Advertisement

Surgical Endoscopy

, Volume 26, Issue 6, pp 1548–1553 | Cite as

Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study

  • Do Joong Park
  • Sang-Uk Han
  • Woo Jin Hyung
  • Min Chan Kim
  • Wook Kim
  • Seong Yeob Ryu
  • Seung-Wan Ryu
  • Kyo Young Song
  • Hyuk-Joon Lee
  • Gyu-Seok Cho
  • Hyung-Ho Kim
  • Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group
Article

Abstract

Background

Recently, the number of laparoscopic procedures for gastric cancer has increased rapidly. Laparoscopic surgery is reported to have many advantages over open gastrectomy with oncologic safety in early gastric cancer. However, there were few reports on long-term outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC). The aim of this study was to investigate long-term survival outcomes after LAG for AGC.

Methods

The data of 1,485 patients who underwent LAG between April 1998 and December 2005 by ten surgeons at ten hospitals were collected retrospectively. Among them, 239 patients who were diagnosed with AGC on final pathologic examination were enrolled in the present study to investigate long-term clinical outcomes.

Results

The ratio of male to female patients was 151:88 and the mean age was 57.1 years. One hundred ninety-three subtotal gastrectomies, 41 total gastrectomies, and 5 proximal gastrectomies were performed. D1 + α, D1 + β, and D2 lymph node dissections were performed for 14, 62, and 163 cases, respectively. The median follow-up period was 55.4 months. The overall 5-year survival rate of the 239 AGC patients was 78.8% and the disease-specific 5-year survival rate was 85.6%. The 5-year survival rates of the TNM staging system’s (7th ed.) stages were 90.5% (stage Ib, n = 86), 86.4% (stage IIa, n = 53), 78.3% (stage IIb, n = 44), 52.8% (stage IIIa, n = 24), 52.9% (stage IIIb, n = 24), and 37.5% (stage IIIc, n = 8) (p < 0.001).

Conclusion

The long-term survival outcome rates of LAG for AGC in the present study were comparable to those previously reported for open gastrectomy. Based on the present results, a well-designed phase III trial comparing LAG and open gastrectomy for AGC will be needed to affirm the validity of LAG for AGC.

Keywords

Laparoscopy-assisted gastrectomy Advanced gastric cancer Long-term survival 

Notes

Acknowledgment

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (grant No. 0520310).

Disclosure

Drs. Do Joong Park, Sang-Uk Han, Woo Jin Hyung, Min Chan Kim, Wook Kim, Seong Yeob Ryu, Seung-Wan Ryu, Kyo Young Song, Hyuk-Joon Lee, Gyu-Seok Cho, and Hyung-Ho Kim have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  2. 2.
    Kim HH, Kim KH, Kim DH, Korean Laparoscopic Gastrointestinal Surgery Study Group (2005) Nationwide survey of laparoscopic gastric surgery in Korea, 2004. J Korean Gastric Cancer Assoc 5:295–303Google 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: early results. Surg Endosc 19:168–173PubMedCrossRefGoogle Scholar
  4. 4.
    Kitano S, Shiraishi N, Fujii 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:S306–S311PubMedCrossRefGoogle Scholar
  5. 5.
    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
  6. 6.
    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
  7. 7.
    Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727PubMedCrossRefGoogle Scholar
  8. 8.
    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
  9. 9.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237PubMedCrossRefGoogle Scholar
  10. 10.
    Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH (2009) Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23:1252–1258PubMedCrossRefGoogle Scholar
  11. 11.
    Lee J, Kim W (2009) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol 100:693–698PubMedCrossRefGoogle Scholar
  12. 12.
    Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  13. 13.
    Hwang SH, Park J, Jee YS, Kim MC, Kim HH, Lee HJ, Yang HK, Lee KU (2009) Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. Arch Surg 144:559–564PubMedCrossRefGoogle Scholar
  14. 14.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd english Edition. Gastric Cancer 1:10–24PubMedCrossRefGoogle Scholar
  15. 15.
    Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5:1–5PubMedCrossRefGoogle Scholar
  16. 16.
    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
  17. 17.
    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420PubMedCrossRefGoogle Scholar
  18. 18.
    Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ (2005) Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 92:1099–1102PubMedCrossRefGoogle Scholar
  19. 19.
    Lee SW, Nomura E, Bouras G, Tokuhara T, Tsunemi S, Tanigawa N (2010) Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. J Am Coll Surg 211:33–40PubMedCrossRefGoogle Scholar
  20. 20.
    Moriguchi S, Maehara Y, Korenaga D, Sugimachi K, Nose Y (1992) Risk factors which predict pattern of recurrence after curative surgery for patients with advanced gastric cancer. Surg Oncol 1:341–346PubMedCrossRefGoogle Scholar
  21. 21.
    Park CH, Song KY, Kim SN (2008) Treatment results for gastric cancer surgery: 12 years’ experience at a single institute in Korea. Eur J Surg Oncol 34:36–41PubMedCrossRefGoogle Scholar
  22. 22.
    Yoo CH, Noh SH, Shin DW, Choi SH, Min JS (2000) Recurrence following curative resection for gastric carcinoma. Br J Surg 87:236–242PubMedCrossRefGoogle Scholar
  23. 23.
    Ahn HS, Lee HJ, Hahn S, Kim WH, Lee KU, Sano T, Edge SB, Yang HK (2010) Evaluation of the Seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer 116:5592–5598PubMedCrossRefGoogle Scholar
  24. 24.
    Saito H, Osaki T, Murakami D, Sakamoto T, Kanaji S, Tatebe S, Tsujitani S, Ikeguchi M (2006) Effect of age on prognosis in patients with gastric cancer. ANZ J Surg 76:458–461PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Do Joong Park
    • 1
  • Sang-Uk Han
    • 2
  • Woo Jin Hyung
    • 3
  • Min Chan Kim
    • 4
  • Wook Kim
    • 5
  • Seong Yeob Ryu
    • 6
  • Seung-Wan Ryu
    • 7
  • Kyo Young Song
    • 8
  • Hyuk-Joon Lee
    • 9
  • Gyu-Seok Cho
    • 10
  • Hyung-Ho Kim
    • 1
    • 9
  • Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group
  1. 1.Department of Surgery, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnam-siKorea
  2. 2.Department of SurgeryAjou University College of MedicineSuwonKorea
  3. 3.Department of SurgeryYonsei University College of MedicineSeoulKorea
  4. 4.Department of SurgeryDong-A University College of MedicineBusanKorea
  5. 5.Department of Surgery, Holy Family HospitalCatholic University of KoreaBucheonKorea
  6. 6.Department of SurgeryChonnam National University School of MedicineGwangjuKorea
  7. 7.Department of SurgeryKeimyung University School of MedicineDaeguKorea
  8. 8.Department of Surgery, Kangnam St. Mary’s HospitalCatholic University of KoreaSeoulKorea
  9. 9.Department of SurgerySeoul National University College of MedicineSeoulKorea
  10. 10.Department of SurgerySoonchunhyang University College of MedicineSeoulKorea

Personalised recommendations