Advertisement

Surgical Endoscopy

, Volume 26, Issue 6, pp 1702–1709 | Cite as

Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer

  • Atsushi Hamabe
  • Takeshi Omori
  • Koji Tanaka
  • Toshirou Nishida
Article

Abstract

Background

Laparoscopy-assisted gastrectomy (LAG) has been established as a low-invasive surgery for early gastric cancer. However, it remains unknown whether it is applicable also for advanced gastric cancer, mainly because the long-term results of LAG with D2 lymph node dissection for advanced gastric cancer have not been well validated compared with open gastrectomy (OG).

Methods

A retrospective cohort study was performed to compare LAG and OG with D2 lymph node dissection. For this study, 167 patients (66 LAG and 101 OG patients) who underwent gastrectomy with D2 lymph node dissection for advanced gastric cancer were reviewed. Recurrence-free survival and overall survival time were estimated using Kaplan–Meier curves. Stratified log-rank statistical evaluation was used to compare the difference between the LAG and OG groups stratified by histologic type, pathologic T status, N status, and postoperative adjuvant chemotherapy. The adjusted Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of LAG.

Results

The 5-year recurrence-free survival rate was 89.6% in the LAG group and 75.8% in the OG group (nonsignificant difference; stratified log-rank statistic, 3.11; P = 0.0777). The adjusted HR of recurrence for LAG compared with OG was 0.389 [95% confidence interval (CI) 0.131–1.151]. The 5-year overall survival rate was 94.4% in the LAG group and 78.5% in the OG group (nonsignificant difference; stratified log-rank statistic, 0.4817; P = 0.4877). The adjusted HR of death for LAG compared with OG was 0.633 (95% CI 0.172–2.325).

Conclusions

The findings show that LAG with D2 lymph node dissection is acceptable in terms of long-term results for advanced gastric cancer cases and may be applicable for advanced gastric cancer treatment.

Keywords

Gastrectomy Gastric cancer Laparoscopic surgery Lymph node excision 

Notes

Acknowledgment

We thank Toshimitsu Hamasaki, Associate Professor in the Department of Biomedical Statistics at Osaka University Graduate School of Medicine, who gave statistical advice for this article.

