Long-term outcomes of laparoscopy-assisted distal gastrectomy versus open distal gastrectomy for gastric cancer: a 10-year single-institution experience
- 198 Downloads
Laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer has been widely applied; however, its oncologic efficacy has yet been well established. The study aimed to compare the long-term oncologic outcomes of LADG versus open distal gastrectomy (ODG) on gastric cancer.
The clinicopathologic data of gastric cancer patients who underwent distal gastrectomy with curative intent from October 2004 through September 2014 were included and analyzed in a retrospective cohort. The last follow-up was September 2016.
769 eligible patients (LADG 414 vs. ODG 355) were included in the study. No significant difference was observed between the groups in 5-year DFS (LADG 61.2% vs. ODG 59.1%; p = 0.384) and OS rates (LADG 65.8% vs. ODG 66.3%; p = 0.750). During surgery, though LADG group had longer operating time, the blood loss was less than ODG group. LADG group had faster postoperative recovery course including shorter time to oral intake, ambulation, and discharge time. Postoperative complication rate within 30 days showed no significant difference between the groups (LADG 15.7% vs. ODG 13.0%; p = 0.281). Age over 65 years old, blood loss > 200 ml, postoperative complication, and advanced T and N stage were identified as independent risk factors for DFS and OS.
LADG could yield similar oncologic outcomes compared with ODG in treating distal gastric cancer. However, the findings need to be further confirmed through ongoing prospective randomized controlled trials.
KeywordsGastric cancer Laparoscopy Gastrectomy Oncologic outcome Long term
This work was supported by the grants from the State’s Key Project of Research and Development Plan (2017YFC0108300, 2017YFC0108301), National Natural Science Foundation of China (81672446), Guangdong Provincial Science and Technology Key Project (2014A020215014), Research Fund of Public Welfare in the Health Industry, the National Health and Family Planning Commission of China (201402015), the Southern Medical University Clinical Research Start-Up Project (LC2016ZD003), Guangzhou Science and Technology Project (201400000004-5), and the Key Clinical Specialty Discipline Construction Program (170).
Compliance with ethical standards
Drs. Hao Wang, Tingyu Mou, Hao Chen, Yanfeng Hu, Tian Lin, Tuanjie Li, Jiang Yu, Hao Liu, and Guoxin Li have no conflicts of interest or financial ties to disclose.
- 3.Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, Lordick F, Ohtsu A, Omuro Y, Satoh T, Aprile G, Kulikov E, Hill J, Lehle M, Ruschoff J, Kang YK, To GATI (2010) Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 376(9742):687–697CrossRefGoogle Scholar
- 6.Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Lee HJ, Korean Laparo-endoscopic Gastrointestinal Surgery Study G (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage i gastric cancer: short-term outcomes from a Multicenter Randomized Controlled Trial (KLASS-01). Ann Surg 263(1):28–35CrossRefGoogle Scholar
- 7.Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Hyung WJ, Group KL-eGSS (2016) Long-term outcomes of laparoscopic distal gastrectomy compared with open distal gastrectomy for clinical stage I gastric adenocarcinoma (KLASS-01): a multi-center prospective randomized controlled trial. J Clin Oncol 34(15_suppl):4060–4060CrossRefGoogle Scholar
- 8.Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a Randomized Controlled Trial. J Clin Oncol 34(12):1350–1357CrossRefGoogle Scholar
- 9.Honda M, Hiki N, Kinoshita T, Yabusaki H, Abe T, Nunobe S, Terada M, Matsuki A, Sunagawa H, Aizawa M, Healy MA, Iwasaki M, Furukawa TA (2016) Long-term outcomes of laparoscopic versus open surgery for clinical stage I gastric cancer: The LOC-1 Study. Ann Surg 264(2):214–222CrossRefPubMedCentralGoogle Scholar
- 11.Hu Y, Ying M, Huang C, Wei H, Jiang Z, Peng X, Hu J, Du X, Wang B, Lin F, Xu J, Dong G, Mou T, Li G, Chinese Laparoscopic Gastrointestinal Surgery Study G (2014) Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective cohort study from China. Surg Endosc 28(7):2048–2056CrossRefGoogle Scholar
- 12.Hu YF, Yu J, Zhang C, Wang YN, Cheng X, Huang F, Li GX (2010) Development and implementation of a clinical data mining system for gastric cancer surgery. Chin J Gastrointest Surg 13(7):510–515Google Scholar
- 14.Hu YF, Yu J, Wang YN, Zhang C, Cheng X, Li GX (2010) Learning curve of laparoscopic D2 gastrectomy for gastric cancer. J South Med Univ 30(5):1095–1098Google Scholar
- 19.Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(2):146–148Google Scholar
- 21.Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K, Group JGCSS (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13(4):238–244CrossRefGoogle Scholar
- 22.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):417–420CrossRefGoogle Scholar
- 23.Lan H, Zhu N, Lan Y, Jin K, Teng L (2015) Laparoscopic gastrectomy for gastric cancer in China: an overview. Hepatogastroenterology 62(137):234–239Google Scholar
- 26.Hao YX, Yu PW, Qian F, Zhao YL, Shi Y, Tang B, Zeng DZ, Zhang C (2016) Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer: a retrospective study in a single minimally invasive surgery center. Medicine (Baltimore) 95(25):e3936CrossRefPubMedCentralGoogle Scholar
- 32.Marrelli D, Morgagni P, de Manzoni G, Coniglio A, Marchet A, Saragoni L, Tiberio G, Roviello F, Italian Research Group for Gastric C (2012) Prognostic value of the 7th AJCC/UICC TNM classification of noncardia gastric cancer: analysis of a large series from specialized Western centers. Ann Surg 255(3):486–491CrossRefGoogle Scholar
- 34.Park DJ, 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 G (2012) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc 26(6):1548–1553CrossRefGoogle Scholar
- 35.Park HA, Park SH, Cho SI, Jang YJ, Kim JH, Park SS, Mok YJ, Kim CS (2013) Impact of age and comorbidity on the short-term surgical outcome after laparoscopy-assisted distal gastrectomy for adenocarcinoma. Am Surg 79(1):40–48Google Scholar
- 37.Mizuno A, Kanda M, Kobayashi D, Tanaka C, Iwata N, Yamada S, Fujii T, Nakayama G, Sugimoto H, Koike M, Fujiwara M, Kodera Y (2016) Adverse effects of intraoperative blood loss on long-term outcomes after curative gastrectomy of patients with stage II/III gastric cancer. Dig Surg 33(2):121–128CrossRefGoogle Scholar