Laparoscopic Versus Open Subtotal Gastrectomy for Adenocarcinoma: A Case–Control Study
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The aim of this study is to compare technical feasibility and oncologic efficacy of totally laparoscopic versus open subtotal gastrectomy for gastric adenocarcinoma.
Laparoscopic gastrectomy for adenocarcinoma is emerging in the West as a technique that may offer benefits for patients, although large-scale studies are lacking.
This study was designed as a case-controlled study from a prospective gastric cancer database. Thirty consecutive patients undergoing laparoscopic subtotal gastrectomy for adenocarcinoma were compared with 30 patients undergoing open subtotal gastrectomy. Controls were matched for stage, age, and gender via a statistically generated selection of all gastrectomies performed during the same period of time. Patient demographics, tumor–node–metastasis (TNM) stage, histologic features, location of tumor, lymph node retrieval, recurrence, margins, and early and late postoperative complications were compared.
Tumor location and histology were similar between the two groups. Median operative time for the laparoscopic approach was 270 min (range 150–485 min) compared with median of 126 min (range 85–205 min) in the open group (p < 0.01). Hospital length of stay after laparoscopic gastrectomy was 5 days (range 2–26 days), compared with 7 days (range 5–30 days) in the open group (p = 0.01). Postoperative pain, as measured by number of days of IV narcotic use, was significantly lower for laparoscopic patients, with a median of 3 days (range 0–11 days) compared with 4 days (range 1–13 days) in the open group (p < 0.01). Postoperative early complications trended towards a decrease for laparoscopic versus open surgery patients (p = 0.07); however, there were significantly more late complications for the open group (p = 0.03). Short-term recurrence-free survival and margin status was similar between the two groups (p = not significant) with adequate lymph node retrieval in both groups.
Laparoscopic subtotal gastrectomy for adenocarcinoma is comparable to the open approach with regard to oncologic principles of resection, with equivalent margin status and adequate lymph node retrieval, demonstrating technically feasibility and equivalent short-term recurrence-free survival. Additional benefits of decreased postoperative complications, decreased length of hospital stay, and decreased narcotic use make this a preferable approach for selected patients.
- Fleshman JW. Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum. 1996;39:53. CrossRef
- Fleshman JW. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246:655. CrossRef
- Fowler DL, White SA. Laparoscopic resection of a submucosal gastric lipoma: a case report. J Laparoendosc Surg. 1991;1(5):303–6.
- Novitsky YW, Kercher KW, Sing RF, Heniford BT. Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg. 2006;243(6):738–45. CrossRef
- Ohgami M, Otani Y, Furukawa T, Kubota T, Kumai K, Kitajima M. Curative laparoscopic surgery for early gastric cancer: eight years experience. Nippon Geka Gakkai Zasshi. 2000;101(8):539–45.
- Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4(2):146–8.
- Uyama I. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer. 1999;2:230. CrossRef
- Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di PM, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241(2):232–7. CrossRef
- Varela JE, Hiyashi M, Nguyen T, Sabio A, Wilson SE, Nguyen NT. Comparison of laparoscopic and open gastrectomy for gastric cancer. Am J Surg. 2006;192(6):837–42. CrossRef
- Weber KJ, Reyes CD, Gagner M, Divino CM. Comparison of laparoscopic and open gastrectomy for malignant disease. Surg Endosc. 2003;17(6):968–71. CrossRef
- Cunningham D. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11. CrossRef
- Siewert JR. Gastric cancer: the dispute between East and West. Gastric Cancer. 2005;8(2):59–61. CrossRef
- Kitajima M. Strategies for gastric cancer treatment in the twenty-first century: minimally invasive and tailored approaches integrating basic science and clinical medicine. Gastric Cancer. 2005;8:55–8. CrossRef
- Kitano S. Minimally invasive surgery for gastric tumors. Surg Clin North Am. 2005;85:151–64. CrossRef
- Khanna A, Koniaris LG, Nakeeb A, Schoeniger LO. Laparoscopic spleen-preserving distal pancreatectomy. J Gastrointest Surg. 2005;9(5):733–8. CrossRef
- Orsenigo E, Baccari P, Bissolotti G, Staudacher C. Laparoscopic central pancreatectomy. Am J Surg. 2006;191(4):549–52. CrossRef
- Strong VE, D’Angelica M, Tang L, Prete F, Gonen M, Coit D, et al. Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol. 2007;14(12):3392–400. CrossRef
- Burke EC, Karpeh MS, Conlon KC, Brennan MF. Laparoscopy in the management of gastric adenocarcinoma. Ann Surg. 1997;225(3):262–7. CrossRef
- Burke EC. Peritoneal lavage cytology in gastric cancer: an independent predictor of outcome. Ann Surg Oncol. 1998;5:411. CrossRef
- Sarela AI, Lefkowitz R, Brennan MF, Karpeh MS. Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg. 2006;191(1):134–8. CrossRef
- Ludwig K, Klautke G, Bernhard J, Weiner R. Minimally invasive and local treatment for mucosal early gastric cancer. Surg Endosc. 2005;19(10):1362–6. CrossRef
- Schubert D, Kuhn R, Nestler G, Kahl S, Ebert MP, Malfertheiner P, et al. Laparoscopic-endoscopic rendezvous resection of upper gastrointestinal tumors. Dig Dis. 2005;23(2):106–12. CrossRef
- Azagra JS. Gastrectomie totale par voie coelioscopique: aspects techniques et resultats preliminaires. J Coelio-Chir. 1996;3:45.
- Azagra JS, Goergen M, de SP, Ibanez-Aguirre J. Minimally invasive surgery for gastric cancer. Surg Endosc. 1999;13(4):351–7. CrossRef
- Anderson C, Ellenhorn J, Hellan M, Pigazzi A. Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surg Endosc. 2007 Mar 8.
- Escalona A, Perez G, Crovari F, Boza C, Pimentel F, Devaud N, et al. Laparoscopic gastrectomy in gastric cancer: experience in four patients. Rev Med Chil. 2007;135(4):512–6.
- Reyes CD, Weber KJ, Gagner M, Divino CM. Laparoscopic vs open gastrectomy. A retrospective review. Surg Endosc. 2001;15(9):928–31. CrossRef
- Tanimura S. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc. 2008; Epub ahead of print.
- Kim MC. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol. 2005;11:7508.
- Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg. 2003;238(3):391–9.
- Laparoscopic Versus Open Subtotal Gastrectomy for Adenocarcinoma: A Case–Control Study
Annals of Surgical Oncology
Volume 16, Issue 6 , pp 1507-1513
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- 1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-1217, New York, NY, USA
- 2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA