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Published in: Surgical Endoscopy 10/2010

01-10-2010

Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival

Authors: Raffaele Pugliese, Dario Maggioni, Fabio Sansonna, Andrea Costanzi, Giovanni Carlo Ferrari, Stefano Di Lernia, Carmelo Magistro, Paolo De Martini, Francesco Pugliese

Published in: Surgical Endoscopy | Issue 10/2010

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Abstract

Background

The purpose of this study is to assess outcomes and 5-year survival after subtotal gastrectomy (SG) for early and advanced distal adenocarcinoma with D2 dissection performed by minimally invasive surgery (MIS).

Methods

From June 2000 to October 2009 a total of 70 patients with adenocarcinoma of the lower third of the stomach underwent SG with D2 nodal clearance by MIS. This series enrolled 37 patients with early gastric cancer (EGC) and 33 with advanced gastric cancer (AGC). SG was attempted by conventional laparoscopy (CL) in 52 cases and by robot-assisted (RA) technique in 18. Clinical and histopathologic results with 5-year survival were analyzed.

Results

No intraoperative complication was registered. Conversion to laparotomy was required in five patients. Overall, the mean operating time for SG was 254 min (range = 145–460) and estimated mean blood loss was 146 ml (range = 45–250). Postoperative complications occurred in seven patients, including two duodenal leakages none of which required laparotomy. There were two postoperative deaths, one caused by hepatic failure and one by hemorrhagic stroke. Preoperative understaging occurred in ten cases (three were AGC). On average, 30 ± 8 lymph nodes were collected. The distance of proximal resection margin was 6.6 cm (range = 4–8.5 cm). Short-term results were equal with those of laparoscopic and RA gastrectomy. The mean hospital stay of all patients was 10 days (range = 7–24). The mean follow-up span was 53 months (range = 3–112). Relapse of disease occurred in 12 patients, 10 of whom died from the disease and their mean survival was 25 months (range = 12–38). The overall 3-year survival was 85% for CL gastrectomy and 78% for RA gastrectomy, but this difference was not significant with the log rank test (p > 0.05). The overall 5-year survival was 81% (97% for EGC and 67% for AGC).

