Top

World Journal of Surgical Oncology

Published in:

Open Access 01-12-2013 | Research

Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China

Authors: Jian-Xian Lin, Chang-Ming Huang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jun Lu

Published in: World Journal of Surgical Oncology | Issue 1/2013

Abstract

Background

Gastric cancer is a common malignancy worldwide and a common cause of death from cancer. Despite recent advances in multimodality treatment and targeted therapy, complete resection remains the only treatment that can lead to cure. This study was devised to investigate the technical feasibility, safety and oncologic efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer without serosa invasion.

Methods

A retrospective matched cohort study was performed in south China comparing laparoscopy-assisted gastrectomy and open gastrectomy for advanced gastric cancer without serosa invasion. Eighty-three patients with advanced gastric cancer undergoing laparoscopy-assisted gastrectomy between January 2008 and December 2010 were enrolled. These patients were compared with 83 patients with advanced gastric cancer undergoing open gastrectomy during the same period.

Results

There was no significant difference in clinicopathologic characteristics between the two groups. Regarding perioperative characteristics, the operation time and time to ground activities did not differ between the two groups, whereas the blood loss, transfused patient number, time to first flatus, time to resumption of diet, and postoperative hospital stay were significantly less in laparoscopy-assisted gastrectomy than in open gastrectomy (P <0.05). There was no statistically significant difference in postoperative morbidity and mortality. No significant difference in the number of lymph nodes dissected was observed between these two groups. There was no significant difference in the cumulative survival rate between the two groups.

Conclusion

Laparoscopy-assisted gastrectomy with D2 lymphadenectomy is a safe and feasible procedure for advanced gastric cancer without serosa invasion. To be accepted as a choice treatment for advanced gastric cancer, well-designed randomized controlled trials comparing short-term and long-term outcomes between laparoscopy-assisted gastrectomy and open gastrectomy in a larger number of patients are necessary.

Available only for authorised users

Parkin DM, Bray F, Ferlay J, Pisani P: Global Cancer statistics 2002. CA Cancer J Clin. 2005, 55: 74-108. 10.3322/canjclin.55.2.74.CrossRefPubMed

Kitano S, Iso Y, Moriyama M, Sugimachi K: Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994, 4 (2): 146-148.PubMed

Han HS, Kim YW, Yi NJ, Fleischer GD: Laparoscopy-assisted D2 subtotal gastrectomy in early gastric cancer. Surg Laparosc Endosc Percutan Tech. 2003, 13 (6): 361-365. 10.1097/00129689-200312000-00002.CrossRefPubMed

Lee JH, Han HS, Lee JH: A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005, 19 (2): 168-173. 10.1007/s00464-004-8808-y.CrossRefPubMed

Lee JH, Yom CK, Han HS: Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc. 2009, 23 (8): 1759-1763. 10.1007/s00464-008-0198-0.CrossRefPubMed

Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A: Laparoscopic total gastrectomy with distal pancreato-splenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer. 1999, 2: 230-234. 10.1007/s101200050069.CrossRefPubMed

Sobin LH, Gospodarowicz MK, Wittekind C: International Union Against Cancer (UICC) TNM classification of malignanttumours. 2010, New York: Wiley-Liss, 7

Mochiki E, Kamiyama Y, Aihara R, Nakabayashi T, Asao T, Kuwano H: Laparoscopic assisted distal gastrectomy for early gastric cancer: five years' experience. Surgery. 2005, 137 (3): 317-322. 10.1016/j.surg.2004.10.012.CrossRefPubMed

Yakoub D, Athanasiou T, Tekkis P, Hanna GB: Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach?. Surg Oncol. 2009, 18 (4): 322-333. 10.1016/j.suronc.2008.08.006.CrossRefPubMed

10.

Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM: Gastric adenocarcinoma: review and considerations for future directions. Ann Surg. 2005, 241 (1): 27-39.PubMedCentralPubMed

11.

Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K, Japan Clinical Oncology Group: D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008, 359 (5): 453-462. 10.1056/NEJMoa0707035.CrossRefPubMed

12.

Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ: Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide DUTCH D1 D2 trial. Lancet Oncol. 2010, 11 (5): 439-449. 10.1016/S1470-2045(10)70070-X.CrossRefPubMed

13.

Hur H, Jeon HM, Kim W: Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years’ experience. J Surg Oncol. 2008, 98 (7): 515-519. 10.1002/jso.21155.CrossRefPubMed

14.

Kawamura H, Homma S, Yokota R, Yokota K, Watarai H, Hagiwara M, Sato M, Noguchi K, Ueki S, Kondo Y: Inspection of safety and accuracy of D2 lymph node dissection in laparoscopy-assisted distal gastrectomy. World J Surg. 2008, 32 (11): 2366-2370. 10.1007/s00268-008-9697-3.CrossRefPubMed

15.

Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, Osugi H: Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc. 2008, 22 (5): 1161-1164. 10.1007/s00464-008-9786-2.CrossRefPubMed

16.

Bo T, Zhihong P, Peiwu Y, Feng Q, Ziqiang W, Yan S, Yongliang Z, Huaxin L: General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them. Surg Endosc. 2009, 23 (8): 1860-1865. 10.1007/s00464-008-0312-3.CrossRefPubMed

17.

Tekkis PP, Senagore AJ, Delaney CP, Fazio VW: Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg. 2005, 242 (1): 83-91. 10.1097/01.sla.0000167857.14690.68.PubMedCentralCrossRefPubMed

18.

