Laparoscopy-Assisted Distal Gastrectomy with D2 Lymph Node Dissection Following Standardization—A Preliminary Study
Laparoscopy-assisted distal gastrectomy (LADG) with standard D2 dissection is a complex procedure usually performed only by experienced surgeons, and the feasibility of this procedure still remains unclear.
Patients who underwent LADG at the Cancer Institute Hospital between April 2006 and October 2008 were recruited for this study. Early surgical outcomes were compared between patients who underwent complete D2 dissection (complete D2 group; n = 42) and those who underwent D1 + beta dissection (D1 + beta group; n = 179) to determine the feasibility of laparoscopic D2 lymph node dissection.
In complete D2 group, the operation time was longer (253 ± 10 vs 224 ± 4 min; P = 0.005), and the number of retrieved lymph nodes was larger (41 ± 2 vs 35 ± 1; P = 0.002) compared with those in D1 + beta group. The other early surgical outcomes monitored for the two groups were not different between groups.
LADG with complete D2 lymph node dissection can be performed safely if the procedure is standardized and an experienced laparoscopic surgeon performs the surgery. To be accepted as a standard treatment for advanced gastric cancer, well-designed prospective trial is necessary.
KeywordsLaparoscopy-assisted gastrectomy Gastric cancer D2 lymph node dissection
- 7.Miura S, Kodera Y, Fujiwara M, Ito S, Mochizuki Y, Yamamura Y, Hibi K, Ito K, Akiyama S, Nakao A. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. J Am Coll Surg 2004;198:933–938. doi: 10.1016/j.jamcollsurg.2004.01.021.PubMedCrossRefGoogle Scholar
- 8.Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 2005;241:232–237. doi: 10.1097/01.sla.0000151892.35922.f2.PubMedCrossRefGoogle Scholar
- 14.Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, van Krieken JH, Meijer S, Plukker JT, van Elk PJ, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H, Sasako M. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004;22:2069–2077. doi: 10.1200/JCO.2004.08.026.PubMedCrossRefGoogle Scholar
- 15.Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745–748. doi: 10.1016/S0140-6736(95)90637-1.PubMedCrossRefGoogle Scholar
- 16.Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial.The Surgical Cooperative Group. Lancet 1996;347:995–999. doi: 10.1016/S0140-6736(96)90144-0.PubMedCrossRefGoogle Scholar
- 17.Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999;79:1522–1530. doi: 10.1038/sj.bjc.6690243.PubMedCrossRefGoogle Scholar
- 20.Lee SW, Shinohara H, Matsuki M, Okuda J, Nomura E, Mabuchi H, Nishiguchi K, Takaori K, Narabayashi I, Tanigawa N. Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery. J Am Coll Surg 2003;197:927–936. doi: 10.1016/j.jamcollsurg.2003.07.021.PubMedCrossRefGoogle Scholar
- 21.Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, Seto Y, Yoshiba H, Nohara K, Inoue H, Muto T. The benefits of standardizing the operative procedure for the assistant in laparoscopy-assisted gastrectomy for gastric cancer. Langenbecks Arch Surg 2008;393:963–971. doi: 10.1007/s00423-008-0374-7.PubMedCrossRefGoogle Scholar
- 23.Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C. 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 2007;194:839–844. doi: 10.1016/j.amjsurg.2007.08.037, discussion 844.PubMedCrossRefGoogle Scholar
- 26.Fujiwara M, Kodera Y, Miura S, Kanyama Y, Yokoyama H, Ohashi N, Hibi K, Ito K, Akiyama S, Nakao A. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a phase II study following the learning curve. J Surg Oncol 2005;91:26–32. doi: 10.1002/jso.20166.PubMedCrossRefGoogle Scholar