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Feasibility of Laparoscopic Distal Gastrectomy for Stage I Gastric Cancer in Patients Outside of Clinical Trials

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Randomized controlled trials, including the Japan Clinical Oncology Group (JCOG) 0912 trial, have shown the safety of laparoscopy-assisted distal gastrectomy (LADG) for select healthy patients. It is unclear whether LADG is feasible in patients who do not meet trial eligibility criteria.

Methods

The present study retrospectively reviewed 547 patients with clinical stage I gastric cancer who underwent distal or pylorus-preserving gastrectomy. Of these, 185 were identified as not fulfilling the eligibility criteria of JCOG 0912; the short-term surgical outcomes between LADG and open distal gastrectomy (ODG) were compared in this group before and after propensity score matching.

Results

Patients who were not eligible for inclusion in the trial comprised 33.8% of the total. After matching, there were 59 patients each in the LADG and ODG groups, with an improved balance of confounding factors between the two groups. LADG was associated with significantly longer operation time, less blood loss, and shorter postoperative hospital stay than ODG. The rate of overall postoperative complications of Clavien–Dindo Grade II or higher did not differ significantly between the LADG and ODG groups (23.7 vs. 18.6%, respectively; p = 0.653). The incidence of pneumonia (6.8 vs. 5.1%), intra-abdominal infectious complications (5.1 vs. 3.4%), and stasis syndrome (5.1 vs. 3.4%) was also comparable between the two groups.

Conclusion

LADG was as safe as ODG in patients who did not meet the eligibility criteria of JCOG 0912. LADG could be a standard treatment option for patients with stage I gastric cancer, regardless of their general condition.

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References

  1. Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, Terashima M, Misawa K, Teshima S, Koeda K, Nunobe S, Fukushima N, Yasuda T, Asao Y, Fujiwara Y, Sasako M. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017;20(4):699–708.

    Article  PubMed  Google Scholar 

  2. 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. 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. 2016;263(1):28–35.

    Article  PubMed  Google Scholar 

  3. 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. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. J Clin Oncol. 2016;34(12):1350–1357.

    Article  PubMed  Google Scholar 

  4. Sasako M, Sano T, Yamamoto S, Sairenji M, Arai K, Kinoshita T, Nashimoto A, Hiratsuka M, Japan Clinical Oncology G. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol. 2006;7(8):644–651.

    Article  PubMed  Google Scholar 

  5. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–449.

    Article  PubMed  Google Scholar 

  6. Yamada H, Shinohara T, Takeshita M, Umesaki T, Fujimori Y, Yamagishi K. Postoperative complications in the oldest old gastric cancer patients. Int J Surg. 2013;11(6):467–471.

    Article  PubMed  Google Scholar 

  7. Endo S, Shimizu Y, Ikenaga M, Ohta K, Yamada T. Survival benefit of gastrectomy for gastric cancer in patients >/=85 years old: A retrospective propensity score-matched analysis. Surgery. 2017;161(4):984–994.

    Article  PubMed  Google Scholar 

  8. Wu X-S, Wu W-G, Li M-L, Yang J-H, Ding Q-C, Zhang L, Mu J-S, Gu J, Dong P, Lu J-H, Liu Y-B. Impact of being overweight on the surgical outcomes of patients with gastric cancer: a meta-analysis. World J Gastroenterol. 2013;19(28):4596–4606.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS. The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg. 2008;248(5):793–799.

    Article  PubMed  Google Scholar 

  10. Jeong SH, Ahn HS, Yoo MW, Cho JJ, Lee HJ, Kim HH, Lee KU, Yang HK. Increased morbidity rates in patients with heart disease or chronic liver disease following radical gastric surgery. J Surg Oncol. 2010;101(3):200–204.

    PubMed  Google Scholar 

  11. Lee JY, Kim HI, Kim YN, Hong JH, Alshomimi S, An JY, Cheong JH, Hyung WJ, Noh SH, Kim CB. Clinical Significance of the Prognostic Nutritional Index for Predicting Short- and Long-Term Surgical Outcomes After Gastrectomy: A Retrospective Analysis of 7781 Gastric Cancer Patients. Medicine (Baltimore). 2016;95(18):e3539.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–196.

    Article  PubMed  Google Scholar 

  14. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours, 7th Edition. New York: Wiley-Blackwell; 2010.

