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Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective cohort study from China

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Abstract

Background

Laparoscopy-assisted gastrectomy (LAG) has been indicated to be safe, feasible, and oncologically efficacious for the treatment of early gastric cancer by both retrospective and prospective studies. Although some reports have demonstrated that LAG was also a safe and technically feasible procedure for advanced gastric cancer (AGC), its oncologic outcomes have not yet been confirmed in a multicenter, large-scale study. The aim of this study was to evaluate the oncologic outcomes of LAG for AGC on a multicenter basis in China.

Methods

Data of 1,184 consecutive patients with locally AGC who underwent LAG with curative intent between February 2003 and December 2009 were collected from the Chinese Laparoscopic Gastrointestinal Surgery Study group database and retrospectively analyzed. Survival rates were estimated by the Kaplan–Meier method. Risk factors for recurrence and survival were evaluated by Cox regression models.

Results

Postoperatively, 121 patients (10.2 %) experienced complications, and 1 patient died (0.1 %). Median follow-up was 12 months. Recurrence was observed in 185 patients (16.7 %), including hematogenous (31 patients), peritoneal (52), locoregional (25), distant lymph node (LN) (8), mixed (63), and uncertain (6) recurrences. The cumulative 3-year overall survival and disease-free survival rates were 75.3 and 69.0 %, respectively. The 3-year overall survival and disease-free survival rates were 89.7 and 88.9 % for stage I tumors, 85.0 and 77.0 % for stage II, 60.5 and 59.3 % for stage III. Independent risk factors for recurrence were tumor size > 40 mm, intraoperative blood transfusion, and advanced tumor stage. For survival, age > 65 years, tumor size > 40 mm, and advanced tumor stage were independent risk factors.

Conclusions

In addition to being safe and technically feasible, LAG for locally AGC could also yield acceptable short-term oncologic outcomes.

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Acknowledgments

The study was supported by the National High Technology Research and Development Program of China (863 Program) issued by the Ministry of Science and Technology of China (2012AA021103); the Development Center for Medical Science and Technology, Ministry of Health of China (W2011WAI44); the Research Fund of Public welfare in Health Industry, Health Ministry of China (No. 201402015); and Guangdong Provincial Science and Technology Key Project (2012A030400012).

The authors are grateful to the Chinese Laparoscopic and Endoscopic Surgery Society, the Chinese Gastric Cancer Association, and Ethicon Endo-Surgery of Johnson & Johnson Medical (China) Ltd. for their support in establishing the CLASS group and nationwide database.

We also acknowledge the following contributors to the CLASS group: Zhongchen Liu, Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University (Xiamen); Ziwei Wang, Department of General Surgery, the First Affiliated Hospital of Chongqing Medical University (Chongqing); Dong Wei, Department of Anorectal Surgery, the 150th Center Hospital of PLA (Luoyang); Mingsheng Sun, Department of General Surgery, the First Hospital of Nanchang (Nanchang); Zonghai Huang, Department of General Surgery, Zhujiang Hospital, Southern Medical University (Guangzhou); Zhigang Jie, Department of General Surgery, the First Affiliated Hospital of Nanchang University (Nanchang); Zhenxiang Rong, Department of General Surgery, the First People’s Hospital of Shunde (Shunde); Yihong Sun, Department of General Surgery, Zhongshan Hospital, Fudan University (Shanghai); Kai Pan, Department of Gastrointestinal Surgery, Shenzhen People’s Hospital (Shenzhen); Shunrong Huang, Department of Gastrointestinal Surgery, the People’s Hospital of Guangxi Zhuang Autonomous Region (Nanning); Ziyu Li, Department of Gastrointestinal Surgery, Beijing Cancer Hospital, Peking University (Beijing); Kaixiong Tao, Department of Laparoscopic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (Wuhan); Chuyuan Hong, Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Guangzhou Medical University (Guangzhou); Enders Kwok-wai Ng, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong (Hong Kong).

Disclosures

Drs. Yanfeng Hu, Mingang Ying, Changming Huang, Hongbo Wei, Zhiwei Jiang, Xiang Peng, Jiankun Hu, Xiaohui Du, Baolin Wang, Feng Lin, Jian Xu, Guanglong Dong, Tingyu Mou, and Guoxin Li have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China

    Yanfeng Hu, Tingyu Mou & Guoxin Li

  2. Department of Abdominal Surgery, Fujian Provincial Cancer Hospital, Fuzhou, China

    Mingang Ying

  3. Department of Gastric Surgery, The Affiliated Union Hospital, Fujian Medical University, Fuzhou, China

    Changming Huang

  4. Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Hongbo Wei

  5. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, Nanjing, China

    Zhiwei Jiang

  6. Department of Gastrointestinal Surgery, The First People’s Hospital of Foshan, Foshan, China

    Xiang Peng

  7. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China

    Jiankun Hu

  8. Department of General Surgery, General Hospital of PLA, Beijing, China

    Xiaohui Du & Guanglong Dong

  9. Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Baolin Wang

  10. Department of Gastrointestinal Surgery, Guangdong General Hospital, Guangzhou, China

    Feng Lin

  11. Department of General Surgery, Jiaozhou Central Hospital of Qingdao, Qingdao, China

    Jian Xu

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  1. Yanfeng Hu
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  2. Mingang Ying
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  3. Changming Huang
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  7. Jiankun Hu
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  10. Feng Lin
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  11. Jian Xu
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  12. Guanglong Dong
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  14. Guoxin Li
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For the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group

Corresponding authors

Correspondence to Tingyu Mou or Guoxin Li.

Additional information

The first two authors contributed equally to this article, and both should be considered first author. Tingyu Mou and Guoxin Li also contributed equally, and both should be considered as co-corresponding author.

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Hu, Y., Ying, M., Huang, C. et al. Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective cohort study from China. Surg Endosc 28, 2048–2056 (2014). https://doi.org/10.1007/s00464-014-3426-9

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  • DOI: https://doi.org/10.1007/s00464-014-3426-9

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