Disclosures

Toshirou Nishida has a grant from the Novartis Pharma K. K. for basic research investigating gastrointestinal stromal tumor (GIST). Atsushi Hamabe, Takeshi Omori, and Koji Tanaka 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.
    Tokunaga M, Hiki N, Fukunaga T, Nohara K, Katayama H, Akashi Y, Ohyama S, Yamaguchi T (2009) Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection following standardization: a preliminary study. J Gastrointest Surg 13:1058–1063PubMedCrossRefGoogle Scholar
  3. 3.
    Kawamura H, Homma S, Yokota R, Yokota K, Watarai H, Hagiwara M, Sato M, Noguchi K, Ueki S, Kondo Y (2008) Inspection of safety and accuracy of D2 lymph node dissection in laparoscopy-assisted distal gastrectomy. World J Surg 32:2366–2370PubMedCrossRefGoogle Scholar
  4. 4.
    Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 194:839–844PubMedCrossRefGoogle Scholar
  5. 5.
    Ziqiang W, Feng Q, Zhimin C, Miao W, Lian Q, Huaxing L, Peiwu Y (2006) Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management. Surg Endosc 20:1738–1743PubMedCrossRefGoogle Scholar
  6. 6.
    Weber KJ, Reyes CD, Gagner M, Divino CM (2003) Comparison of laparoscopic and open gastrectomy for malignant disease. Surg Endosc 17:968–971PubMedCrossRefGoogle Scholar
  7. 7.
    Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open versus laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:306–311CrossRefGoogle Scholar
  8. 8.
    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
  9. 9.
    Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K, JCOG Gastric Cancer Surgical Study Group (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–240PubMedCrossRefGoogle Scholar
  10. 10.
    Hur H, Jeon HM, Kim W (2008) Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years’ experience. J Surg Oncol 98:515–519PubMedCrossRefGoogle Scholar
  11. 11.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1:10–24PubMedCrossRefGoogle Scholar
  12. 12.
    Omori T, Nakajima K, Nishida T, Uchikoshi F, Kitagawa T, Ito T, Matsuda H (2005) A simple technique for circular-stapled Billroth I reconstruction in laparoscopic gastrectomy. Surg Endosc 19:734–736PubMedCrossRefGoogle Scholar
  13. 13.
    Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nakahara M, Toshirou N (2009) A simple and safe method for gastrojejunostomy in laparoscopic distal gastrectomy using the hemidouble-stapling technique: efficient purse-string stapling technique. Dig Surg 26:441–445PubMedCrossRefGoogle Scholar
  14. 14.
    Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, Nakahara M, Nishida T (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197:13–17CrossRefGoogle Scholar
  15. 15.
    Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Okajima K (1995) Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg 19:532–536PubMedCrossRefGoogle Scholar
  16. 16.
    Sano T, Yamamoto S, Sasako M (2002) Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma: Japan clinical oncology group study JCOG 0110-MF. Jpn J Clin Oncol 32:363–364PubMedCrossRefGoogle Scholar
  17. 17.
    Dulucq JL, Wintringer P, Stabilini C, Solinas L, Perissat J, Mahajna A (2005) Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study. Surg Endosc 19:933–938PubMedCrossRefGoogle Scholar
  18. 18.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Paola MD, 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
  19. 19.
    Lee JH, Yom CK, Han HS (2009) Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 23:1759–1763PubMedCrossRefGoogle Scholar
  20. 20.
    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72PubMedCrossRefGoogle Scholar
  21. 21.
    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
  22. 22.
    Saka M, Morita S, Fukagawa T, Katai H (2011) Present and future status of gastric cancer surgery. Jpn J Clin Oncol 41:307–313PubMedCrossRefGoogle Scholar
  23. 23.
    Kong SH, Yoo MW, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK (2010) Validation of limited lymphadenectomy for lower-third gastric cancer based on depth of tumour invasion. Br J Surg 98:65–72PubMedCrossRefGoogle Scholar
  24. 24.
    Tanizawa Y, Terashima M (2010) Lymph node dissection in the resection of gastric cancer: review of existing evidence. Gastric Cancer 13:137–148PubMedCrossRefGoogle Scholar
  25. 25.
    Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hasumi A (2000) Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach. Gastric Cancer 3:50–55PubMedCrossRefGoogle Scholar
  26. 26.
    Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, Osugi H (2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22:1161–1164PubMedCrossRefGoogle Scholar
  27. 27.
    Japan Gastric Cancer Association (2004) Guidelines for diagnosis and treatment of carcinoma of the stomach (2nd English edn). Retrieved 30 April 2011 at http://www.jgca.jp
  28. 28.
    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
  29. 29.
    Papp A, Vereczkei, Lantos J, Horváth OP (2003) The effect of different levels of peritoneal CO2 pressure on bleeding time of spleen capsule injury. Surg Endosc 17:1125–1128PubMedCrossRefGoogle Scholar
  30. 30.
    Song KY, Kim SN, Park CH (2008) Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 22:655–659PubMedCrossRefGoogle Scholar
  31. 31.
    Lee J, Kim W (2009) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol 15:693–698CrossRefGoogle Scholar
  32. 32.
    Pugliese R, Maggioni D, Sansonna F, Costanzi A, Ferrari GC, Di Lernia S, Magistro C, De Martini P, Pugliese F (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surg Endosc 24:2594–2602PubMedCrossRefGoogle Scholar
  33. 33.
    Song J, Lee HJ, Cho GS, Han SU, Kim MC, Ryu SW, Kim W, Song KY, Kim HH, Hyung WJ, Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group (2010) Recurrence following laparoscopy-assisted gastrectomy for gastric cancer: a multicenter retrospective analysis of 1, 417 patients. Ann Surg Oncol 17:1777–1786PubMedCrossRefGoogle Scholar
  34. 34.
    Hwang SH, Park do 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
  35. 35.
    Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Atsushi Hamabe
    • 1
  • Takeshi Omori
    • 1
  • Koji Tanaka
    • 1
  • Toshirou Nishida
    • 1
  1. 1.Department of SurgeryOsaka Police HospitalTennoji-kuJapan

Personalised recommendations