Total and subtotal laparoscopic gastrectomy for adenocarcinoma
- First Online:
Laparoscopic gastrectomies are currently performed in many centers, but compliance with oncologic requirements still represents a subject open to debate. The aim of this work was to compare the short-term and oncologic outcomes after laparoscopic and open surgery in gastric adenocarcinoma.
From June 2000 through June 2005, 147 patients in our institution underwent gastrectomy by open or mininvasive approach for adenocarcinoma. The laparoscopy group included 48 patients, 29 with early gastric cancer (EGC) and 19 with antral advanced gastric cancer (AGC). The short-term results and oncologic data were compared to those obtained in 99 patients who underwent open surgery. Survival in the laparoscopy group was analyzed.
In the laparoscopy group no intraoperative complications were observed, and conversion was needed in only one patient with a large advanced tumor. Overall, 32 lymph nodes were collected by D2 dissection, 30 for EGC, 34 for advanced cancers. The resection margin was 6.7 cm (range: 4–8 cm). The mean operating time was 240 min (range: 150–360 min), with a blood loss of 150 ml on average (range: 70–250 ml). Morbidity included two duodenal leaks that healed without reoperation; after enclosing or reinforcing the staple line, no further leaking was noted. There was one death from massive bleeding in a cirrhotic patient. Ambulation and oral feeding started significantly earlier than in open surgery. The mean hospital stay was 10 days (range: 7–24 days), significantly shorter than the stay of 18 days after open surgery (p < 0.05). All patients treated laparoscopically were alive without recurrence at the end of this study.
Short-term results with laparoscopic gastrectomy were better than with open surgery in this study. Oncologic radicality was a major concern, but in the authors’ experience the extent of lymphadenectomy was the same as in open surgery. This study suggests that laparoscopic gastrectomy in malignancies is a reliable tool and oncologic requirements can be warranted.
KeywordsEarly gastric cancer Gastrectomy Laparoscopy Lymphadenectomy
- 6.Azagra J, Goergen M, Gilbart E, Alonso J, Ceuterick M (2001) Laparoscopy-assisted total gastrectomy with extended D2 lymphadenectomy for cancer: technical aspects. Le Jour Coelio-chir 40: 79–83Google Scholar
- 14.Hartgrink HH, van de Velde CJH, Putter H, Bonekamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, van Krieken JHJM, Meijer S, Plukker JTM, van Elk PJ, Obertop H, Gouma DJ, van Lanschot JJB, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H, Sasako M (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final Results of the Randomized Dutch Gastric Cancer Group Trial. J Clin Oncol 22: 2069–2077PubMedCrossRefGoogle Scholar
- 20.Japanese Classification of Gastric Carcinoma. 2nd English edition (1998) Gastric Cancer 1: 10–24Google Scholar
- 25.McCulloch P, Nita ME, Kazi H, Gama-Rodrigues J (2004) Extended versus limited lymph node dissection technique for adenocarcinoma of the stomach (Cochrane Review). In The Cochrane Library , Issue 1. Chichester, UK: John Wiley & Sons, LtdGoogle Scholar