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Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a case–control study

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Abstract

In a non-specialized setting, laparoscopic distal gastrectomy (LDG) for locally advanced diseases remains controversial, particularly given to the technical demands of the learning curve required to perform an adequate resection with D2 lymph node dissection. Inclusion criteria for this statistically generated matching controlled study were all patients who underwent subtotal laparoscopic gastrectomies from January 2006 until September 2009 for locally advanced gastric adenocarcinoma (stage II–IIIb), compared with matched patients who underwent the same procedure in an open fashion during the same period. Sixty case-matched patients were evaluated (30 laparoscopic vs. 30 open). Operative time was significantly longer (p < 0.05) for LDG. Benefits for LDG (p < 0.05) were observed among surgical short-term outcome (postoperative hospital stay, ambulation, first bowel movement, first flatus, first stool, first eating and use of analgesic drugs) and postoperative non-surgical site complications (cardiopulmonary, urinary, etc.). The 42 months’ overall survival was similar (p = 0.646). Laparoscopic gastrectomy is a safe technique in a non-academic hospital setting for locally advanced gastric cancer; it seems to be adequate in terms of margin status and adequate lymph node retrieval and is associated with additional benefits as a decreased length of hospital stay, a decreased narcotic use and fewer complications.

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References

  1. Nagai Y, Tanimura H, Takifuji K, Kashiwagi H, Yamoto H, Nakatani Y (1995) Laparoscope-assisted Billroth I gastrectomy. Surg Laparosc Endosc 5(4):281–287

    PubMed  CAS  Google Scholar 

  2. Kitano S, Shimoda K, Miyahara M, Shiraishi N, Bandoh T, Yoshida T et al (1995) Laparoscopic approaches in the management of patients with early gastric carcinomas. Surg Laparosc Endosc 5(5):359–362

    PubMed  CAS  Google Scholar 

  3. Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hasumi A (2000) Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach. Gastric Cancer 43(1):50–55

    Article  Google Scholar 

  4. Fleshman JW (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655

    Article  PubMed  Google Scholar 

  5. Rodríguez Santiago JM, Clemares M, Roig-Garcia J, Asensio JI, Feliu X, Toscano E et al (2009) Gastric cancer and laparoscopy: analysis of data from the National register of laparoscopic gastric surgery. Circ Esp 85(5):280–286

    Article  Google Scholar 

  6. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, Dutch Gastric Cancer Group et al (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340(12):908–914

    Article  PubMed  CAS  Google Scholar 

  7. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V et al (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 79(9–10):1522–1530

    Article  PubMed  CAS  Google Scholar 

  8. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I et al (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(11):2069–2077

    Article  PubMed  CAS  Google Scholar 

  9. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF et al (2006) Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 7(4):309–315

    Article  PubMed  CAS  Google Scholar 

  10. Edwards P, Blackshaw GR, Lewis WG, Barry JD, Allison MC, Jones DR (2004) Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma. Br J Cancer 90(10):1888–1892

    Article  PubMed  CAS  Google Scholar 

  11. Biffi R, Chiappa A, Luca F, Pozzi S, Lo Faso F, Cenciarelli S et al (2006) Extended lymph node dissection without routine spleno-pancreatectomy for treatment of gastric cancer: low morbidity and mortality rates in a single center series of 250 patients. J Surg Oncol 93(5):394–400

    Article  PubMed  Google Scholar 

  12. Yildrim E, Celen O, Berberoglu U (2001) The Turkish experience with curative gastrectomies for gastric carcinoma: is D2 dissection worthwhile? J Am Coll Surg 192:25–37

    Article  Google Scholar 

  13. Degiuli M, Sasako M, Calgaro M, Garino M, Rebecchi F, Mineccia M, Italian Gastric Cancer Study Group et al (2004) Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol 30(3):303–308

    PubMed  CAS  Google Scholar 

  14. Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A, Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group (2005) Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 92(9):1103–1109

