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Laparoscopy-assisted distal gastrectomy versus laparoscopy-assisted total gastrectomy with D2 lymph node dissection for middle-third advanced gastric cancer

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Abstract

Background

There still remains controversy for the choice of resection extent for gastric cancer involving the middle-third of the stomach. The aim of this study was to compare the technical feasibility and long-term outcomes of laparoscopy-assisted distal gastrectomy (LADG) versus laparoscopy-assisted total gastrectomy (LATG) for middle-third advanced gastric cancer (AGC) and to determine which is the optimal surgical procedure.

Methods

For this study, clinical data for 379 patients who underwent LADG or LATG with D2 lymph node dissection between April 2005 and June 2014 were analyzed retrospectively. The short- and long-term outcomes were compared between the propensity score-matched groups.

Results

The LADG group had a significantly shorter operating time (212.74 vs. 241.79 min, P < 0.001), less estimated blood loss (114.38 vs. 181.51 ml, P = 0.000), shorter first flatus and postoperative hospital stay. Additionally, the total cost of hospitalization was significantly higher in the LATG group than LADG group (71187.58 vs. 65783.25 RMB, P = 0.000). There were no significant differences in postoperative complications rate between the LADG group and the LATG group. The 5-year overall survival (OS) rates were 64.4% in the LADG group and 61.0% in the LATG group (P = 0.548). The resection extent was not an independent prognostic factor for the OS.

Conclusions

LADG with D2 nodal dissection is a feasible treatment strategy for middle-third AGC with better short-term outcomes and similar long-term survival rates compared with LATG. We recommended that DG should be the optimal surgical procedure for middle one-third AGC under the premise of negative proximal resection margin.

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Acknowledgements

The authors are thankful to medical staff of Xijing Hospital of Digestive Diseases for their management of database.

Funding

This study was supported by the National Key Basic Research Program of China (No. 2014CBA02002).

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Authors and Affiliations

  1. Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China

    Zhengyan Li, Gang Ji, Bin Bai, Deliang Yu, Yezhou Liu, Bo Lian & Qingchuan Zhao

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  1. Zhengyan Li
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  2. Gang Ji
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  3. Bin Bai
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  4. Deliang Yu
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Correspondence to Qingchuan Zhao.

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Disclosures

Zhengyan Li, Qingchuan Zhao, Gang Ji, Bin Bai, Deliang Yu, Yezhou Liu, and Bo Lian have no conflicts of interest or financial ties to disclose.

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Li, Z., Ji, G., Bai, B. et al. Laparoscopy-assisted distal gastrectomy versus laparoscopy-assisted total gastrectomy with D2 lymph node dissection for middle-third advanced gastric cancer. Surg Endosc 32, 2255–2262 (2018). https://doi.org/10.1007/s00464-017-5919-9

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  • DOI: https://doi.org/10.1007/s00464-017-5919-9

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