Elsevier

Surgery

Volume 137, Issue 3, March 2005, Pages 317-322
Surgery

Original communication
Laparoscopic assisted distal gastrectomy for early gastric cancer: Five years' experience

https://doi.org/10.1016/j.surg.2004.10.012Get rights and content

Background

Laparoscopic assisted gastrectomy is being reported increasingly as the treatment of choice for early gastric cancer. However, no reports concerning the prognosis of patients who have undergone laparoscopic assisted distal gastrectomy (LADG) for early gastric cancer or data comparing the results to those obtained after open gastric surgery are yet available.

Methods

A retrospective study was performed comparing laparoscopic assisted and open distal gastrectomies for early gastric cancer. Eighty-nine patients who underwent LADG were compared to 60 who underwent conventional open distal gastrectomy (DG) in terms of pathologic findings, operative outcome, complications, and survival.

Results

There were no significant differences between LADG and DG in operation time (209 vs 200 minutes), complication rate (9% vs 18%), and 5-year survival rate (98% vs 95%). There were differences between LADG and DG with regard to blood loss (237 vs 412 mL), number of lymph nodes (19 vs 25), postoperative stay (17 vs 25 days), and the duration of epidural analgesia (2 vs 4 days) (P < .05 each).

Conclusions

For properly selected patients, LADG can be a curative and minimally invasive treatment for early gastric cancer.

Section snippets

Patients

We studied 149 patients with early gastric cancer who had undergone a Billroth I gastrectomy between April 1998 and January 2003 at Gunma University Hospital of Japan. Eighty-nine patients underwent LADG, and 60 underwent conventional open distal gastrectomy (DG). The evaluation of the preoperative stages of gastric cancer was based on examination, including gastrointestinal (GI) endoscopy, endoscopic ultrasonography, and an upper gastrointestinal series. The diagnostic accuracy of preoperative

Results

The clinicopathologic characteristics of the study groups are presented in Table I. The age, gender, histologic type, depth of wall invasion, tumor size, and lymph node metastases did not differ between the LADG and DG groups. Location of neoplasms (lower stomach) and grossly elevated type occurred more often in the LADG group than in the DG group (P < .05).

The perioperative data are summarized in Table II. In the LADG and DG groups, the operative times were 210 ± 6 and 201 ± 5 minutes, while

Discussion

The survival rate of patients with early gastric cancer is better than that of patients with advanced gastric cancer. The 5-year survival rate for early gastric cancer has been reported to be as high as 90%.11, 12 Recently, some researchers have suggested that early gastric cancer can be treated effectively by laparoscopic surgery in selected groups of patients.5, 6, 7, 8, 9 However, the long-term oncologic results of laparoscopic gastrectomy are unknown. LADG can be used safely and affords the

Conclusion

The authors believe that LADG is a safe and useful operation for most early gastric cancers. If the patient is selected properly, LADG can be a curative and minimally invasive treatment for early gastric cancer.

References (29)

  • T. Asao et al.

    Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer

    Br J Surg

    (2001)
  • E. Mochiki et al.

    Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer

    World J Surg

    (2002)
  • E. Mochiki et al.

    The technique of laparoscopically assisted total gastrectomy with jejunal interposition for early gastric cancer

    Surg Endosc

    (2002)
  • S. Kitano et al.

    A randomized controlled trial comparing open vs. laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report

    Surgery

    (2002)
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    Supported by grants #13671280 (Dr Mochiki) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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