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Feasibility of Laparoscopic Radical Gastrectomy for Gastric Cancer of Clinical Stage II or Higher: Early Outcomes in a Phase II Study (KUGC04)

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

A phase II study was performed to evaluate the safety and efficacy of laparoscopic gastrectomy (LG) for gastric cancer of clinical stage II or higher.

Methods

The eligibility criteria were gastric cancer of clinical stage II or higher that was amenable to potentially curative resection. Patients with prior chemotherapy, tumors requiring total gastrectomy (TG), tumors that invaded adjacent organs, and patients with bulky lymph node metastasis were included. The primary endpoint was incidence of postoperative complications of grade II or higher in the Clavien–Dindo classification. The sample size was determined to be 73, based on an expected rate of complications of 19 % and a threshold of 30 %. Gastrectomy was performed by expert surgeons who were certified by the Japan Society for Endoscopic Surgery.

Results

A total of 73 patients were enrolled; 54 patients (74 %) had clinical T stage T4a/T4b, and 47 patients (64 %) were administered preoperative chemotherapy. The type of surgery was distal gastrectomy in 41 patients and TG in 31 patients. Dissection of D2 or more was performed in 62 patients (85 %). Of the 25 patients who underwent D2/D2+ TG, 15 underwent splenectomy or pancreaticosplenectomy. R0 resection was performed in 64 patients (88 %). The median number of resected lymph nodes was 56, and postoperative complications occurred in 15 patients (20.5 %), which was significantly lower than the threshold value (p = 0.039). One in-hospital death occurred (1.4 %).

Conclusion

LG for gastric cancer of clinical stage II or higher can be safely performed by experienced surgeons.

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References

  1. Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255(3):446–56.

    Article  PubMed  Google Scholar 

  2. Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R. Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc. 2013;27(5):1509–20.

    Article  PubMed  Google Scholar 

  3. Lee JH, Kim JG, Jung HK, et al. Clinical practice guidelines for gastric cancer in Korea: an evidence-based approach. J Gastric Cancer 2014;14(2):87–104.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yoshimura F, Inaba K, Kawamura Y, et al. Clinical outcome and clinicopathological characteristics of recurrence after laparoscopic gastrectomy for advanced gastric cancer. Digestion 2011;83(3):184–90.

    Article  PubMed  Google Scholar 

  5. Lee J, Kim W. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol. 2009;100(8):693–8.

    Article  PubMed  Google Scholar 

  6. Kim HI, Hur H, Kim YN, et al. Standardization of D2 lymphadenectomy and surgical quality control (KLASS-02-QC): a prospective, observational, multicenter study [NCT01283893]. BMC Cancer 2014;14:209.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hu Y, Huang C, Sun Y, et al. Laparoscopic D2 subtotal gastrectomy versus conventional open surgery for advanced gastric cancer: the safety analysis from a multicenter prospective randomized controlled trial in China (CLASS-01 trial). J Clin Oncol. 2015;33(Suppl 3):abstr 122.

  8. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 2nd English edition. Gastric Cancer 1998;1(1):10–24.

    Article  PubMed  Google Scholar 

  9. Yasuda K, Shiraishi N, Inomata M, Shiroshita H, Izumi K, Kitano S. Prognostic significance of macroscopic serosal invasion in advanced gastric cancer. Hepatogastroenterology 2007;54(79):2028–31.

    PubMed  Google Scholar 

  10. Suk D, Joo JE. Growth patterns of stomach cancer in relation to biological characteristics. Yonsei Med J. 1986;27(4):292–9.

    Article  CAS  PubMed  Google Scholar 

  11. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 3rd English edition. Gastric Cancer 2011;14(2):101–12.

    Article  Google Scholar 

  12. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  13. Obama K, Okabe H, Hosogi H, Tanaka E, Itami A, Sakai Y. Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: from a viewpoint of pancreas-related complications. Surgery 2011;149(1):15–21.

    Article  PubMed  Google Scholar 

  14. Okabe H, Obama K, Kan T, Tanaka E, Itami A, Sakai Y. Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg. 2010;211(1):e1–6.

    Article  PubMed  Google Scholar 

  15. Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y. Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg. 2014;259(1):109–16.

    Article  PubMed  Google Scholar 

  16. Gunji S, Okabe H, Obama K, Sakai Y. Aortoenteric fistula at the site of esophagojejunostomy after laparoscopic total gastrectomy: report of a case. Surg Today 2014;44(11):2162–6.

