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Total and subtotal laparoscopic gastrectomy for adenocarcinoma

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Abstract

Background

Laparoscopic gastrectomies are currently performed in many centers, but compliance with oncologic requirements still represents a subject open to debate. The aim of this work was to compare the short-term and oncologic outcomes after laparoscopic and open surgery in gastric adenocarcinoma.

Methods

From June 2000 through June 2005, 147 patients in our institution underwent gastrectomy by open or mininvasive approach for adenocarcinoma. The laparoscopy group included 48 patients, 29 with early gastric cancer (EGC) and 19 with antral advanced gastric cancer (AGC). The short-term results and oncologic data were compared to those obtained in 99 patients who underwent open surgery. Survival in the laparoscopy group was analyzed.

Results

In the laparoscopy group no intraoperative complications were observed, and conversion was needed in only one patient with a large advanced tumor. Overall, 32 lymph nodes were collected by D2 dissection, 30 for EGC, 34 for advanced cancers. The resection margin was 6.7 cm (range: 4–8 cm). The mean operating time was 240 min (range: 150–360 min), with a blood loss of 150 ml on average (range: 70–250 ml). Morbidity included two duodenal leaks that healed without reoperation; after enclosing or reinforcing the staple line, no further leaking was noted. There was one death from massive bleeding in a cirrhotic patient. Ambulation and oral feeding started significantly earlier than in open surgery. The mean hospital stay was 10 days (range: 7–24 days), significantly shorter than the stay of 18 days after open surgery (p < 0.05). All patients treated laparoscopically were alive without recurrence at the end of this study.

Conclusions

Short-term results with laparoscopic gastrectomy were better than with open surgery in this study. Oncologic radicality was a major concern, but in the authors’ experience the extent of lymphadenectomy was the same as in open surgery. This study suggests that laparoscopic gastrectomy in malignancies is a reliable tool and oncologic requirements can be warranted.

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References

  1. Adachi Y, Shirahishi 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

    Article  PubMed  CAS  Google Scholar 

  2. Adachi Y, Shirahishi N, Ikebe K, Aramaki M, Bandoh T, Kitano S (2001) Evaluation of the cost of laparoscopic-assisted Billroth I gastrectomy. Surg Endosc 15: 932–936

    Article  PubMed  CAS  Google Scholar 

  3. Asao T, Hosouchi Y, Nakabayashi T, Haga N, Mochiki E, Kuwano H (2001) Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer. Br J Surg 88: 128–132

    Article  PubMed  CAS  Google Scholar 

  4. Azagra JS, Goergen M, De Simone P, Ibanez-Aguirre J. (1999) The current role of laparoscopy surgery in the treatment of benign gastroduodenal disease. Hepatogastroenterology 46: 1522–1526

    PubMed  CAS  Google Scholar 

  5. Azagra JS, Goergen M, De Simone P, Ibanez-Aguirre J (1999) Minimally invasive surgery for gastric cancer. Surg Endosc 13: 351–357

    Article  PubMed  CAS  Google Scholar 

  6. Azagra J, Goergen M, Gilbart E, Alonso J, Ceuterick M (2001) Laparoscopy-assisted total gastrectomy with extended D2 lymphadenectomy for cancer: technical aspects. Le Jour Coelio-chir 40: 79–83

    Google Scholar 

  7. Ballesta Lopez C, Ruggiero R, Poves I, Bettonica C, Procaccini E (2002) The contribution of laparoscopy to the treatment of gastric cancer. Surg Endosc 16: 616–619

    Article  PubMed  CAS  Google Scholar 

  8. Dulucq JL, Wintringer P, Stabilini C, Solinas L, Perissat J, Mahajina A. (2005) Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study. Surg Endosc 19: 933–938

    Article  PubMed  Google Scholar 

  9. Eguchi T, Takahashi Y, Ikarashi M, Kasahara M, Fuji M (2000) Is extended lymph node dissection necessary for gastric cancer in elderly patients? Eur J Surg 166: 949–953

    Article  PubMed  CAS  Google Scholar 

  10. Goh P, Tekant Y, Isaac J, Kum CK, Ngoi SS (1992) The technique of laparoscopic Billroth II gastrectomy. Surg Laparosc Endosc 2: 258–260

    PubMed  CAS  Google Scholar 

  11. Goh P, Alponat A, Mak K, Kum CK (1997) Early international results of laparoscopic gastrectomies. Surg Endosc 11: 650–652

    Article  PubMed  CAS  Google Scholar 

  12. Goh PMY, Khan AZ, So JBY, Lomanto D, Cheah WK, Muthiah R, Gandhi A (2001) Early experience with laparoscopic radical gastrectomy for advanced gastric cancer. Surg Laparosc Endosc Percutan Tech 11: 83–87

    Article  PubMed  CAS  Google Scholar 

  13. Han HS, Kim YW, Yi NJ, Fleischer G (2003) Laparoscopic-assisted D2 subtotal gastrectomy in early gastric cancer. Surg Laparosc Endosc Percutan Tech 13: 361–365

    Article  PubMed  Google Scholar 

  14. Hartgrink HH, van de Velde CJH, Putter H, Bonekamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, van Krieken JHJM, Meijer S, Plukker JTM, van Elk PJ, Obertop H, Gouma DJ, van Lanschot JJB, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H, Sasako M (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final Results of the Randomized Dutch Gastric Cancer Group Trial. J Clin Oncol 22: 2069–2077

    Article  PubMed  CAS  Google Scholar 

  15. Hochwald SN, Brennan MF, Klimstra DS, Kim S, Karpeh MS (1999) Is lymphadenectomy necessary for early gastric cancer? Ann Surg Oncol 6: 664–670

