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Laparoscopy-Assisted vs. Open Total Gastrectomy for Advanced Gastric Cancer: Long-Term Outcomes and Technical Aspects of a Case–Control Study

Journal of Gastrointestinal Surgery volume 17, pages 1202–1208 (2013)Cite this article

Abstract

Background and Objectives

An increasing number of studies comparing laparoscopy-assisted distal gastrectomy and conventional open distal gastrectomy have been reported; the technical feasibility and clinical efficacy have been confirmed. However, few data are available to compare laparoscopy-assisted total gastrectomy (LATG) and open techniques for the treatment of advanced gastric cancer (AGC). The aim of this study is to compare the oncologic efficacy and long-term outcomes of LATG vs. open total gastrectomy (OTG) for AGC and to provide our experiences regarding these surgical difficulties as well.

Methods

Using data from a clinical database of all operations performed in our department by a special surgical team, we retrospectively analysed data from 117 cases of LATG and matched OTG performed between January 2004 and December 2010. This analysis was a case–control study in which patients in the two groups were matched according to tumour location, age, gender, BMI and TNM stage via a propensity score matching method. Patient clinical characteristics, lymph node retrieval, early postoperative complications, recurrence and long-term outcomes were compared.

Results

The demographics, preoperative data and characteristics of the tumour were similar in both groups. No significant differences were found in the LATG group compared with the OTG group with regard to the number of retrieved lymph nodes or distance from the proximal margin. Operating time was longer in the LATG group than in the OTG group (292.8 ± 49.5 vs. 242.1 ± 47.4, p < 0.05). Significant differences were found between LATG and OTG with regard to blood loss, postoperative hospitalisation and times of analgesic injection. The early postoperative complication rates in the LATG group were significantly lower than in the OTG group (11.1 vs. 16.3 %, p < 0.05). Operative mortality was zero in both groups. During a median follow-up of 61.2 (range, 6–84) months, the overall 5-year survival rates in the LATG group and OTG group were 49.3 and 46.5 %, respectively; there was no significant difference between the two groups (p = 0.756).

Conclusion

Our results suggest that LATG is technically feasible for advanced gastric cancer patients and can yield good short- and long-term oncologic outcomes as compared with conventional OTG.

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References

  1. Shiraishi N,Yasuda K,Kitano S (2006) Laparoscopic gastrectomy with lymph node dissection for gastric cancer. Gastric Cancer 9:167–176.

    PubMed  Article  Google Scholar 

  2. 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 98:515–9.

    PubMed  Article  Google Scholar 

  3. Shim JH, Song KY, Kim SN,et al.(2009) Laparoscopy-assisted distal gastrectomy for overweight patients in the Asian population. Surg Today 39:481–6.

    PubMed  Article  Google Scholar 

  4. Hwang SI, Kim HO, Yoo CH, et al. (2009) Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23:1252–8.

    PubMed  Article  Google Scholar 

  5. Sakuramoto S, Kikuchi S, Futawatari N, et al.(2009) Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc 23:2416–2423.

    PubMed  Article  Google Scholar 

  6. Huscher CG, Mingoli A, Sgarzini G,et al.(2007) 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 194:839–844.

    PubMed  Article  Google Scholar 

  7. Mochiki E, Toyomasu Y, Ogata K,et al.(2008) Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc 22:1997–2002

    PubMed  Article  Google Scholar 

  8. Topal B, Leys E, Ectors N,et al.(2008) Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 22:980–984

    PubMed  Article  CAS  Google Scholar 

  9. Tanimura S, Higashino M, Fukunaga Y,et al.(2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22:1161–1164

    PubMed  Article  CAS  Google Scholar 

  10. Ziqiang W, Feng Q, Zhimin C, et al.(2006) Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management. Surg Endosc 20:1738–43.

    PubMed  Article  CAS  Google Scholar 

  11. Bo T, Zhihong P, Peiwu Y, et al.(2009) General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them. Surg Endosc 23:1860–5.

    PubMed  Article  CAS  Google Scholar 

  12. Sano T, Aiko T(2011) New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer 14:97–100.

    PubMed  Article  Google Scholar 

  13. Ziqiang W, ZhiMin C, Jun C, et al.(2008) A modified method of laparoscopic side-to-side esophagojejunal anastomosis: report of 14 cases. Surg Endosc 22:2091–4.

    PubMed  Article  Google Scholar 

  14. Francescutti V, Choy I, Biertho L, et al.(2009) Gastrectomy and esophagogastrectomy for proximal and distal gastric lesions: a comparison of open and laparoscopic procedures. Surg Innov 16:134–9.

    PubMed  Article  Google Scholar 

  15. Cuschieri A, Fayers P, Fielding J,et al.(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 347:995–9.

    PubMed  Article  CAS  Google Scholar 

  16. Uyama I, Sugioka A, Fujita J,et al.(1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234.

    PubMed  Article  Google Scholar 

  17. Kunisaki C, Makino H, Oshima T,et al.(2011)Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc 25:1300–5.

    PubMed  Article  Google Scholar 

  18. Usui S, Nagai K, Hiranuma S,et al.(2008) Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer 11:233–7.

    PubMed  Article  Google Scholar 

  19. Tokunaga M, Hiki N, Fukunaga T, et al.(2009) Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection following standardization–a preliminary study. J Gastrointest Surg 13:1058–1063.

    PubMed  Article  Google Scholar 

  20. Pugliese R, Maggioni D, Sansonna F, et al.(2009) Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures. Eur J Surg Oncol 35:281–288.

    PubMed  Article  CAS  Google Scholar 

  21. Lee J, Kim W (2009) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences.. J Surg Oncol 15,100:693–8.

    Article  Google Scholar 

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Affiliations

  1. Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 400038, China

    T. Bo, Y. Peiwu, Q. Feng, Z. Yongliang, S. Yan, H. Yingxue & L. Huaxing

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  1. T. Bo
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  2. Y. Peiwu
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  3. Q. Feng
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  4. Z. Yongliang
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  5. S. Yan
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  6. H. Yingxue
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  7. L. Huaxing
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Correspondence to Y. Peiwu.

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Bo, T., Peiwu, Y., Feng, Q. et al. Laparoscopy-Assisted vs. Open Total Gastrectomy for Advanced Gastric Cancer: Long-Term Outcomes and Technical Aspects of a Case–Control Study. J Gastrointest Surg 17, 1202–1208 (2013). https://doi.org/10.1007/s11605-013-2218-1

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  • DOI: https://doi.org/10.1007/s11605-013-2218-1

Keywords

  • Laparoscope
  • Total gastrectomy
  • Gastric cancer
  • Outcome