Abstract
Background
Laparoscopically assisted gastric surgery has become an option for the treatment of early gastric cancer. However, the feasibility and safety of laparoscopically assisted gastrectomy for advanced gastric cancer has rarely been studied. This study evaluated the short- and long-term outcomes of laparoscopically assisted distal gastrectomy (LADG) for advanced gastric cancer.
Methods
The study retrospectively analyzed the clinical and follow-up data for 346 cases after LADG and for 313 cases after conventional open distal gastrectomy (ODG) used to treat advanced gastric cancer from January 2004 to June 2009 at the authors’ hospital. The surgical safety, postoperative complications, survival rate, and recurrence and metastasis of cancer were compared between the LADG and ODG groups.
Results
The average time for the LADG and ODG procedures did not differ significantly (211 ± 56 vs 204 ± 41 min), but bleeding during the operation and incision length in the LADG group were significantly less than in the ODG group. The proximal and distal margins of tumors were, respectively, 6.25 ± 2.04 and 5.68 ± 1.71 cm in the LADG group compared with 6.29 ± 2.11 and 5.62 ± 1.59 cm in the ODG group. Neither intergroup difference was significant. The number of lymph node dissections also was similar in the two groups: 33.2 ± 12.5 in the LADG group and 32.8 ± 15.6 in the ODG group. The incidence of postoperative complications in the LADG group (6.7%) was significantly lower than in the ODG group (13.1%). During the follow-up period of 6 to 72 months (average, 37 months), the survival rates were 87.2% at 1 year, 57.2% at 3 years, and 50.30% at 5 years in the LADG group compared with 87.1% at 1 year, 54.1% at 3 years, and 49.2% at 5 years in the ODG group (all similar between the groups). The differences in recurrence and metastasis between the two groups were not statistically significant.
Conclusion
Laparoscopically assisted gastrectomy for advanced gastric cancer is safe and effective. In this study, it did not differ significantly from open surgery in terms of survival rate or recurrence after surgery based on long-term follow-up evaluation. It can achieve the same beneficial effects as open surgery, and it has the advantages of a small operation wound, less bleeding, good safety, rapid postoperative recovery, and fewer complications.
Similar content being viewed by others
References
Lee JH, Yom CK, Han HS (2009) Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 23:1759–1763
Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72
Sakuramoto S, Kikuchi S, Kuroyama S, Futawatari N, Katada N, Kobayashi N, Watanabe M (2006) Laparoscopy-assisted distal gastrectomy for early gastric cancer: experience with 111 consecutive patients. Surg Endosc 20:55–60
Kitano S, Yasuda K, Shiraishi N (2006) Laparoscopic surgical resection for early gastric cancer. Eur J Gastroenterol Hepatol 18:855–861
Mochiki E, Kamiyama 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
Tanimura S, Higashino M, Fukunaga Y, Kishida S, Ogata A, Fujiwara Y, Osugi H (2006) Respiratory function after laparoscopic distal gastrectomy: an index of minimally invasive surgery. World J Surg 30:1211–1215
Azagra JS, Ibañez-Aguirre JF, Goergen M, Ceuterick M, Bordas-Rivas JM, Almendral-López ML, Moreno-Elola A, Takieddine M, Guérin E (2006) Long-term results of laparoscopic extended surgery in advanced gastric cancer: a series of 101 patients. Hepatogastroenterology 53:304–308
Kim MC, Kim HH, Jung GJ (2005) Surgical outcome of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer. Eur J Surg Oncol 31:401–405
Dulucq JL, Wintringer P, Perissat J, Mahajna A (2005) Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute’s prospective analysis. J Am Coll Surg 200:191–197
Zhan WH (2006) Improve level of diagnosis treatment and academic research of gastric cancer in China (in Chinese). Chin J Gastrointest Surg 9:5–7
Shiraishi N, Yasuda K, Kitano S (2006) Laparoscopic gastrectomy with lymph node dissection for gastric cancer. Gastric Cancer 9:167–176
Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopic-assisted billroth I gastrectomy. Surg Laparosc Endosc 4:146–148
Uyama I, Sugioka A, Sakurai Y, Komori Y, Hanai T, Matsui H, Fujita J, Nakamura Y, Ochiai M, Hasumi A (2004) Hand-assisted laparoscopic function-preserving and radical gastrectomies for advanced-stage proximal gastric cancer. J Am Coll Surg 199:508–515
Kim MC, Kim KH, Kim HH, Jung GJ (2005) Comparison of laparoscopy assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 91:90–94
Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, Meyer S, Plukker JT, Van Elk P, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H, Dutch Gastric Cancer Group (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340:908–914
de Manzoni G, Verlato G, Guglielmi A, Laterza E, Genna M, Cordiano C (1996) Prognostic significance of lymph node dissection in gastric cancer. Br J Surg 83:1604–1607
Roukos DH, Lorenz M, Encke A (1998) Evidence of survival benefit of extended (D2) lymphadenectomy in western patients with gastric cancer based on a new concept: a prospective long-term follow-up study. Surgery 123:573–578
Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial: surgical cooperative group. Br J Cancer 79:1522–1530
Shubao Wang (1999) An analysis of 37-year clinical experience in treating gastric cancer: a report of 2, 326 cases (in Chinese). Chin J Oncol Pract 26:325–329
Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, Costanzi A, Pauna J, de Martini P (2007) Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21:21–27
Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH (2009) Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23:1252–1258
Allieta R, Nardi M Jr, Brachet-Contul R, Millo P, Fabozzi M, Cornaglia S, Parini U (2009) Laparoscopic gastrectomy for treatment of advanced gastric cancer: preliminary experience on 38 cases. Minerva Chir 64:445–456
Hur H, Jeon HM, Kim W (2008) Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years’ experience. J Surg Oncol 98:515–519
Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distalgastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237
Disclosures
Yongliang Zhao, Peiwu Yu, Yingxue Hao, Feng Qian, Bo Tang, Yan Shi, Huaxing Luo, and Yanqi Zhang have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhao, Y., Yu, P., Hao, Y. et al. Comparison of outcomes for laparoscopically assisted and open radical distal gastrectomy with lymphadenectomy for advanced gastric cancer. Surg Endosc 25, 2960–2966 (2011). https://doi.org/10.1007/s00464-011-1652-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1652-y