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Surgical Endoscopy

, Volume 23, Issue 8, pp 1759–1763 | Cite as

Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer

  • Joo-Ho Lee
  • Cha-Kyong Yom
  • Ho-Seong Han
Article

Abstract

Backgroud

Application of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) is still controversial because of scant evidence of long-term safety and feasibility. We evaluated the long-term outcome of LADG compared with conventional open distal gastrectomy (ODG) for EGC.

Methods

Between March 1999 and July 2006, 106 patients underwent LADG and 105 patients underwent ODG for EGC. Clinicopathologic characteristics, postoperative outcomes, hospital course, postoperative morbidity, postoperative mortality, and long-term outcomes, including cancer recurrence and survival, were retrospectively compared between the two groups. Survival of all patients was confirmed with 55-month median follow-up.

Results

Postoperative recovery was significantly faster in the LADG group; passing flatus occurred earlier, starting a liquid diet began sooner, and postoperative hospital stay was shorter (p < 0.05). Mean operation time was significantly longer in the LADG group. Postoperative complications in the LADG group occurred less frequently compared with in the ODG group (4.7% versus 13.3%, p = 0.046). Tumor recurrence occurred in two cases (0.9%) and death related to recurrence occurred in only one patient (0.5%). Overall 5-year survival rate (5-YSR) of all patients was 95.5%, while disease-specific 5-YSR was 98.8%. There was no significant difference in survival rates between the two groups; overall 5-YSR of the ODG and LADG groups was 94.9% and 95.9%, respectively.

Conclusions

Our data suggest that LADG for EGC is feasible and safe. We expect the results of the present study to be confirmed by prospective randomized analysis.

Keywords

Early gastric cancer Laparoscopy-assisted distal gastrectomy Long-term outcome 

References

  1. 1.
    Kunisaki C, Shimada H, Nomura M, Akyama H (2001) Appropriate lymph node dissection for early gastric cancer based on lymph node metastasis. Surgery 129:153–157PubMedCrossRefGoogle Scholar
  2. 2.
    Nakamura K, Morisaki T, Sugitani A, Ogawa T, Uchiyama A, Kinukawa N, Tanaka M (1999) An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis. Cancer 85:1500–1505PubMedCrossRefGoogle Scholar
  3. 3.
    Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs. laparoscopy-assisted distal gastrectomy in early gastric cancer. Surg Endosc 19:168–173PubMedCrossRefGoogle Scholar
  4. 4.
    Han HS, Kim YW, Lee NJ, Fleischer GD (2003) Laparoscopy-assisted D2 subtotal gastrectomy in early gastric cancer. Surg Laparosc Endosc Percutan Tech 13:361–365PubMedCrossRefGoogle Scholar
  5. 5.
    Kodama M, Koyama K (1991) Indications for pylorus preserving gastrectomy for early gastric cancer located in the middle third of the stomach. World J Surg 15:628–634PubMedCrossRefGoogle Scholar
  6. 6.
    Nomura E, Isozaki H, Fujii K, Toyoda M, Niki M, Sako S, Mabuchi H, Nishiguchi K, Tanigawa N (2003) Postoperative evaluation of function preserving gastrectomy for early gastric cancer. Hepatogastroenterology 50:2246–2250PubMedGoogle Scholar
  7. 7.
    Kitano S, Shiraishi N, Fuju K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs. laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:306–311CrossRefGoogle Scholar
  8. 8.
    Yom CK, Oh SY, Lee JH (2004) Chronogical changes of surgical strategy for early gastric cancer: our 10 years’ experience. J Korean Surg Soc 66:478–483Google Scholar
  9. 9.
    Fujiwara M, Kodera Y, Misawa K, Kinoshita M, Kinoshita T, Miura S, Ohashi N, Nakayama G, Koike M, Nakao A (2008) Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery. J Am Coll Surg 206:138–143PubMedCrossRefGoogle Scholar
  10. 10.
    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72PubMedCrossRefGoogle Scholar
  11. 11.
    Shehzad K, Mohiuddin K, Nizami S, Sharma H, Khan IM, Memon B, Memon MA (2007) Current status of minimal access surgery for gastric cancer. Surg Oncol 16:85–98PubMedCrossRefGoogle Scholar
  12. 12.
    Hosono S, Arimoto Y, Ohtani H, Kanamiya Y (2006) Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy. World J Gastroenterol 12:7676–7683PubMedGoogle Scholar
  13. 13.
    Tanimura S, Higashino M, Fukunaga Y, Osugi H (2003) Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 17:758–762PubMedCrossRefGoogle Scholar
  14. 14.
    Kim MC, Kim KH, Kim HH, Jung GJ (2005) Comparison of laparoscopy assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 91:90–94PubMedCrossRefGoogle Scholar
  15. 15.
    Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M (2006) Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg 203:162–169PubMedCrossRefGoogle Scholar
  16. 16.
    Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC (2006) Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg 202:874–880PubMedCrossRefGoogle Scholar
  17. 17.
    Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176PubMedCrossRefGoogle Scholar
  18. 18.
    Ibanez Aguirre FJ, Azagra JS, Erro Azcárate ML, Goergen M, Rico Selas P, Moreno Elola-Olaso A, Clemares de Lama M, de Simone P, Echenique Elizondo MM (2006) Laparoscopic gastrectomy for gastric adenocarcinoma. Long-term results. Rev Esp Enferm Dig 98:491–500PubMedGoogle Scholar
  19. 19.
    The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Surgery, Ewha Medical CenterEwha Womans University School of MedicineSeoulRepublic of Korea
  2. 2.Department of Surgery, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Department of Surgery, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea

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