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Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gastrectomy in advanced gastric cancer

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Abstract

Background

The use of laparoscopy-assisted distal gastrectomy (LADG) in advanced gastric cancer (AGC) remains a controversial topic, mainly because of doubts about its oncologic validity. To date, literature on the prognosis for AGC after LADG is scarce. This study evaluated the procedure’s long-term benefits compared with those of the conventional, open distal gastrectomy (ODG).

Methods

This study involved 201 patients, 66 of whom underwent LADG, with a mean follow-up period of 49.2 months, from January 1999 to March 2010. A clear set of criteria was used to select patients (including no evidence of lymph node metastasis) and surgeons (subject to their experience). Survival outcomes were assessed by Kaplan–Meier analysis and log-rank testing. The postoperative recovery and complications of the patients also were monitored.

Results

No significant difference was observed between LADG and ODG in terms of overall survival or disease-specific survival. The corresponding 5-year survival rates for individual tumor node metastasis stages also were comparable in each group. The number of lymph nodes harvested was similar in the two groups, although the operation time was significantly shorter for ODG. The postoperative hospital stay was shorter for LADG patients (average stay of 8.4 vs. 18.1 days in the ODG group; p < 0.001), and the postoperative complication rate was almost half that for ODG (13.6 vs. 25.0 %; p = 0.048).

Conclusion

The combination of the long- and short-term data indicates that LADG should be considered as a feasible alternative to ODG for the treatment of AGC. Its widespread integration requires the accumulation of similar results across multiple centers worldwide.

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References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. Leung WK, Wu M, Kakugawa Y, Kim JJ, Yeoh K, Goh KL et al (2008) Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 9:279–287

    Article  PubMed  Google Scholar 

  3. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted billroth 1 gastrectomy. Surg Laparosc Endosc 4:146–148

    PubMed  CAS  Google Scholar 

  4. Ohtani H, Tamamori Y, Noguchi K, Azuma T, Fujimoto S, Oba H et al (2011) Meta-analysis of laparoscopy-assisted and open distal gastrectomy for gastric cancer. J Surg Res 171: 479–485

    Google Scholar 

  5. Huscher C, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A et al (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 

  6. 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 1:1759–1763

    Article  Google Scholar 

  7. Ryu K, Kim YW, Lee J, Nam BH, Kook MC, Choi I et al (2008) Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 1:625–1631

    Google Scholar 

  8. Sakuramoto S, Kikuchi S, Kuroyama S, Futawatari N, Katada N, Kobayashi N et al (2006) Laparoscopy-assisted distal gastrectomy for early gastric cancer. Surg Endosc 1:55–60

    Article  Google Scholar 

  9. Shuang J, Qi S, Zheng J, Zhao Q, Li J, Kang Z et al (2011) A case control study of laparoscopy-assisted and open distal gastrectomy for advanced gastric cancer. J Gastrointest Surg 1:57–62

    Article  Google Scholar 

  10. Hwang S, Kim H, Yoo C, Shin J, Son B (2009) Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 1:1252–1258

    Article  Google Scholar 

  11. Brenner H, Rothenbacher D, Arndt V (2009) Epidemiology of stomach cancer. Methods Mol Biol 472:467–477

    Article  PubMed  Google Scholar 

  12. Japanese Gastric Cancer Society (2004) Guidelines for diagnosis and treatment of carcinoma of the stomach. Japan

  13. Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, Jung EJ et al (2011) Risk of recurrence after laparoscopy-assisted radical gastrectomy for gastric cancer performed by a single surgeon. Surg Endosc 1:872–878

    Article  Google Scholar 

  14. Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumors, 7th edn. Wiley-Blackwell, Oxford

    Google Scholar 

  15. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L (1999) Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group. Ann Surg 230:170–178

    Article  PubMed  CAS  Google Scholar 

  16. Brennan MF (2005) Current status of surgery for gastric cancer: a review. Gastric Cancer 1:64–70

    Article  Google Scholar 

  17. Wolters U, Wolf T, Stützer H, Schröder T (1996) ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 77:217–222

    Article  PubMed  CAS  Google Scholar 

  18. American Society of Anaesthesiologists (2011) ASA physical status classification system. http://www.asahq.org/clinical/physicalstatus.htm Accessed 16 March 2011