    Google Scholar 

  15. Japanese Gastric Cancer A. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–112.

    Article  Google Scholar 

  16. Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.

    Article  Google Scholar 

  17. Tejeda HA, Green SB, Trimble EL, Ford L, High JL, Ungerleider RS, Friedman MA, Brawley OW. Representation of African-Americans, Hispanics, and whites in National Cancer Institute cancer treatment trials. J Natl Cancer Inst. 1996;88(12):812–816.

    Article  CAS  PubMed  Google Scholar 

  18. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA. 2004;291(22):2720–2726.

    Article  CAS  PubMed  Google Scholar 

  19. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K, Group A-G. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357(18):1810–1820.

    Article  CAS  PubMed  Google Scholar 

  20. Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W, Toh Y, Nagaie T, Takagi S, Yamamura Y, Yanaoka K, Orita H, Takeuchi M. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9(3):215–221.

    Article  CAS  PubMed  Google Scholar 

  21. Hunter CP, Frelick RW, Feldman AR, Bavier AR, Dunlap WH, Ford L, Henson D, Macfarlane D, Smart CR, Yancik R, et al. Selection factors in clinical trials: results from the Community Clinical Oncology Program Physician's Patient Log. Cancer Treat Rep. 1987;71(6):559–565.

    CAS  PubMed  Google Scholar 

  22. Global Burden of Disease Cancer C. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2017;3(4):524–548.

  23. Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T, Japan Cancer Surveillance Research G. Cancer incidence and incidence rates in Japan in 2005: based on data from 12 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol. 2011;41(1):139–147.

    Article  PubMed  Google Scholar 

  24. Bild DE, Fitzpatrick A, Fried LP, Wong ND, Haan MN, Lyles M, Bovill E, Polak JF, Schulz R. Age-related trends in cardiovascular morbidity and physical functioning in the elderly: the Cardiovascular Health Study. J Am Geriatr Soc. 1993;41(10):1047–1056.

    Article  CAS  PubMed  Google Scholar 

  25. Epstein M. Aging and the kidney. J Am Soc Nephrol. 1996;7(8):1106–1122.

    CAS  PubMed  Google Scholar 

  26. Miki Y, Makuuchi R, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Risk factors for postoperative pneumonia after gastrectomy for gastric cancer. Surg Today. 2016;46(5):552–556.

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported in part by The National Cancer Center Research and Development Fund (29-A-3).

Funding

This work was supported in part by The National Cancer Center Research and Development Fund (29-A-3).

Author information

Authors and Affiliations

  1. Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Keiichi Fujiya, Masanori Tokunaga, Noriyuki Nishiwaki, Kenichiro Furukawa, Hayato Omori, Sanae Kaji, Rie Makuuchi, Tomoyuki Irino, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura & Masanori Terashima

  2. Division of Gastric Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan

    Masanori Tokunaga

Authors
  1. Keiichi Fujiya
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  2. Masanori Tokunaga
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  3. Noriyuki Nishiwaki
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  4. Kenichiro Furukawa
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  5. Hayato Omori
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  6. Sanae Kaji
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  7. Rie Makuuchi
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  8. Tomoyuki Irino
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  9. Yutaka Tanizawa
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  10. Etsuro Bando
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  11. Taiichi Kawamura
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  12. Masanori Terashima
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Contributions

Fujiya K contributed to conception, data acquisition, analysis, and writing manuscript. Tokunaga M contributed to conception and revision. Nishiwaki N, Furukawa K, Omori H, Kaji S, Makuuchi R, Irino T, Tanizawa Y, Bando E, and Kawamura T contributed to data acquisition. Terashima M contributed to interpretation of data and revision.

Corresponding author

Correspondence to Masanori Tokunaga.

Ethics declarations

The present study was approved by the Institutional Review Board of the Shizuoka Cancer Center (Approval no. 28-J160-28-1-3).

Conflict of Interest

The authors declare that they have no conflicts of interest.

Disclosures

The authors have nothing to disclose.

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Fujiya, K., Tokunaga, M., Nishiwaki, N. et al. Feasibility of Laparoscopic Distal Gastrectomy for Stage I Gastric Cancer in Patients Outside of Clinical Trials. J Gastrointest Surg 22, 1665–1671 (2018). https://doi.org/10.1007/s11605-018-3842-6

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  • DOI: https://doi.org/10.1007/s11605-018-3842-6

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