Top

Published in:

01-08-2013 | Gastrointestinal Oncology

Oncologic Outcomes of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Authors: Tetsu Fukunaga, MD, PhD, Naoki Hiki, MD, PhD, Takeshi Kubota, MD, PhD, Souya Nunobe, MD, PhD, Masanori Tokunaga, MD, Kyoko Nohara, MD, Takeshi Sano, MD, PhD, Toshiharu Yamaguchi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2013

Abstract

Background

In both advanced and early gastric cancer with preoperatively suspected lymph node metastasis, extended lymph node dissection is needed to achieve R0. Since extended lymph node dissection is difficult to perform laparoscopically, few reports have reported long-term outcomes in large numbers of patients. The purpose of this study was to investigate oncologic outcomes after laparoscopy-assisted distal gastrectomy (LADG) with extended lymph node dissection.

Methods

Between April 2004 and March 2010, LADG with extended lymph node dissection was performed at our hospital for 880 patients diagnosed with T1N0-1 or T2N0 (N is classified by Japanese topographic classification) gastric cancer in the lower or middle body of the stomach. D2 lymph node dissection was performed for stage IB (T1N1, T2N0) cancers. Modified D2 lymph node dissection was performed for stage IA (T1N0). Overall survival (OS), disease-free survival (DFS), and form of tumor recurrence at 4 years were investigated retrospectively.

Results

Median follow-up was 42 months. The 4-year OS was 98.2 % for all patients. By stage, OS/DFS were 99.0/99.0 % in stage IA patients, 95.9/95.9 % in stage IB, 92.6/92.0 % in stage IIA, and 90.0/92.9 % in stage IIB. A total of 11 patients died, including 4 deaths from recurrence (liver metastasis, n = 1; peritoneal dissemination, n = 2; distant lymph node and bone metastases, n = 1). There is 1 patient is alive with recurrence (liver). Mean time until recurrence was 14 months.

Conclusions

Oncologic outcomes were good in patients with T1N0-1 and T2N0 gastric cancer who underwent LADG with extended lymph node dissection. This approach appears effective for treating T1N0-1 and T2N0 gastric cancer.

Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.PubMed

Sonqun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.CrossRef

Tanizawa Y, Terashima M. Lymph node dissection in the resection of gastric cancer: review of existing evidence. Gastric Cancer. 2010;13:137–48.PubMedCrossRef

Japanese Gastric Cancer Association. Japanese gastric cancer treatment guideline 2010 (vol. 3). Gastric Cancer. 2010;14:113–23.CrossRef

Fukunaga T, Hiki N, Tokunaga M, Nohara K, Akashi Y, Katayama H, et al. Left-sided approach for suprapancreatic lymph node dissection in laparoscopy-assisted distal gastrectomy without duodenal transaction. Gastric Cancer. 2009;12:106–12.PubMedCrossRef

Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English Edition. Gastric Cancer. 1998;1:10–24.PubMedCrossRef

International Union Against Cancer. Sobin LH, Gospodarowicz MK, Wittekind CH eds. TNM Classification of Malignant Tumours. 7th ed. New York: Wiley-Blackwell; 2009.

Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:S306–11.PubMedCrossRef

Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.PubMedCrossRef

10.

Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer. Surg Endosc. 2009;23:1759–63.PubMedCrossRef

11.

Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic node dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer. 2010;13:238–44.PubMedCrossRef

12.

Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. 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. 1999;79:1522–30.PubMedCrossRef

13.

Degiuli M, Sasako M, Calgaro M, Garino M, Rebecchi F, Mineccia M, et al. 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. 2004;30:303–8.PubMedCrossRef

14.

Liu C, Lu Y, Jun Z, Zhang R, Yao F, Lu P, et al. Impact of total retrieved lymph nodes on staging and survival of patients with gastric cancer invading the subserosa. Surg Oncol. 2009;18:379–84.PubMedCrossRef

15.

Shen JY, Kim S, Cheong JH, Kim YI, Hyung WJ, Choi WH, et al. The impact of total retrieved lymph nodes on staging and survival of patients with pT3 gastric cancer. Cancer. 2007;110:745–51.PubMedCrossRef

16.

Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245:68–72.PubMedCrossRef

17.

Lee SW, Nomura E, Bouras G, Tokuhara T, Tsunemi S, Tanigawa N. Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. J Am Coll Surg. 2010;211:33–40.PubMedCrossRef

18.

Degiuli M, Sasako M, Ponti A, Italian Gastric Cancer Study Group. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg. 2010;97:643–9.PubMedCrossRef

19.

Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;59:453–62.CrossRef

20.

Jacobi CA, Sabat R, Böhm B, Zieren HU, Volk HD, Müller JM. Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells. Surgery. 1997;121:72–8.PubMedCrossRef

21.

Zhang X, Guo X, Zhang A, Wang Y, Zhao J. Influence of carbon dioxide pneumoperitoneum environment on adhesion and metastasis of a human ovarian cancer cell line. Surg Endosc. 2009;23:108–12.PubMedCrossRef

22.

Lee SW, Southall J, Allendorf J, Bessler M, Whelan RL. Traumatic handling of the tumor independent of pneumoperitoneum increases port site implantation rate of colon cancer in a murine model. Surg Endosc. 1998;12:828–34.PubMedCrossRef

23.

Isobe Y, Nashimoto A, Akazawa K, Oda I, Hayashi K, Miyashiro I, et al. Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry. Gastric Cancer. 2011;14:301–16.PubMedCrossRef

24.

Youn HG, An JY, Choi MG, Noh JH, Sohn TS, Kim S. Recurrence after curative resection of early gastric cancer. Ann Surg Oncol. 2010;17:448–54.PubMedCrossRef

25.

Yokoyama T, Kamada K, Tsurui Y, Kashizuka H, Okano E, Ogawa S, et al. Clinicopathological analysis for recurrence of stage Ib gastric cancer. Gastric Cancer. 2011;14:372–7.PubMedCrossRef

26.

Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc. 2008;22:1161–4.PubMedCrossRef

Title: Oncologic Outcomes of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer
Authors: Tetsu Fukunaga, MD, PhD
Naoki Hiki, MD, PhD
Takeshi Kubota, MD, PhD
Souya Nunobe, MD, PhD
Masanori Tokunaga, MD
Kyoko Nohara, MD
Takeshi Sano, MD, PhD
Toshiharu Yamaguchi, MD, PhD
Publication date: 01-08-2013
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 8/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-2930-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Oncologic Outcomes of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2013

The Prognostic Nutritional Index Predicts Long-term Outcomes of Gastric Cancer Patients Independent of Tumor Stage

Long-Term Survival Outcomes of Video-assisted Thoracic Surgery (VATS) Lobectomy After Transitioning from Open Lobectomy

Function-Preserving Gastrectomy for Early Gastric Cancer

Intraperitoneal Cytokine Level in Patients with Peritoneal Surface Malignancies. A Study of the RENAPE (French Network for Rare Peritoneal Malignancies)

C4.4A Expression Is Associated with a Poor Prognosis of Esophageal Squamous Cell Carcinoma

The Prognostic Value of Lymph Node Ratio in Node-Positive Breast Cancer: A Dutch Nationwide Population-Based Study