Morbidity and mortality after laparoscopic gastrectomy for advanced gastric cancer: results of a phase II clinical trial
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Very few reports are available on laparoscopic gastrectomy (LG) for advanced gastric cancer (AGC) patients. We therefore conducted a prospective phase II clinical trial to address the feasibility of LG in AGC. Morbidity and mortality were evaluated.
The eligibility criteria were as follows: 20–80 years of age, cT2N0–cT4aN2, American Society of Anesthesiologists score of 3 or less, and no other malignancy. A total of 204 patients were enrolled onto this study. Of these, 16 were excluded because far-advanced stages of disease were identified after laparoscopic exploration, and 31 were excluded because early gastric cancer was diagnosed postoperatively. All patients underwent a D2 lymphadenectomy. Morbidity was stratified according to the Clavien–Dindo classification.
Conversion to open surgery occurred in 11 patients (7.0 %). The mean hospital stay was 6.3 days for distal gastrectomy and 8.5 days for total gastrectomy. The mean number of collected lymph nodes was 52.7 for distal gastrectomy and 63.8 for total gastrectomy. The rates of local and systemic complications of grade II or more were 8.3 and 3.2 %. One patient died of operative complications. In multivariate analysis, old age (>70 years) was an independent risk factor for complications, and old age and Billroth I anastomosis were predictable risk factors for local complications.
LG with D2 lymphadenectomy was safe and technically feasible for the treatment of AGC, with acceptable rate of morbidity and mortality. ClinicalTrial.gov Registration: NCT01441336.
KeywordsAdvanced gastric cancer Laparoscopic gastrectomy Morbidity Short-term outcomes
Ju-Hee Lee, Sang-Yong Son, Chang Min Lee, Sang Hoon Ahn, Do Joong Park, and Hyung-Ho Kim have no conflicts of interest or financial ties to disclose.
- 1.Hosono S, Arimoto Y, Ohtani H, Kanamiya Y (2006) Meta-analysis of short term outcomes after laparoscopic-assisted distal gastrectomy. World J Gastroenterol 12:7677–7683Google Scholar
- 5.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(3):417–420PubMedCrossRefGoogle Scholar
- 9.Kim KH, Kim MC, Jung GJ, Choi HJ, Jang JS, Kwon HC (2012) Comparative analysis of five-year survival results of laparoscopy-assisted gastrectomy versus open gastrectomy for advanced gastric cancer: a case-control study using a propensity score method. Dig Surg 29(2):165–171PubMedCrossRefGoogle Scholar
- 12.Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Lee HJ, Cho GS, Han SU, Hyung WJ, Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean multicenter study. Ann Surg Oncol 15(10):2692–2700PubMedCrossRefGoogle Scholar
- 14.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, Group ACTS-GC (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357(18):1810–1820PubMedCrossRefGoogle Scholar
- 18.Park do J, Han SU, Hyung WJ, Kim MC, Kim W, Ryu SY, Ryu SW, Song KY, Lee HJ, Cho GS, Kim HH, Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group (2012) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc 26(6):1548–1553PubMedCrossRefGoogle Scholar
- 21.Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A, Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group (2005) Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 92:1103–1109PubMedCrossRefGoogle Scholar
- 24.Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Park SR, Kim MJ, Lee JS (2009) Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 100(5):392–395PubMedCrossRefGoogle Scholar
- 26.Noh SY, Lee JH, Ahn SH, Son SY, Lee CM, Park DJ, Kim HH, Lee HJ, Yang HK (2012) Intracorporeal end-to-side esophagojejunostomy using a laparoscopic purse-string clamp during laparoscopic total gastrectomy. J Korean Soc Endosc Laparosc Surg 15(2):32–37Google Scholar