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Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery

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Abstract

Background

Completion total gastrectomy for remnant gastric cancer (RGC) is technically challenging, especially using the minimally invasive approach. Only a few small case series have reported the technical feasibility of completion total gastrectomy by minimally invasive surgery (MIS). The aim of this study was to compare the efficacy and safety of MIS and open surgery for RGC.

Methods

We retrospectively analyzed 76 completion total gastrectomies for RGC between 2005 and 2012. Indications for MIS were limited to no evidence of serosa invasion or lymph node metastasis to extraperigastric areas on preoperative evaluation. We compared patient characteristics, intraoperative factors, post-operative outcomes, and survival for the MIS and open surgery groups.

Results

Eighteen patients underwent completion total gastrectomy with MIS (10 laparoscopic, 8 robotic) and 58 patients underwent open surgery. Operation time was longer in the MIS than the open group (266 vs. 203 min, P = 0.004), but the groups had similar estimated blood loss, frequency of unplanned other organ resection, and number of retrieved lymph nodes. The MIS group had a significantly earlier initiation of soft diet, shorter hospital stay, and fewer pain medication injections. Complication rates, recurrence, and overall 5-year survival were similar for the two groups. When we compared laparoscopy with robotic, similar result was shown in all parameters except operation time.

Conclusions

Compared to open surgery, MIS for RGC demonstrated better short-term outcome and comparable oncologic results. MIS for RGC is feasible and safe and maintains advantages of minimal invasiveness. Both laparoscopic and robotic approaches are reasonable to the management of RGC.

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References

  1. Balfour DC (1922) Factors influencing the life expectancy of patients operated on for gastric ulcer. Ann Surg 76:405–408

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Ikeguchi M, Kondou A, Shibata S, Yamashiro H, Tsujitani S, Maeta M, Kaibara N (1994) Clinicopathologic differences between carcinoma in the gastric remnant stump after distal partial gastrectomy for benign gastroduodenal lesions and primary carcinoma in the upper third of the stomach. Cancer 73:15–21

    Article  CAS  PubMed  Google Scholar 

  3. Kodera Y, Yamamura Y, Torii A, Uesaka K, Hirai T, Yasui K, Morimoto T, Kato T, Kito T (1996) Gastric remnant carcinoma after partial gastrectomy for benign and malignant gastric lesions. J Am Coll Surg 182:1–6

    CAS  PubMed  Google Scholar 

  4. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

  5. Ohashi M, Katai H, Fukagawa T, Gotoda T, Sano T, Sasako M (2007) Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg 94:92–95

    Article  CAS  PubMed  Google Scholar 

  6. Jeong O, Park Y (2011) Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer 11:69–77

    Article  PubMed Central  PubMed  Google Scholar 

  7. Furukawa H, Iwanaga T, Hiratsuka M, Imaoka S, Ishikawa O, Kabuto T, Sasaki Y, Kameyama M (1993) Gastric remnant cancer as a metachronous multiple lesion. Br J Surg 80:54–56

    Article  CAS  PubMed  Google Scholar 

  8. Lordick F, Siewert JR (2005) Recent advances in multimodal treatment for gastric cancer: a review. Gastric Cancer 8:78–85

    Article  PubMed  Google Scholar 

  9. Pointner R, Schwab G, KÃnigsrainer A, Bodner E, Schmid KW (1988) Early cancer of the gastric remnant. Gut 29:298–301

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Song J, Kim JY, Kim S, Choi WH, Cheong JH, Hyung WJ, Choi SH, Noh SH (2009) Laparoscopic completion total gastrectomy in remnant gastric cancer: technical detail and experience of two cases. Hepatogastroenterology 56:1249–1252

    PubMed  Google Scholar 

  11. Cho HJ, Kim W, Hur H, Jeon HM (2009) Laparoscopy-assisted completion total gastrectomy for gastric cancer in remnant stomach: report of 2 cases. Surg Laparosc Endosc Percutaneous Tech 19:e57–e60

    Article  Google Scholar 

  12. Qian F, Yu P, Hao Y, Sun G, Tang B, Shi Y, Zhao Y, Lan Y, Luo H, Mo A (2010) Laparoscopy-assisted resection for gastric stump cancer and gastric stump recurrent cancer: a report of 15 cases. Surg Endosc 24:3205–3209

    Article  PubMed  Google Scholar 

  13. Nagai E, Nakata K, Ohuchida K, Miyasaka Y, Shimizu S, Tanaka M (2014) Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study. Surg Endosc 28:289–296

    Article  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

  15. (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123

  16. Chalikonda S, Aguilar Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26:2397–2402

    Article  CAS  PubMed  Google Scholar 

  17. Asbun HJ, Stauffer JA (2012) Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the accordion severity grading system. J Am Coll Surg 215:810–819

    Article  PubMed  Google Scholar 

  18. Cheung TT, Poon RT, Yuen WK, Chok KS, Jenkins CR, Chan SC, Fan ST, Lo CM (2013) Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience. Ann Surg 257:506–511

