Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study
- 1.1k Downloads
The oncologic safety and feasibility of laparoscopic D2 gastrectomy for advanced gastric cancer are still uncertain. The aim of this study is to compare our results for laparoscopic D2 gastrectomy with those for open D2 gastrectomy.
Between 1998 and 2008, a total of 336 patients with clinical T2, T3, or T4 tumors underwent laparoscopic (n = 186) or open (n = 150) gastrectomy involving D2 lymph node dissection with curative intent. To produce this study population, 123 patients in the open group who matched those of the laparoscopic group with regard to age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, tumor location, and clinical tumor stage were retrospectively selected. The short- and long-term outcomes of these patients were examined.
Laparoscopic D2 gastrectomy was associated with significantly less operative blood loss and shorter hospital stay, but longer operative time, compared with open D2 gastrectomy. The mortality and morbidity rates of the laparoscopic group were comparable to those of the open group (1.1 % vs. 0, P = 0.519, and 24.2 % vs. 28.5 %, P = 0.402). The 5-year disease-free and overall survival rates were 65.8 and 68.1 % in the laparoscopic group and 62.0 and 63.7 % in the open group (P = 0.737 and P = 0.968). There were no differences in the patterns of recurrence between the two groups.
This study suggests that laparoscopic D2 gastrectomy provides reasonable oncologic outcomes with acceptable morbidity and low mortality rates. Although operation time is currently long, this approach is associated with several advantages of laparoscopic surgery, including quick recovery of bowel function and short hospital stay. Laparoscopic D2 gastrectomy may offer a favorable alternative to open D2 gastrectomy for patients with advanced gastric cancer.
KeywordsLaparoscopic gastrectomy Stomach neoplasm D2 dissection Mortality and morbidity Outcome
Drs Shinohara, Satoh, Kanaya, Ishida, Taniguchi, Isogaki, Inaba, Yanaga, and Uyama have no competing interests and financial disclosures.
- 2.Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T, Japan cancer surveillance research group (2009) Cancer incidence and incidence rates in Japan in 2005: based on data from 12 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) Project. Jpn J Clin Oncol 39:850–858PubMedCrossRefGoogle Scholar
- 19.Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Soga R, Wakayama A, Okamoto K, Ohyama A, Hasumi A (1999) Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer 2:186–190PubMedCrossRefGoogle Scholar
- 22.Sobin LH, Wittekind CH (2002) TNM classification of malignant tumors, 6th edn. Springer, HeidelbergGoogle Scholar
- 27.Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K (2004) Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol 22:2767–2773PubMedCrossRefGoogle Scholar
- 30.Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW, van Lanschot, Meyer J, de Graaf S, von Meyenfeldt MF, Tilanus H, van de Velde CJH (1995) Randomised comparison of mortality after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748PubMedCrossRefGoogle Scholar
- 42.Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, Guillou PJ, Thorpe H, Brown J, Delgado S, Kuhrij E, Hanglind E, Påhlman L, Transatlantic Laparoscopically Assisted vs Open Coloectomy Trials Study Group (2007) Laparoscopically assisted vs open colectomy for colon cancer. Arch Surg 142:298–303PubMedCrossRefGoogle Scholar