Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection
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Laparoscopic gastrectomy has gained acceptance as treatment for early gastric cancer. However, its role for advanced gastric cancer remains unclear. This study aimed to compare the oncologic outcomes between laparoscopic and open gastrectomy in the management of advanced gastric cancer for patients receiving adjuvant chemoradiotherapy.
This study reviewed consecutive patients treated with gastric cancer resection and adjuvant chemoradiation (45 Gy/25 with 5-fluorouracil [FU]-based chemotherapy), at a quaternary care comprehensive cancer center between 1 Jan 2000 and 30 Nov 2009. Of 203 patients, 21 were treated with laparoscopic gastrectomy. These patients were compared with patients who had open surgery and evaluated for overall survival, relapse-free survival, and site of first disease recurrence.
The 21 patients in the laparoscopic group had a median age of 61.3 years (range, 28.2–76.6 years) and a median follow-up period of 21.3 months (range, 6.7–50.4 months). The majority of the patients (71%) were men. Most of these patients had tumor node metastasis (TNM) v6 stage 2 (33%) or 3 (52%) disease as classified by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). The demographic characteristics of the laparoscopic and open groups were similar. The incidence of recurrence was 38.1% (8/21) in the laparoscopic group and 36.8% (67/182) in the open group. In the laparoscopic group, the site of first recurrence was distant in three patients, peritoneal in four patients, and mixed in one patient (locoregional and distant). The recurrence patterns did not differ significantly between the laparoscopic and open surgery groups. In the open group, recurrence was distant in 26 patients, peritoneal in 12 patients, and locoregional in 15 patients. At presentation, 14 patients showed a mixed pattern. The 3-year relapse-free survival rate was 58% (range, 50–66%), and the difference between the two groups by Gray’s test was not significant (P = 0.32). The 3-year overall survival rate was 65.9% (range, 58–73%) and did not differ significantly between the two groups in the univariate (P = 0.92) or multivariate (P = 0.54) analysis.
The study findings suggest that laparoscopic gastrectomy is an oncologically safe procedure for advanced gastric cancer with outcomes similar to those for open resection.
KeywordsAdjuvant chemoradiotherapy Advanced gastric cancer Laparoscopic gastrectomy Recurrence pattern
S. J. MacLellan, H. J. MacKay, J. Ringash, L. Jacks, Z. Kassam Z, T. Conrad, I. Khalili, and A. Okrainec have no conflicts of interest or financial ties to disclose.
- 11.Korean Laparoscopic Gastrointestinal Surgery Study Group (2005) Nationwide survey of laparoscopic gastric surgery in Korea, 2004. J Korean Gastric Cancer Assoc 5:9Google Scholar
- 13.Rosin D, Brasesco O, Rosenthal RJ (2001) Laparoscopy for gastric tumors. Surg Oncol Clin North Am 10:511–529Google Scholar
- 14.Miura S, Kodera Y, Fujiwara M, Ito S, Mochizuki Y, Yamamura Y, Hibi K, Ito K, Akiyama S, Nakao A (2004) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. J Am Coll Surg 198:933–938PubMedCrossRefGoogle Scholar
- 17.Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725–830PubMedCrossRefGoogle Scholar
- 25.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
- 34.Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, Meyer S, Plukker JT, Van Elk P, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H (1999) Extended lymph node dissection for gastric cancer. N Engl J Med 340:908–914PubMedCrossRefGoogle Scholar
- 43.Rohatgi PR, Yao JC, Hess K, Schnirer I, Rashid A, Mansfield PF, Pisters PW, Ajani JA (2006) Outcome of gastric cancer patients after successful gastrectomy. Cancer 107:2280–2576Google Scholar
- 49.Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, Smith DB, Langley RE, Verma M, Weeden S, Chua YJ (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20PubMedCrossRefGoogle Scholar