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Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection

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Abstract

Background

Laparoscopic gastrectomy has gained acceptance as treatment for early gastric cancer. However, its role for advanced gastric cancer remains unclear. This study aimed to compare the oncologic outcomes between laparoscopic and open gastrectomy in the management of advanced gastric cancer for patients receiving adjuvant chemoradiotherapy.

Methods

This study reviewed consecutive patients treated with gastric cancer resection and adjuvant chemoradiation (45 Gy/25 with 5-fluorouracil [FU]-based chemotherapy), at a quaternary care comprehensive cancer center between 1 Jan 2000 and 30 Nov 2009. Of 203 patients, 21 were treated with laparoscopic gastrectomy. These patients were compared with patients who had open surgery and evaluated for overall survival, relapse-free survival, and site of first disease recurrence.

Results

The 21 patients in the laparoscopic group had a median age of 61.3 years (range, 28.2–76.6 years) and a median follow-up period of 21.3 months (range, 6.7–50.4 months). The majority of the patients (71%) were men. Most of these patients had tumor node metastasis (TNM) v6 stage 2 (33%) or 3 (52%) disease as classified by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). The demographic characteristics of the laparoscopic and open groups were similar. The incidence of recurrence was 38.1% (8/21) in the laparoscopic group and 36.8% (67/182) in the open group. In the laparoscopic group, the site of first recurrence was distant in three patients, peritoneal in four patients, and mixed in one patient (locoregional and distant). The recurrence patterns did not differ significantly between the laparoscopic and open surgery groups. In the open group, recurrence was distant in 26 patients, peritoneal in 12 patients, and locoregional in 15 patients. At presentation, 14 patients showed a mixed pattern. The 3-year relapse-free survival rate was 58% (range, 50–66%), and the difference between the two groups by Gray’s test was not significant (P = 0.32). The 3-year overall survival rate was 65.9% (range, 58–73%) and did not differ significantly between the two groups in the univariate (P = 0.92) or multivariate (P = 0.54) analysis.

Conclusion

The study findings suggest that laparoscopic gastrectomy is an oncologically safe procedure for advanced gastric cancer with outcomes similar to those for open resection.

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Disclosures

S. J. MacLellan, H. J. MacKay, J. Ringash, L. Jacks, Z. Kassam Z, T. Conrad, I. Khalili, and A. Okrainec have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Toronto Western Hospital, University Health Network, 8MP-Room 325, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada

    S. J. MacLellan & A. Okrainec

  2. Princess Margaret Hospital, University Health Network, DMOH 5-110, 610 University Ave., Toronto, ON, M5G 2M9, Canada

    H. J. MacKay

  3. Princess Margaret Hospital, University Health Network, 5th Floor Rm. 900, 610 University Ave., Toronto, ON, M5G 2M9, Canada

    J. Ringash, Z. Kassam & T. Conrad

  4. Department of Biostatistics, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada

    L. Jacks

  5. Department of Medical Imaging, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

    I. Khalili

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  1. S. J. MacLellan
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  2. H. J. MacKay
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  3. J. Ringash
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  5. Z. Kassam
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Correspondence to S. J. MacLellan.

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Presented at the SAGES 2011 Annual Meeting, March 30–April 2, 2011, San Antonio, TX.

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MacLellan, S.J., MacKay, H.J., Ringash, J. et al. Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection. Surg Endosc 26, 1813–1821 (2012). https://doi.org/10.1007/s00464-011-2118-y

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  • DOI: https://doi.org/10.1007/s00464-011-2118-y

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