Skip to main content

Advertisement

Log in

Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

Laparoscopically assisted distal gastrectomy (LADG) with limited lymph node dissection (D1+alpha) has been used to treat a subset of patients with early gastric cancer. Technical advances have expanded indications for LADG to more advanced gastric cancers. However, little data are available on the feasibility or advantages of LADG with standard radical D2 lymph node dissection for patients with gastric cancer.

Methods

This study reviewed the clinical features of 37 patients who underwent LADG with D2 lymph node dissection for preoperatively diagnosed gastric carcinoma, then compared the results with the features of 31 patients who underwent conventional open distal gastrectomy (ODG) with D2 lymph node dissection.

Results

The laparoscopic procedure was not converted to laparotomy in any patient. There was no operative mortality and no serious morbidity among the patients who underwent LADG with D2 lymph node dissection. As compared with the ODG group, the LADG group had less operative blood loss (p < 0.001), earlier recovery of bowel activity (p = 0.012), and a shorter duration of fever after surgery (p = 0.015), despite the longer operation time (p = 0.007).

Conclusions

According to this study, LADG with D2 lymph node dissection is feasible and provides several advantages similar to those of limited lymph node dissection (D1+alpha). Depending on surgeons’ technical proficiency, LADG can be used with standard radical lymph node dissection for patients with gastric cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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: 806–810

    PubMed  CAS  Google Scholar 

  2. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ (1999) Extended lymph node dissection for gastric cancer. N Engl J Med 340: 908–914

    Article  PubMed  CAS  Google Scholar 

  3. Bonenkamp JJ, Songun J, Hermans J, Sasako M, Welvaart K, Plukkeo JT, van Elk P, Obertop H, Gouma DJ, Taat CW, van Lanschot J, Meyer S, de Graaf PW, von Meyenfeldt MF, Tilanus H, van de Velde CJH (1995) Randomized comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345: 745–748

    Article  PubMed  CAS  Google Scholar 

  4. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P (1996) Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial. The Surgical Cooperative Group. Lancet 347: 995–999

    CAS  Google Scholar 

  5. Dent DM, Madden MV, Price SK (1988) Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma. Br J Surg 75: 110–112

    PubMed  CAS  Google Scholar 

  6. Fujiwara M, Kodera M, Kasai Y, Kanyama Y, Hibi K, Akiyama S, Nakao A (2003) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: review of 43 cases. J Am Coll Surg 196: 75–81

    Article  PubMed  Google Scholar 

  7. Iriyama K, Asakawa T, Koike H, Nishiwaki H, Suzuki H (1989) Is extensive lymphadenectomy necessary for surgical treatment of intramucosal carcinoma of the stomach? Arch Surg 124: 309–311

    PubMed  CAS  Google Scholar 

  8. Japanese Gastric Cancer Association (1998) Japanese Classification of Gastric Carcinoma. 2nd English edition. Gastric Cancer 1: 10–24

    PubMed  Google Scholar 

  9. Jinnai D (1968) Evaluation of extended radical operation for gastric cancer with regard to lymph node metastasis and follow-up results. Jpn J Cancer Res 3: 225–231

    Google Scholar 

  10. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4: 146–148

    PubMed  CAS  Google Scholar 

  11. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131: S306–311

    Article  PubMed  Google Scholar 

  12. Kitaoka H, Yoshikawa K, Hirota T, Itabashi M (1984) Surgical treatment of early gastric cancer. Jpn J Clin Oncol 14: 283–293

    PubMed  CAS  Google Scholar 

  13. Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asano T, Kuwano H (2002) Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg 26: 1145–1149

    Article  PubMed  Google Scholar 

  14. Nagai Y, Tanimura H, Takifuji K, Kashiwagi H, Yamoto H, Nakatani Y (1995) Laparoscope-assisted Billroth I gastrectomy. Surg Laparosc Endosc 5: 281–287

    PubMed  CAS  Google Scholar 

  15. Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients with heavier weight? Ann Surg 238: 680–685

    PubMed  Google Scholar 

  16. Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23: 187–193

    PubMed  CAS  Google Scholar 

  17. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimada T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48: 225–229

    Article  PubMed  CAS  Google Scholar 

  18. Reyes CD, Weber KJ, Gagner M, Divino CM (2001) Laparoscopic vs open gastrectomy: a retrospective review. Surg Endosc 15: 928–931

    Article  PubMed  CAS  Google Scholar 

  19. Robertson CS, Chung SC, Woods SD, Griffin SM, Raimes SA, Lau JT, Li AK (1994) A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer. Ann Surg 220: 176–182

    PubMed  CAS  Google Scholar 

  20. Shimizu S, Uchiyama A, Mizumoto K, Morisaki T, Nakamura K, Shimura H, Tanaka M (2000) Laparoscopically assisted distal gastrectomy for early gastric cancer: is it superior to open surgery? Surg Endosc 14: 27–31

    Article  PubMed  CAS  Google Scholar 

  21. Snedecor GW, Cochran WG (1980) Statistical methods. Ames IA: Iowa State University Press

    Google Scholar 

  22. Tanimura S, Higashino M, Fukunaga Y, Osugi H (2003) Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 17: 758–762

    Article  PubMed  CAS  Google Scholar 

  23. Uyama I, Sugiola 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: 186–190

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to H. Noshiro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Noshiro, H., Nagai, E., Shimizu, S. et al. Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc 19, 1592–1596 (2005). https://doi.org/10.1007/s00464-005-0175-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0175-9

Keywords

Navigation