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Surgical Endoscopy

, Volume 27, Issue 8, pp 2877–2885 | Cite as

Morbidity and mortality after laparoscopic gastrectomy for advanced gastric cancer: results of a phase II clinical trial

  • Ju-Hee Lee
  • Sang-Yong Son
  • Chang Min Lee
  • Sang Hoon Ahn
  • Do Joong Park
  • Hyung-Ho KimEmail author
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Advanced gastric cancer Laparoscopic gastrectomy Morbidity Short-term outcomes 

Notes

Disclosures

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.

References

  1. 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
  2. 2.
    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
  3. 3.
    Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135:806–810PubMedCrossRefGoogle Scholar
  4. 4.
    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(5):721–727PubMedCrossRefGoogle Scholar
  5. 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
  6. 6.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver 3). Gastric Cancer 14:113–123CrossRefGoogle Scholar
  7. 7.
    Hamabe A, Omori T, Tanaka K, Nishida T (2012) Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc 26(6):1702–1799PubMedCrossRefGoogle Scholar
  8. 8.
    Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27(1):286–294PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Uyama I, Sakurai Y, Komori Y, Nakamura Y, Syoji M, Tonomura S, Yoshida I, Masui T, Inaba K, Ochiai M (2005) Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer. Gastric Cancer 8(4):253–257PubMedCrossRefGoogle Scholar
  11. 11.
    Lee JH, Ahn SH, Park do J, Kim HH, Lee HJ, Yang HK (2012) Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg 36(10):2394–2399PubMedCrossRefGoogle Scholar
  12. 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
  13. 13.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  14. 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
  15. 15.
    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(7):515–519PubMedCrossRefGoogle Scholar
  16. 16.
    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(6):1252–1258PubMedCrossRefGoogle Scholar
  17. 17.
    Yoshimura F, Inaba K, Kawamura Y, Ishida Y, Taniguchi K, Isogaki J, Satoh S, Kanaya S, Sakurai Y, Uyama I (2011) Clinical outcome and clinicopathological characteristics of recurrence after laparoscopic gastrectomy for advanced gastric cancer. Digestion 83(3):184–190PubMedCrossRefGoogle Scholar
  18. 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
  19. 19.
    Cai J, Wei D, Gao CF, Zhang CS, Zhang H, Zhao T (2011) A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig Surg 28:331–337PubMedCrossRefGoogle Scholar
  20. 20.
    Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11(5):439–449PubMedCrossRefGoogle Scholar
  21. 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
  22. 22.
    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
  23. 23.
    Lee JH, Park do J, Kim HH, Lee HJ, Yang HK (2012) Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien–Dindo classification. Surg Endosc 26(5):1287–1295PubMedCrossRefGoogle Scholar
  24. 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
  25. 25.
    Jeong GA, Cho GS, Kim HH, Lee HJ, Ryu SW, Song KY (2009) Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery 146(3):469–474PubMedCrossRefGoogle Scholar
  26. 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
  27. 27.
    Cho GS, Kim W, Kim HH, Ryu SW, Kim MC, Ryu SY (2009) Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly. Br J Surg 96(12):1437–1442PubMedCrossRefGoogle Scholar
  28. 28.
    Hwang SH, Park do J, Jee YS, Kim HH, Lee HJ, Yang HK, Lee KU (2009) Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg 208(2):186–192PubMedCrossRefGoogle Scholar
  29. 29.
    Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 247(6):962–967PubMedCrossRefGoogle Scholar
  30. 30.
    Fujiwara M, Kodera Y, Kasai Y, Kanyama Y, Hibi K, Ito K, Akiyama S, Nakao A (2003) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: a review of 43 cases. J Am Coll Surg 196:75–81PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ju-Hee Lee
    • 1
  • Sang-Yong Son
    • 1
  • Chang Min Lee
    • 1
  • Sang Hoon Ahn
    • 1
  • Do Joong Park
    • 1
    • 2
  • Hyung-Ho Kim
    • 1
    • 2
    Email author
  1. 1.Department of SurgerySeoul National University Bundang HospitalBundang-gu, Seongnam-shiSouth Korea
  2. 2.Department of SurgerySeoul National University College of MedicineSeoulSouth Korea

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