Conclusion

D2 subtotal gastrectomy performed by MIS is reproducible and safe. The long-term outcomes and 5-year survival are acceptable. Extended lymphadenectomy was carried out for both EGC and AGC so as to ensure adequate nodal clearance and compensate preoperative underestimation.
Literature
1.
go back to reference Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English edn. Gastric Cancer 1:10–24CrossRefPubMed Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English edn. Gastric Cancer 1:10–24CrossRefPubMed
2.
go back to reference Douglass HO Jr, Hundahl SA, Macdonald JS, Khatri VP (2007) Gastric cancer: D2 dissection or low Maruyama index-based surgery—a debate. Surg Oncol Clin N Am 16:133–155CrossRefPubMed Douglass HO Jr, Hundahl SA, Macdonald JS, Khatri VP (2007) Gastric cancer: D2 dissection or low Maruyama index-based surgery—a debate. Surg Oncol Clin N Am 16:133–155CrossRefPubMed
3.
go back to reference Kanellos D, Kanellos I (2009) Impact of laparoscopic D2 gastrectomy on long-term survival for early gastric cancer. Surg Endosc 23:1681–1683CrossRefPubMed Kanellos D, Kanellos I (2009) Impact of laparoscopic D2 gastrectomy on long-term survival for early gastric cancer. Surg Endosc 23:1681–1683CrossRefPubMed
4.
go back to reference Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer. Surg Endosc 19:168–173CrossRefPubMed Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer. Surg Endosc 19:168–173CrossRefPubMed
5.
6.
go back to reference Saragoni L, Gaudio M, Morgagni P, Folli S, Vio A, Scarpi E, Saragoni A (2000) The role of growth patterns, according to Kodama’s classification, and lymph node status, as important prognostic factors in early gastric cancers: analysis of 412 cases. Gastric Cancer 3:134–140CrossRefPubMed Saragoni L, Gaudio M, Morgagni P, Folli S, Vio A, Scarpi E, Saragoni A (2000) The role of growth patterns, according to Kodama’s classification, and lymph node status, as important prognostic factors in early gastric cancers: analysis of 412 cases. Gastric Cancer 3:134–140CrossRefPubMed
7.
go back to reference Yang SH, Zhang YC, Yang KH, Li YP, He XD, Tian JH, Lv TH, Hui YH, Sharma N (2009) An evidence-based medicine review of lymphadenectomy extent for gastric cancer. Am J Surg 197:246–251CrossRefPubMed Yang SH, Zhang YC, Yang KH, Li YP, He XD, Tian JH, Lv TH, Hui YH, Sharma N (2009) An evidence-based medicine review of lymphadenectomy extent for gastric cancer. Am J Surg 197:246–251CrossRefPubMed
8.
go back to reference Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, Costanzi A, Pauna I, de Martini P (2007) Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21:21–27CrossRefPubMed Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, Costanzi A, Pauna I, de Martini P (2007) Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21:21–27CrossRefPubMed
9.
go back to reference Pugliese R, Maggioni D, Sansonna F, Ferrari GC, Di Lernia S, Magistro C, Pauna I, Forgione A, Costanzi A, Brambilla C, Pugliese F (2008) Robot-assisted laparoscopic gastrectomy with D2 dissection for adenocarcinoma: initial experience with 17 patients. J Rob Surg 2:217–222CrossRef Pugliese R, Maggioni D, Sansonna F, Ferrari GC, Di Lernia S, Magistro C, Pauna I, Forgione A, Costanzi A, Brambilla C, Pugliese F (2008) Robot-assisted laparoscopic gastrectomy with D2 dissection for adenocarcinoma: initial experience with 17 patients. J Rob Surg 2:217–222CrossRef
10.
go back to reference Pugliese R, Maggioni D, Sansonna F, Ferrari GC, Forgione A, Costanzi A, Magistro C, Pauna J, Di Lernia S, Citterio D, Brambilla C (2009) Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures. Eur J Surg Oncol 35:281–288PubMed Pugliese R, Maggioni D, Sansonna F, Ferrari GC, Forgione A, Costanzi A, Magistro C, Pauna J, Di Lernia S, Citterio D, Brambilla C (2009) Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures. Eur J Surg Oncol 35:281–288PubMed
11.
go back to reference Bo T, Zhihong P, Peiwu Y, Feng Q, Ziqiang W, Yan S, Yongliang Z, Huaxin L (2009) General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them. Surg Endosc 23:1860–1865CrossRefPubMed Bo T, Zhihong P, Peiwu Y, Feng Q, Ziqiang W, Yan S, Yongliang Z, Huaxin L (2009) General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them. Surg Endosc 23:1860–1865CrossRefPubMed
12.
go back to reference Hur H, Jeon HM, Kim W (2008) Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years experience. J Surg Oncol 98:515–519CrossRefPubMed Hur H, Jeon HM, Kim W (2008) Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years experience. J Surg Oncol 98:515–519CrossRefPubMed
13.
go back to reference Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 194:839–844CrossRefPubMed Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 194:839–844CrossRefPubMed
14.