    Article  PubMed  Google Scholar 

  19. Li M, Lian L, Xiao L, Wu W, He Y, Song X (2012) Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis. Am J Surg 204:779–786

    Article  PubMed  Google Scholar 

  20. van de Wall BJ, Draaisma WA, Schouten ES, Broeders IA, Consten EC (2010) Conventional and laparoscopic reversal of the Hartmann procedure: a review of literature. J Gastrointest Surg 14:743–752

    Article  PubMed Central  PubMed  Google Scholar 

  21. Zeng Y, Yang Z, Peng J, Lin H, Cai L (2012) Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256:39–52

    Article  PubMed  Google Scholar 

  22. Yamada H, Kojima K, Yamashita T, Kawano T, Sugihara K, Nihei Z (2005) Laparoscopy-assisted resection of gastric remnant cancer. Surg Laparosc Endosc Percutaneous Tech 15:226–229

    Article  Google Scholar 

  23. Corcione F, Pirozzi F, Marzano E, Cuccurullo D, Settembre A, Miranda L (2008) Laparoscopic approach to gastric remnant-stump: our initial successful experience on 3 cases. Surg Laparosc Endosc Percutaneous Tech 18:502–505

    Article  Google Scholar 

  24. Makino H, Kunisaki C, Izumisawa Y, Tokuhisa M, Oshima T, Nagano Y, Fujii S, Kimura J, Takagawa R, Kosaka T, Ono HA, Akiyama H, Endo I (2010) Effect of obesity on laparoscopy-assisted distal gastrectomy compared with open distal gastrectomy for gastric cancer. J Surg Oncol 102:141–147

    Article  PubMed  Google Scholar 

  25. Yano H, Monden T, Kinuta M, Nakano Y, Tono T, Matsui S, Iwazawa T, Kanoh T, Katsushima S (2001) The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer. Gastric Cancer 4:93–97

    Article  CAS  PubMed  Google Scholar 

  26. Jeong O, Jung MR, Kim GY, Kim HS, Ryu SY, Park YK (2013) Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case-control study using propensity score matching method. J Am Coll Surg 216:184–191

    Article  PubMed  Google Scholar 

  27. Sarlos D, Kots L, Stevanovic N, von Felten S, Schär G (2012) Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol 120:604–611

    Article  PubMed  Google Scholar 

  28. Yoon HM, Kim Y, Ryu KW, Eom BW, Park JY, Choi IJ, Kim CG, Lee JY, Cho SJ, Rho JY (2012) Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc 26:1377–1381

    Article  PubMed  Google Scholar 

  29. Sasako M, Maruyama K, Kinoshita T, Okabayashi K (1991) Surgical treatment of carcinoma of the gastric stump. Br J Surg 78:822–824

    Article  CAS  PubMed  Google Scholar 

  30. Ahn HS, Kim JW, Yoo M, Park DJ, Lee H, Lee KU, Yang H (2008) Clinicopathological features and surgical outcomes of patients with remnant gastric cancer after a distal gastrectomy. Ann Surg Oncol 15:1632–1639

    Article  PubMed  Google Scholar 

  31. Yoo CH, Noh SH, Shin DW, Choi SH, Min JS (2000) Recurrence following curative resection for gastric carcinoma. Br J Surg 87:236–242

    Article  CAS  PubMed  Google Scholar 

  32. Li J, Zhang S, Liu J, Shao M, Chen L (2012) Review of clinical investigation on recurrence of gastric cancer following curative resection. Chin Med J 125:1479–1495

    PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the assistance of BioScience Writers, LLC (Houston, TX, USA) in copyediting of the manuscript and corrections of English language usage. This work was supported by a grant from Yonsei University College of Medicine (6-2008-0195).

Disclosures

All authors (I.G. Kwon, I. Cho, A. Guner, Y.Y. Choi, H.B. Shin, H.I. Kim, J.Y. An, J.H. Cheong, S.H. Noh, and W.J. Hyung) have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    In Gyu Kwon, In Cho, Ali Guner, Yoon Young Choi, Hyun Beak Shin, Hyoung-Il Kim, Ji Yeong An, Jae-Ho Cheong, Sung Hoon Noh & Woo Jin Hyung

  2. Department of Surgery, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey

    Ali Guner

  3. Gastric Cancer Clinic, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea

    Hyoung-Il Kim, Ji Yeong An, Jae-Ho Cheong, Sung Hoon Noh & Woo Jin Hyung

  4. Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea

    Woo Jin Hyung

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  1. In Gyu Kwon
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Correspondence to Woo Jin Hyung.

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Kwon, I.G., Cho, I., Guner, A. et al. Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery. Surg Endosc 28, 2452–2458 (2014). https://doi.org/10.1007/s00464-014-3496-8

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  • DOI: https://doi.org/10.1007/s00464-014-3496-8

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