Abstract
Background
Laparoscopically assisted distal gastrectomy (LADG) with limited lymph node dissection (D1+alpha) has been used to treat a subset of patients with early gastric cancer. Technical advances have expanded indications for LADG to more advanced gastric cancers. However, little data are available on the feasibility or advantages of LADG with standard radical D2 lymph node dissection for patients with gastric cancer.
Methods
This study reviewed the clinical features of 37 patients who underwent LADG with D2 lymph node dissection for preoperatively diagnosed gastric carcinoma, then compared the results with the features of 31 patients who underwent conventional open distal gastrectomy (ODG) with D2 lymph node dissection.
Results
The laparoscopic procedure was not converted to laparotomy in any patient. There was no operative mortality and no serious morbidity among the patients who underwent LADG with D2 lymph node dissection. As compared with the ODG group, the LADG group had less operative blood loss (p < 0.001), earlier recovery of bowel activity (p = 0.012), and a shorter duration of fever after surgery (p = 0.015), despite the longer operation time (p = 0.007).
Conclusions
According to this study, LADG with D2 lymph node dissection is feasible and provides several advantages similar to those of limited lymph node dissection (D1+alpha). Depending on surgeons’ technical proficiency, LADG can be used with standard radical lymph node dissection for patients with gastric cancers.
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References
Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135: 806–810
Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ (1999) Extended lymph node dissection for gastric cancer. N Engl J Med 340: 908–914
Bonenkamp JJ, Songun J, Hermans J, Sasako M, Welvaart K, Plukkeo JT, van Elk P, Obertop H, Gouma DJ, Taat CW, van Lanschot J, Meyer S, de Graaf PW, von Meyenfeldt MF, Tilanus H, van de Velde CJH (1995) Randomized comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345: 745–748
Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P (1996) Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial. The Surgical Cooperative Group. Lancet 347: 995–999
Dent DM, Madden MV, Price SK (1988) Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma. Br J Surg 75: 110–112
Fujiwara M, Kodera M, Kasai Y, Kanyama Y, Hibi K, Akiyama S, Nakao A (2003) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: review of 43 cases. J Am Coll Surg 196: 75–81
Iriyama K, Asakawa T, Koike H, Nishiwaki H, Suzuki H (1989) Is extensive lymphadenectomy necessary for surgical treatment of intramucosal carcinoma of the stomach? Arch Surg 124: 309–311
Japanese Gastric Cancer Association (1998) Japanese Classification of Gastric Carcinoma. 2nd English edition. Gastric Cancer 1: 10–24
Jinnai D (1968) Evaluation of extended radical operation for gastric cancer with regard to lymph node metastasis and follow-up results. Jpn J Cancer Res 3: 225–231
Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4: 146–148
Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131: S306–311
Kitaoka H, Yoshikawa K, Hirota T, Itabashi M (1984) Surgical treatment of early gastric cancer. Jpn J Clin Oncol 14: 283–293
Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asano T, Kuwano H (2002) Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg 26: 1145–1149
Nagai Y, Tanimura H, Takifuji K, Kashiwagi H, Yamoto H, Nakatani Y (1995) Laparoscope-assisted Billroth I gastrectomy. Surg Laparosc Endosc 5: 281–287
Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients with heavier weight? Ann Surg 238: 680–685
Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23: 187–193
Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimada T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48: 225–229
Reyes CD, Weber KJ, Gagner M, Divino CM (2001) Laparoscopic vs open gastrectomy: a retrospective review. Surg Endosc 15: 928–931
Robertson CS, Chung SC, Woods SD, Griffin SM, Raimes SA, Lau JT, Li AK (1994) A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer. Ann Surg 220: 176–182
Shimizu S, Uchiyama A, Mizumoto K, Morisaki T, Nakamura K, Shimura H, Tanaka M (2000) Laparoscopically assisted distal gastrectomy for early gastric cancer: is it superior to open surgery? Surg Endosc 14: 27–31
Snedecor GW, Cochran WG (1980) Statistical methods. Ames IA: Iowa State University Press
Tanimura S, Higashino M, Fukunaga Y, Osugi H (2003) Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 17: 758–762
Uyama I, Sugiola A, Fujita J, Komori Y, Matsui H, Soga R, Wakayama A, Okamoto K, Ohyama A, Hasumi A (1999) Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer 2: 186–190
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Noshiro, H., Nagai, E., Shimizu, S. et al. Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc 19, 1592–1596 (2005). https://doi.org/10.1007/s00464-005-0175-9
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DOI: https://doi.org/10.1007/s00464-005-0175-9