go back to reference Hwang S II, Kim HO, Yoo CH, Shin JH, Son BH (2009) Laparoscopically-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23:1252–1258CrossRefPubMed Hwang S II, Kim HO, Yoo CH, Shin JH, Son BH (2009) Laparoscopically-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23:1252–1258CrossRefPubMed
15.
go back to reference Hwang SH, Park DJ, Jee YS, Kim MC, Kim HH, Lee HJ, Yang HK, Lee KU (2009) Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. Arch Surg 144:559–564CrossRefPubMed Hwang SH, Park DJ, Jee YS, Kim MC, Kim HH, Lee HJ, Yang HK, Lee KU (2009) Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. Arch Surg 144:559–564CrossRefPubMed
16.
go back to reference Kakeij Y, Konishi K, Ieiri S, Yasunaga T, Nakamoto M, Tanoue K, Baba H, Maheara Y, Hashizume M (2006) Robotic laparoscopic distal gastrectomy: a comparison of the da Vinci and Zeus systems. J Clin Oncol 2:299–304 Kakeij Y, Konishi K, Ieiri S, Yasunaga T, Nakamoto M, Tanoue K, Baba H, Maheara Y, Hashizume M (2006) Robotic laparoscopic distal gastrectomy: a comparison of the da Vinci and Zeus systems. J Clin Oncol 2:299–304
17.
go back to reference Kiyama T, Fujita I, Kanno H, Tani A, Yoshiyuki T, Kato S, Tajiri T, Barbul A (2008) Laparoscopy-assisted distal gastrectomy for gastric cancer. J Gastrointest Surg 12:1807–1811CrossRefPubMed Kiyama T, Fujita I, Kanno H, Tani A, Yoshiyuki T, Kato S, Tajiri T, Barbul A (2008) Laparoscopy-assisted distal gastrectomy for gastric cancer. J Gastrointest Surg 12:1807–1811CrossRefPubMed
18.
go back to reference Kitano S, Shiraishi N, Ichiro U, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72CrossRefPubMed Kitano S, Shiraishi N, Ichiro U, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72CrossRefPubMed
19.
go back to reference 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(8):693–698CrossRefPubMed 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(8):693–698CrossRefPubMed
20.
go back to reference Memon MA, Khan S, Yunus RM, Barr R, Memon B (2008) Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc 22:1781–1789CrossRefPubMed Memon MA, Khan S, Yunus RM, Barr R, Memon B (2008) Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc 22:1781–1789CrossRefPubMed
21.
go back to reference Park JM, Jin SH, Lee SR, Kim H, Jung IH, Cho YK, Han SU (2008) Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases. Surg Endosc 22:2133–2139CrossRefPubMed Park JM, Jin SH, Lee SR, Kim H, Jung IH, Cho YK, Han SU (2008) Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases. Surg Endosc 22:2133–2139CrossRefPubMed
22.
go back to reference Sarela AI (2009) Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc 23:153–160CrossRefPubMed Sarela AI (2009) Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc 23:153–160CrossRefPubMed
23.
go back to reference Singh KK, Rohatagi A, Rybinkina I, McCulloch P, Mudan S (2008) Laparoscopic gastrectomy for gastric cancer: early experience among the elderly. Surg Endosc 22:1002–1007CrossRefPubMed Singh KK, Rohatagi A, Rybinkina I, McCulloch P, Mudan S (2008) Laparoscopic gastrectomy for gastric cancer: early experience among the elderly. Surg Endosc 22:1002–1007CrossRefPubMed
24.
go back to reference Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, Osugi H (2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22:1161–1164CrossRefPubMed Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, Osugi H (2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22:1161–1164CrossRefPubMed
25.
go back to reference Tokunaga M, Hiki N, Fukunaga T, Miki A, Ohyama S, Seto Y, Yamaguchi T (2008) Does age matter in the indication for laparoscopy-assisted gastrectomy? J Gastrointest Surg 12:1502–1507CrossRefPubMed Tokunaga M, Hiki N, Fukunaga T, Miki A, Ohyama S, Seto Y, Yamaguchi T (2008) Does age matter in the indication for laparoscopy-assisted gastrectomy? J Gastrointest Surg 12:1502–1507CrossRefPubMed
26.
go back to reference Anderson C, Ellemhorn Hellan M, Pigazzi A (2007) Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surg Endosc 21:1662–1666CrossRefPubMed Anderson C, Ellemhorn Hellan M, Pigazzi A (2007) Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surg Endosc 21:1662–1666CrossRefPubMed
27.
go back to reference Patriti A, Ceccarelli G, Bellochi R, Bartoli A, Spaziani A, Di Zitti L, Casciola L (2008) Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma. Surg Endosc 22:2753–2760 Patriti A, Ceccarelli G, Bellochi R, Bartoli A, Spaziani A, Di Zitti L, Casciola L (2008) Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma. Surg Endosc 22:2753–2760
28.
go back to reference Pernazza G, Gentile E, Felicioni L, Tumbiolo S, Giulianotti PC (2006) Improved early survival after robotic gastrectomy in advanced gastric cancer. Surg Laparosc Endosc Percutan Tech 16:286CrossRef Pernazza G, Gentile E, Felicioni L, Tumbiolo S, Giulianotti PC (2006) Improved early survival after robotic gastrectomy in advanced gastric cancer. Surg Laparosc Endosc Percutan Tech 16:286CrossRef
