nodes retrieved between the two approaches, likely owning to surgeon experience at this high volume center (33).…”

Section: Advanced Gastric Cancermentioning

confidence: 78%

Minimally invasive surgery for gastric cancer in USA: current status and future perspectives

Russo¹,

Strong²

2017

Transl. Gastroenterol. Hepatol.

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Abstract:The World Health Organization (WHO) has declared gastric carcinoma a global health concern and gastric cancer remains the third leading cause of cancer deaths worldwide. With the rising incidence of gastric cancer, a body of both retrospective and randomized data has emerged since the early 1990's evaluating the role of minimally invasive platforms in the management of gastric cancer. While Eastern studies have shown that the laparoscopic approach is safe and feasible for advanced gastric cancer in Eastern patients, it is not clear whether this is true for patients in the West. Differences in tumor biology, stage at presentation, institutional volume, and surgeon experience all may impact the efficacy and widespread utilization of minimally invasive approaches in regions where gastric cancer is less prevalent. The majority of studies have pointed to a number of improvements associated with minimally invasive approaches including decreased blood loss, shorter length of hospital stay, lower analgesic requirements, decreased minor complications, and faster recovery without any significant difference in overall or disease specific survival (DSS). The benefits associated with minimally invasive approaches and evidence supporting similar oncologic outcomes compared to the traditional open approach will hopefully expand the indications for minimally invasive surgery in the management of gastric cancer. In the United States, results following initial experiences with minimally invasive techniques, including robotic platforms, have revealed promising results.Well-established laparoscopic and robotic techniques are emerging, particularly from high volume United States institutions, which will hopefully pave the way for increased utilization of minimally invasive surgery for gastric cancer in the West.

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Totally Laparoscopic Gastric Resection with Extended Lymphadenectomy for Gastric Adenocarcinoma

Cited by 59 publications

References 32 publications

Totally Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Matched Cohort Study

Totally Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Matched Cohort Study

Feasibility of Delta-Shaped Anastomoses in Totally Laparoscopic Distal Gastrectomy

Minimally invasive surgery for gastric cancer in USA: current status and future perspectives

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