Laparoscopy-assisted vs. open total gastrectomy for advanced gastric cancer: long-term outcomes and technical aspects of a case-control study.

BACKGROUND AND OBJECTIVES: An increasing number of studies comparing laparoscopy-assisted distal gastrectomy and conventional open distal gastrectomy have been reported; the technical feasibility and clinical efficacy have been confirmed. However, few data are available to compare laparoscopy-assisted total gastrectomy (LATG) and open techniques for the treatment of advanced gastric cancer (AGC). The aim of this study is to compare the oncologic efficacy and long-term outcomes of LATG vs. open total gastrectomy (OTG) for AGC and to provide our experiences regarding these surgical difficulties as well. METHODS: Using data from a clinical database of all operations performed in our department by a special surgical team, we retrospectively analysed data from 117 cases of LATG and matched OTG performed between January 2004 and December 2010. This analysis was a case-control study in which patients in the two groups were matched according to tumour location, age, gender, BMI and TNM stage via a propensity score matching method. Patient clinical characteristics, lymph node retrieval, early postoperative complications, recurrence and long-term outcomes were compared. RESULTS: The demographics, preoperative data and characteristics of the tumour were similar in both groups. No significant differences were found in the LATG group compared with the OTG group with regard to the number of retrieved lymph nodes or distance from the proximal margin. Operating time was longer in the LATG group than in the OTG group (292.8 ± 49.5 vs. 242.1 ± 47.4, p < 0.05). Significant differences were found between LATG and OTG with regard to blood loss, postoperative hospitalisation and times of analgesic injection. The early postoperative complication rates in the LATG group were significantly lower than in the OTG group (11.1 vs. 16.3 %, p < 0.05). Operative mortality was zero in both groups. During a median follow-up of 61.2 (range, 6-84) months, the overall 5-year survival rates in the LATG group and OTG group were 49.3 and 46.5 %, respectively; there was no significant difference between the two groups (p = 0.756). CONCLUSION: Our results suggest that LATG is technically feasible for advanced gastric cancer patients and can yield good short- and long-term oncologic outcomes as compared with conventional OTG.

General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them.

BACKGROUND: The aim of this study was to assess the complications associated with the laparoscopic treatment of gastric cancer and to discuss their management. METHODS: From March 2004 to June 2007, 302 patients affected by gastric adenocarcinoma underwent laparoscopy-assisted gastrectomy. Of the 302 gastric malignancy cases, distal gastrectomy was performed in 161 cases, proximal gastrectomy in 62 cases, and total gastrectomy in 79 cases. In all cases, D1 or D2 lymph node dissection was performed according to the recommended procedures of the Japanese Gastric Cancer Association. RESULTS: Duration of surgery ranged from 180 to 310 min (median 230 min). There were no deaths during surgery and no anesthesiology complications in our series. We recorded 15 (4.97%) intraoperative complications: one transverse colon perforation, one lesion of the liver, two cases of splenic laceration, one injury of cystic artery leading to gangrene of the gallbladder, nine cases of hemorrhage, and one biliary tract injury. Conversion to open surgery was necessary in only five cases (1.7%). We recorded 21 (7.0%) postoperative complications: four cases of intra-abdominal bleeding, seven cases of duodenal stump leakage, one case of duodenal stump leakage followed by arteriole hemorrhage due to fundus of the stomach, two cases of acute pancreatitis, one case of lymphatic fistula, one case of anastomotic fistula, three cases of delayed gastric emptying, and two cases of obstruction of afferent loop. Six patients underwent reoperation, of whom two died after the procedure while the other four recovered postoperatively; other postoperative complications were treated conservatively. The overall operative morbidity and mortality rates were 11.9% and 0.7%, respectively. CONCLUSION: Our results show that laparoscopic-assisted gastrectomy is an adequate treatment for gastric cancer as long as the indications are controlled and only suitable cases are enrolled in the series. The complication rate is low enough to be acceptable. Most complications can be treated effectively via conservative treatment, and only a small number of cases require reoperation.

Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management.

BACKGROUND: The feasibility and safety of laparoscopically assisted gastrectomy with extended lymphadenectomy for advanced gastric cancer has rarely been studied. This study aimed to investigate the feasibility, safety, and cancer clearance of laparoscopically assisted distal gastrectomy with D2 lymphadenectomy. METHODS: Of the 44 patients with distal gastric cancer who underwent radical distal gastrectomy from March 2004 to May 2005, 35 were treated with D2/D2(+) lymphadenectomy. These patients were compared with 58 patients who, during the same period, underwent a conventional open radical distal gastrectomy. RESULTS: The mean total number of retrieved lymph nodes (30.11 +/- 16.97) and the mean tumor margin were comparable with those in the open group. The mean operative time for laparoscopically assisted distal gastrectomy was significantly longer than for open surgery (282.84 +/- 32.81 min vs 223.75 +/- 23.25 min). The patients in the laparoscopic surgery group had less blood loss, shorter times of analgesic injection, and a faster recovery. The rates of complications were comparable between two groups. CONCLUSIONS: Although laparoscopically assisted radical gastrectomy with D2 lymphadenectomy is more time consuming than open surgery, it is a safe, feasible procedure that achieves cancer clearance similar to open surgery and leads to a quick postoperative recovery.