29.
go back to reference Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH (2009) Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc 23:1204–1211CrossRefPubMed Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH (2009) Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc 23:1204–1211CrossRefPubMed
30.
go back to reference Deng JY, Liang H, Sun D, Pan Y, Zhang RP, Wang BG, Zhan HJ (2009) Outcome in relation to numbers of nodes harvested in lymph node-positive gastric cancer. Eur Surg J Oncol 35:814–819 Deng JY, Liang H, Sun D, Pan Y, Zhang RP, Wang BG, Zhan HJ (2009) Outcome in relation to numbers of nodes harvested in lymph node-positive gastric cancer. Eur Surg J Oncol 35:814–819
31.
go back to reference Pesic M, Karanikolic A, Djordevic N, Katic V, Rancic Z, Radojkovic M, Ignjatovic N, Pesic I (2004) The importance of primary gastric cancer location in 5-year survival rate. Arch Oncol 12(Suppl 1):51–53 Pesic M, Karanikolic A, Djordevic N, Katic V, Rancic Z, Radojkovic M, Ignjatovic N, Pesic I (2004) The importance of primary gastric cancer location in 5-year survival rate. Arch Oncol 12(Suppl 1):51–53
32.
go back to reference Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K (2008) D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359:453–462CrossRefPubMed Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K (2008) D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359:453–462CrossRefPubMed
33.
go back to reference Tokunaga M, Hiki N, Fukunaga T, Ohyama S, Yamada K, Yamakuchi T (2009) Better prognosis of T2 gastric cancer with preoperative diagnosis of early gastric cancer. Ann Surg Oncol 16:1514–1519CrossRefPubMed Tokunaga M, Hiki N, Fukunaga T, Ohyama S, Yamada K, Yamakuchi T (2009) Better prognosis of T2 gastric cancer with preoperative diagnosis of early gastric cancer. Ann Surg Oncol 16:1514–1519CrossRefPubMed
34.
go back to reference Chen XZ, Hu JK, Yang K, Wang L, Lu QC (2009) Short-term evaluation of laparoscopy-assisted distal gastrectomy for predictive early gastric cancer: a meta-analysis of randomized controlled trials. Surg Laparosc Endosc Percutan Tech 19:277–284CrossRefPubMed Chen XZ, Hu JK, Yang K, Wang L, Lu QC (2009) Short-term evaluation of laparoscopy-assisted distal gastrectomy for predictive early gastric cancer: a meta-analysis of randomized controlled trials. Surg Laparosc Endosc Percutan Tech 19:277–284CrossRefPubMed
35.
go back to reference Hundahl SA (2006) Low Maruyama index surgery for gastric cancer. Scand J Surg 95:243–248PubMed Hundahl SA (2006) Low Maruyama index surgery for gastric cancer. Scand J Surg 95:243–248PubMed
36.
go back to reference Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, Seto Y, Yoshiba H, Nohara K, Inoue H, Muto T (2008) The benefits of standardizing the operative procedure for the assistant in laparoscopy assisted gastrectomy for gastric cancer. Langenbecks Arch Surg 393:963–971CrossRefPubMed Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, Seto Y, Yoshiba H, Nohara K, Inoue H, Muto T (2008) The benefits of standardizing the operative procedure for the assistant in laparoscopy assisted gastrectomy for gastric cancer. Langenbecks Arch Surg 393:963–971CrossRefPubMed
37.
go back to reference Morgagni P, Marfisi C, Gardini A, Marrelli D, Saragoni L, Roviello F, Vittimberga G, Garcea D, for the Italian Research Group for Gastric Cancer (I.R.G.G.C.) (2009) Subtotal gastrectomy as treatment for distal multifocal early gastric cancer. J Gastrointest Surg 13:2239–2244CrossRefPubMed Morgagni P, Marfisi C, Gardini A, Marrelli D, Saragoni L, Roviello F, Vittimberga G, Garcea D, for the Italian Research Group for Gastric Cancer (I.R.G.G.C.) (2009) Subtotal gastrectomy as treatment for distal multifocal early gastric cancer. J Gastrointest Surg 13:2239–2244CrossRefPubMed
38.
go back to reference Ahn HS, Lee HJ, Yoo MW, Kim SG, Im JP, Kim SH, Kim WH, Lee KU, Yang HK (2009) Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer. J Surg Oncol 99:20–27CrossRefPubMed Ahn HS, Lee HJ, Yoo MW, Kim SG, Im JP, Kim SH, Kim WH, Lee KU, Yang HK (2009) Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer. J Surg Oncol 99:20–27CrossRefPubMed
Metadata
Title
Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival
Authors
Raffaele Pugliese
Dario Maggioni
Fabio Sansonna
Andrea Costanzi
Giovanni Carlo Ferrari
Stefano Di Lernia
Carmelo Magistro
Paolo De Martini
Francesco Pugliese
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 10/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1014-1

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