Tekkis PP, Fazio VW, Lavery IC, Remzi FH, Senagore AJ, Wu JS, Strong SA, Poloneicki JD, Hull TL, Church JM: Evaluation of the learning curve in ileal pouch-anal anastomosis surgery. Ann Surg. 2005, 241 (2): 262-268. 10.1097/01.sla.0000152018.99541.f1.PubMedCentralCrossRefPubMed

19.

Shikora SA, Kim JJ, Tarnoff ME, Raskin E, Shore R: Laparoscopic Roux-en-Y gastric bypass: results and learning curve of a high-volume academic program. Arch Surg. 2005, 140 (4): 362-367. 10.1001/archsurg.140.4.362.CrossRefPubMed

20.

Poon RT, Ng KK, Lam CM, Ai V, Yuen J, Fan ST, Wong J: Learning curve for radiofrequency ablation of liver tumors: prospective analysis of initial 100 patients in a tertiary institution. Ann Surg. 2004, 239 (4): 441-449. 10.1097/01.sla.0000118565.21298.0a.PubMedCentralCrossRefPubMed

21.

Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC: Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum. 2001, 44 (2): 217-222. 10.1007/BF02234296.CrossRefPubMed

22.

Kunisaki C, Makino H, Yamamoto N, Sato T, Oshima T, Nagano Y, Fujii S, Akiyama H, Otsuka Y, Ono HA, Kosaka T, Takagawa R, Shimada H: Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer. Surg Laparosc Endosc Percutan Tech. 2008, 18 (3): 236-241. 10.1097/SLE.0b013e31816aa13f.CrossRefPubMed

23.

Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC: Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006, 202 (6): 874-880. 10.1016/j.jamcollsurg.2006.02.028.CrossRefPubMed

24.

Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH: Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc. 2009, 23 (6): 1252-1258. 10.1007/s00464-008-0140-5.CrossRefPubMed

25.

Scatizzi M, Kröning KC, Lenzi E, Moraldi L, Cantafio S, Feroci F: Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a case–control study. Updates Surg. 2011, 63 (1): 17-23. 10.1007/s13304-011-0043-1.CrossRefPubMed

26.

Kodera Y, Fujiwara M, Ohashi N, Nakayama G, Koike M, Morita S, Nakao A: Laparoscopic surgery for gastric cancer: a collective review with meta-analysis of randomized trials. J Am Coll Surg. 2010, 211 (5): 677-686. 10.1016/j.jamcollsurg.2010.07.013.CrossRefPubMed

27.

Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N: A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007, 245 (1): 68-72. 10.1097/01.sla.0000225364.03133.f8.PubMedCentralCrossRefPubMed

28.

Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY: 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. 2010, 251 (3): 417-420. 10.1097/SLA.0b013e3181cc8f6b.CrossRefPubMed

29.

Miura S, Kodera Y, Fujiwara M, Ito S, Mochizuki Y, Yamamura Y, Hibi K, Ito K, Akiyama S, Nakao A: Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. J Am CollSurg. 2004, 198 (6): 933-938.

30.

Huscher C, Mingoli A, Sgarzini G, Sansonetti A, Piro F, Ponzano C, Brachini G: Value of extended lymphadenectomy in laparoscopic subtotal gastrectomy for advanced gastric cancer. J Am Coll Surg. 2005, 200 (2): 314-10.1016/j.jamcollsurg.2004.10.024.CrossRefPubMed

31.

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

32.

Shuang J, Qi S, Zheng J, Zhao Q, Li J, Kang Z, Hua J, Du J, Shuang J, Qi S, Zheng J, Zhao Q, Li J, Kang Z, Hua J, Du J: A case–control study of laparoscopy-assisted and open distal gastrectomy for advanced gastric cancer. J Gastrointest Surg. 2011, 15 (1): 57-62. 10.1007/s11605-010-1361-1.CrossRefPubMed

33.

Ibanez Aguirre FJ, Azagra JS, ErroAzcárate ML, Goergen M, Rico Selas P, Moreno Elola-Olaso A, Clemares de Lama M, de Simone P, EcheniqueElizondo MM: Laparoscopic gastrectomy for gastric adenocarcinoma. Long-term results. Rev Esp Enferm Dig. 2006, 98 (7): 491-500.CrossRefPubMed

34.

Azagra JS, Ibanez Aguirre JF, Goergen M, Ceuterick M, Bordas-Rivas JM, Almendral-López ML, Moreno-Elola A, Takieddine M, Guérin E: Long-term results of laparoscopic extended surgery in advanced gastric cancer: a series of 101 patients. Hepatogastroenterology. 2006, 53 (68): 304-308.PubMed

Title: Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China
Authors: Jian-Xian Lin
Chang-Ming Huang
Chao-Hui Zheng
Ping Li
Jian-Wei Xie
Jia-Bin Wang
Jun Lu
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2013
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-11-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2013

Overexpression of HSPA2 is correlated with poor prognosis in esophageal squamous cell carcinoma

Eradication of breast cancer with bone metastasis by autologous formalin-fixed tumor vaccine (AFTV) combined with palliative radiation therapy and adjuvant chemotherapy: a case report

Inferior vena cava tumor thrombus that directly infiltrated from paracaval lymph node metastases in a patient with recurrent hepatocellular carcinoma

Investigating citrullinated proteins in tumour cell lines

Urea immunoliposome inhibits human vascular endothelial cell proliferation for hemangioma treatment

Definition of compartment-based radical surgery in uterine cancer: modified radical hysterectomy in intermediate/high-risk endometrial cancer using peritoneal mesometrial resection (PMMR) by M Höckel translated to robotic surgery