    Article  PubMed  CAS  Google Scholar 

  16. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Lirici MM, Napolitano C, Piro F (2004) Videolaparoscopic total and subtotal gastrectomy with extended lymph node dissection for gastric cancer. Am J Surg 188: 728–735

    Article  PubMed  Google Scholar 

  17. Huscher CGS, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer. Five-year results of a randomized prospective trial. Ann Surg 241: 232–237

    Article  PubMed  Google Scholar 

  18. Hyung WJ, Cheong JH, Kim J, Chen J, Choi SH, Noh SH (2004) Application of minimally invasive treatment for early gastric cancer. J Surg Oncol 85: 181–186

    Article  PubMed  Google Scholar 

  19. Kim YW, Bae JM, Lee JH, Ryu KW, Choi IJ, Kim CG, Lee JS, Rho JY (2005) The role of hand-assisted laparoscopic distal gastrectomy for distal gastric cancer. Surg Endosc 19: 29–33

    Article  PubMed  CAS  Google Scholar 

  20. Japanese Classification of Gastric Carcinoma. 2nd English edition (1998) Gastric Cancer 1: 10–24

    Google Scholar 

  21. Kitamura K, Yoneguchi T, Okanoto K, Otsuji E, Taniguchi H, Hagiwara A, Sawai K, Takabashi T (1997) Clinicopathologic features of synchronous multifocal early gastric cancers. Anticancer Res 17: 643–646

    PubMed  CAS  Google Scholar 

  22. Kitano S, Shirahishi N, Fuji 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–S311

    Article  PubMed  Google Scholar 

  23. Kitano S, Shirahishi N (2004) Current status of laparoscopic gastrectomy for cancer in Japan. Surg Endosc 18: 182–185

    Article  PubMed  CAS  Google Scholar 

  24. Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19: 168–173

    Article  PubMed  Google Scholar 

  25. McCulloch P, Nita ME, Kazi H, Gama-Rodrigues J (2004) Extended versus limited lymph node dissection technique for adenocarcinoma of the stomach (Cochrane Review). In The Cochrane Library , Issue 1. Chichester, UK: John Wiley & Sons, Ltd

  26. Mochiki E, Kaniyama Y,Aihara R, Nakabayashi T, Asao T, Kuwano H (2005) Laparoscopic assisted distal gastrectomy for early gastric cancer. Five years’ experience. Surgery 137: 317–322

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  CAS  Google Scholar 

  28. Orringer MB, Marshall B, Iannettoni MD (2000) Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg 119: 277–288

    Article  PubMed  CAS  Google Scholar 

  29. Pugliese R, Maggioni D, Berardi V, Scandroglio I, Pisani D, Mariani A, Di Lernia S, Valli C, Cocozza E (2000) Extended (D2) lymphadenectomy in gastric cancer: a five year experience. Int Surg 85: 209–215

    PubMed  CAS  Google Scholar 

  30. Reyes CD, Weber KJ, Gagner M, Divino CM (2001) Laparoscopic vs open gastrectomy. Surg Endosc 15: 928–931

    Article  PubMed  CAS  Google Scholar 

  31. Shimizu S, Uchiyama A, Mizumoto K, Morisaki, 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

    Article  PubMed  CAS  Google Scholar 

  32. Siewert JR, Bottcher K, Stein HJ, Roder JD, the German Gastric Carcinoma Study Group (1998) Relevant prognostic factors in gastric cancer. Ann Surg 228: 449–461

    Article  PubMed  CAS  Google Scholar 

  33. 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

    Article  PubMed  CAS  Google Scholar 

  34. Tanimura S, Higoshina M, Fukunaga Y, Osugi H (2001) Hand-assisted laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Laparosc Endosc Percutan Tech 11: 155–160

    Article  PubMed  CAS  Google Scholar 

  35. Tuech JJ, Cervi C, Pessaux P, Villapadierna F, Bergamaschi R, Roncery J, Arnaud JP (1999) Early gastric cancer: univariate and multivariate analysis for survival. Hepatogastroenterology 46: 3276–3280

    PubMed  CAS  Google Scholar 

  36. Weber KJ, Reyes CD, Gagner M, Divino CM (2003) Comparison of laparoscopic and open gastrectomy for malignant disease. Surg Endosc 17: 968–971

    Article  PubMed  CAS  Google Scholar 

  37. Yasuda K, Shirahishi N, Inomata M, Fuji K, Sonoda K, Kitano S (2003) Learning curve for laparoscopy-assisted distal gastrectomy. Dig Endosc 15: 280–228

    Article  Google Scholar 

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Authors and Affiliations

  1. Divisione di Chirurgia Generale e d’Urgenza–Ospedale di Niguarda Ca’ Granda, Piazza Ospedale 3, 20162, Milano, Italy

    R. Pugliese, D. Maggioni, F. Sansonna, I. Scandroglio, G. C. Ferrari, S. Di Lernia, A. Costanzi, J. Pauna & P. de Martini

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  1. R. Pugliese
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  2. D. Maggioni
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  3. F. Sansonna
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  4. I. Scandroglio
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  5. G. C. Ferrari
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  6. S. Di Lernia
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  7. A. Costanzi
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  8. J. Pauna
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  9. P. de Martini
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Correspondence to F. Sansonna.

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Pugliese, R., Maggioni, D., Sansonna, F. et al. Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21, 21–27 (2007). https://doi.org/10.1007/s00464-005-0409-x

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  • DOI: https://doi.org/10.1007/s00464-005-0409-x

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