    Article  PubMed  Google Scholar 

  17. An JY, Kim KM, Kim YM, Cheong JH, Hyung WJ, Noh SH. Surgical complications in gastric cancer patients preoperatively treated with chemotherapy: their risk factors and clinical relevance. Ann Surg Oncol. 2012;19(8):2452–8.

    Article  PubMed  Google Scholar 

  18. Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011;253(5):900–11.

    Article  PubMed  Google Scholar 

  19. Katai H, Sasako M, Sano T, Maruyama K. The outcome of surgical treatment for gastric carcinoma in the elderly. Jpn J Clin Oncol. 1998;28(2):112–5.

    Article  CAS  PubMed  Google Scholar 

  20. Kodera Y, Sasako M, Yamamoto S, et al. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg. 2005;92(9):1103–9.

    Article  CAS  PubMed  Google Scholar 

  21. Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, Uyama I. Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg. 2009;144(12):1138–42.

    Article  PubMed  Google Scholar 

  22. Lee JH, Ahn SH, Park DJ, Kim HH, Lee HJ, Yang HK. Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg. 2012;36(10):2394–9.

    Article  PubMed  Google Scholar 

  23. Nakata K, Nagai E, Ohuchida K, Shimizu S, Tanaka M. Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes. Surg Endosc. 2015;29(7):1817–22.

    Article  PubMed  Google Scholar 

  24. Woo JW, Ryu KW, Park JY, et al. Prognostic impact of microscopic tumor involved resection margin in advanced gastric cancer patients after gastric resection. World J Surg. 2014;38(2):439–46.

    Article  PubMed  Google Scholar 

  25. Nagata T, Ichikawa D, Komatsu S, et al. Prognostic impact of microscopic positive margin in gastric cancer patients. J Surg Oncol. 2011;104(6):592–7.

    Article  PubMed  Google Scholar 

  26. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy. Japan Clinical Oncology Group Study 9501. J Clin Oncol. 2004;22(14):2767–73.

    Article  PubMed  Google Scholar 

  27. Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol. 2006;7(8):644–51.

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors thank Yuriko Hayashi for data collection and management. This work was supported by operating support Grants from Kyoto University.

Disclosures

Hiroshi Okabe, Shigeru Tsunoda, Kazutaka Obama, Eiji Tanaka, Shigeo Hisamori, Hisashi Shinohara, and Yoshiharu Sakai have declared no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Hiroshi Okabe MD, PhD, Shigeru Tsunoda MD, PhD, Kazutaka Obama MD, PhD, Eiji Tanaka MD, PhD, Shigeo Hisamori MD, PhD, Hisashi Shinohara MD, PhD & Yoshiharu Sakai MD, PhD

  2. Department of Surgery, Otsu Municipal Hospital, Otsu, Japan

    Hiroshi Okabe MD, PhD

  3. Department of Surgery, Kyoto City Hospital, Kyoto, Japan

    Kazutaka Obama MD, PhD

  4. Department of Surgery, Kobe City Medical Center, West Hospital, Kobe, Japan

    Eiji Tanaka MD, PhD

Authors
  1. Hiroshi Okabe MD, PhD
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  2. Shigeru Tsunoda MD, PhD
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  3. Kazutaka Obama MD, PhD
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  4. Eiji Tanaka MD, PhD
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  5. Shigeo Hisamori MD, PhD
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  6. Hisashi Shinohara MD, PhD
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  7. Yoshiharu Sakai MD, PhD
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Corresponding author

Correspondence to Hiroshi Okabe MD, PhD.

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Supplementary material 1 (TIFF 2391 kb)

Supplementary material 2 (DOCX 12 kb)

Supplemental Fig. 1. Laparoscopic views following lymph node dissection. a D2 distal gastrectomy. The proximal half of the splenic vessels was exposed. b Spleen-preserving D2 total gastrectomy. #10 and #11 lymph nodes were removed while the spleen and splenic branches were preserved. c D2 total gastrectomy with splenectomy. The pancreas and splenic vessels were preserved while #10 lymph nodes were removed with the spleen. d In cases of tumors invading the distal pancreas, the splenic artery was ligated at its root and pancreaticosplenectomy was performed. SPA splenic artery, SPV splenic vein, LGA left gastric artery

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Okabe, H., Tsunoda, S., Obama, K. et al. Feasibility of Laparoscopic Radical Gastrectomy for Gastric Cancer of Clinical Stage II or Higher: Early Outcomes in a Phase II Study (KUGC04). Ann Surg Oncol 23 (Suppl 4), 516–523 (2016). https://doi.org/10.1245/s10434-016-5383-0

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  • DOI: https://doi.org/10.1245/s10434-016-5383-0

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