  19. Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) A comparison of Roux-en-Y and billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 247:962–967

    Article  PubMed  Google Scholar 

  20. Lee J, Kim W (2009) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol 100:693–698

    Article  PubMed  Google Scholar 

  21. Hur H, Jeon H, Kim W (2008) Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years’ experience. J Surg Oncol 98:515–519

    Article  PubMed  Google Scholar 

  22. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, The 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

    Article  PubMed  Google Scholar 

  23. Kim H, Hyung WJ, Cho GS, Kim MC, Han S, Kim W et al (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report: a phase III multicenter, prospective, randomized trial (KLASS trial). Ann Surg 251:417–420

    Article  PubMed  Google Scholar 

  24. Hosono S, Arimoto Y, Ohtani H, Kanamiya Y (2006) Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy. World J Gastroenterol 12:7676–7683

    PubMed  Google Scholar 

  25. Lee S, Choi Y, Park D, Kim H, Yang H, Kim M (2006) Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg 202:874–880

    Article  PubMed  Google Scholar 

  26. Park JM, Jin SH, Lee SR, Kim H, Jung IH, Cho YK et al (2008) Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases. Surg Endosc 1:2133–2139

    Article  Google Scholar 

  27. Huang JL, Wei HB, Zheng ZH, Wei B, Chen TF, Huang Y, Guo WP, Hu B (2010) Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer. Dig Surg 27:291–296

    Article  PubMed  Google Scholar 

  28. Kim M, Kim W, Kim H, Ryu S, Ryu S, Song K et al (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean multicenter study. Ann Surg Oncol 1:2692–2700

    Article  Google Scholar 

  29. Hiki N, Shimizu N, Yamaguchi H, Imamura K, Kami K, Kubota K et al (2006) Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg 93:195–204

    Article  PubMed  CAS  Google Scholar 

  30. Lee S, Choi Y, Park D, Kim H, Yang H, Kim M (2006) Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg 202:874–880

    Article  PubMed  Google Scholar 

  31. Memon M, Khan S, Yunus R, Barr R, Memon B (2008) Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc 1:1781–1789

    Article  Google Scholar 

  32. Ishikawa M, Kitayama J, Kaizaki S, Nakayama H, Ishigami H, Fujii S et al (2005) Prospective randomized trial comparing Billroth I and Roux-en-Y procedures after distal gastrectomy for gastric carcinoma. World J Surg 1:1415–1420

    Article  Google Scholar 

  33. Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M (2005) Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc 1:1592–1596

    Article  Google Scholar 

  34. Songun I, Putter H, Kranenbarg E, Sasako M, van de Velde C (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449

    Article  PubMed  Google Scholar 

  35. Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 20:1–5

    Article  Google Scholar 

  36. Degiuli M, Sasako M, Ponti A (2010) Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 97:643–649

    Article  PubMed  CAS  Google Scholar 

  37. Degiuli M, Sasako M, Ponti A, Calvo F (2004) Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J Cancer 90:1727–1732

    PubMed  CAS  Google Scholar 

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Disclosures

Andrew C. Gordon, Kazuyuki Kojima, Mikito Inokuchi, Keiji Kato, and Kenichi Sugihara have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan

    Andrew C. Gordon, Kazuyuki Kojima, Mikito Inokuchi, Keiji Kato & Kenichi Sugihara

  2. Imperial College London, Tokyo Medical and Dental University, London, UK

    Andrew C. Gordon

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  1. Andrew C. Gordon
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  2. Kazuyuki Kojima
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Correspondence to Andrew C. Gordon.

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Gordon, A.C., Kojima, K., Inokuchi, M. et al. Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gastrectomy in advanced gastric cancer. Surg Endosc 27, 462–470 (2013). https://doi.org/10.1007/s00464-012-2459-1

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  • DOI: https://doi.org/10.1007/s00464-012-2459-1

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