    Article  PubMed  CAS  Google Scholar 

  15. Clavien PA, Sanabria JR, Mentha G, Borst F, Buhler L, Bc Roche et al (1992) Recent results of elective open cholecystectomy in a North American and a European center. Comparison of complications and risk factors. Ann Surg 216(6):618–626

    Article  PubMed  CAS  Google Scholar 

  16. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  17. Ohgami M, Otani Y, Furukawa T, Kubota T, Kumai K, Kitajima M (2000) Curative laparoscopic surgery for early gastric cancer: eight years experience. Nippon Geka Gakkai Zasshi 101(8):539–545

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  19. Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S et al (1999) Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 229(1):49–54

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  21. 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(7):806–810

    Article  PubMed  CAS  Google Scholar 

  22. Yano H, Monden T, Kinuta M, Nakano Y, Tono T, Matsui S et al (2001) The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer. Gastric Cancer 4(2):93–97

    Article  PubMed  CAS  Google Scholar 

  23. Yasuda K, Sonoda K, Shiroshita H, Inomata M, Shiraishi N, Kitano S (2004) Laparoscopically assisted distal gastrectomy for early gastric cancer in the elderly. Br J Surg 91(8):1061–1065

    Article  PubMed  CAS  Google Scholar 

  24. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ et al (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248(5):721–727

    Article  PubMed  Google Scholar 

  25. Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19(9):1172–1176

    Article  PubMed  CAS  Google Scholar 

  26. Huscher CG, 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(2):232–237

    Article  PubMed  Google Scholar 

  27. 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(2):168–173

    Article  PubMed  Google Scholar 

  28. 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(1 Suppl):S306–S311

    Article  PubMed  Google Scholar 

  29. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, 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(3):417–420

    Article  PubMed  Google Scholar 

  30. Ohtani H, Tamamori Y, Noguchi K, Azuma T, Fujimoto S, Oba H et al (2010) A meta-analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer. J Gastrointest Surg 14(6):958–964

    Article  PubMed  Google Scholar 

  31. Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y et al (2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22(5):1161–1164

    Article  PubMed  CAS  Google Scholar 

  32. Kim MC (2005) Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 11:7508

    PubMed  Google Scholar 

  33. Song KY, Kim SN, Park CH (2008) Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 22(3):655–659

    Article  PubMed  CAS  Google Scholar 

  34. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91

    Article  PubMed  Google Scholar 

  35. Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA (2006) Volume and process of care in high-risk cancer surgery. Cancer 106:2476–2481

    Article  PubMed  Google Scholar 

  36. Sarela AI (2009) Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc 23(1):153–160

    Article  PubMed  Google Scholar 

  37. Strong VE, Devaud N, Allen PJ, Gonen M, Brennan MF, Coit D (2009) Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case–control study. Ann Surg Oncol 16(6):1507–1513

    Article  PubMed  Google Scholar 

  38. Grantcharov TP, Kehlet H (2010) Laparoscopic gastric surgery in an enhanced recovery programme. Br J Surg 97:1547–1551

    Article  PubMed  CAS  Google Scholar 

  39. Strong VE, Allen PJ, Brennan MF (2009) Coit D. Ann Surg Oncol 16(9):2665–2666 (author reply 2667)

    Article  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. General Surgery Unit, Ospedale Misericordia e Dolce, Piazza dell’Ospedale 5, 59100, Prato, PO, Italy

    Marco Scatizzi, Katrin C. Kröning, Elisa Lenzi, Luca Moraldi, Stefano Cantafio & Francesco Feroci

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  1. Marco Scatizzi
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  2. Katrin C. Kröning
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  3. Elisa Lenzi
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  4. Luca Moraldi
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Correspondence to Francesco Feroci.

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Scatizzi, M., Kröning, K.C., Lenzi, E. et al. Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a case–control study. Updates Surg 63, 17–23 (2011). https://doi.org/10.1007/s13304-011-0043-1

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  • DOI: https://doi.org/10.1007/s13304-011-0043-1

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