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Medical Oncology

, 32:241 | Cite as

A prospective randomized clinical trial comparing D2 dissection in laparoscopic and open gastrectomy for gastric cancer

  • Ming Cui
  • Ziyu Li
  • Jiadi Xing
  • Zhendan Yao
  • Maoxing Liu
  • Lei Chen
  • Chenghai Zhang
  • Hong Yang
  • Nan Zhang
  • Fei Tan
  • Beihai Jiang
  • Jiabo Di
  • Zaozao Wang
  • Jiafu JiEmail author
  • Xiangqian SuEmail author
Original Paper

Abstract

Laparoscopic surgery is an acceptable alternative to open surgery in colorectal cancer treatment. However, in gastric cancer, there is not much scientific evidence. Here, we proposed a prospective randomized clinical trial to evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. From October 2010 to September 2012, 300 patients with gastric cancer were randomized to undergo either laparoscopy-assisted gastrectomy (LAG) or conventional open gastrectomy (OG) with D2 dissection. Clinicopathological parameters, recovery and complications were compared between these two groups. Thirty cases were excluded because of refusing to be involved in the trial, having peritoneal seeding metastasis or LAG conversed to OG, and finally 270 cases were analyzed (128 in LAG and 142 in OG). No significant differences were observed in gender, age, body mass index, stages and types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)] (P > 0.05). The number of harvested lymph nodes (HLNs) was similar (29.3 ± 11.8 in LAG vs. 30.1 ± 11.4 in OG, P = 0.574). And in the same type of radical resection, no significant difference was found in the number of HLNs between the two groups (PG + D2, P = 0.770; DG + D2, P = 0.500; TG + D2, P = 0.993). The morbidity of the LAG group (21.8 %) was also comparable to the OG group (19.0 %, P = 0.560). However, the LAG group had significantly less blood loss and faster recovery, and a longer operation time (P < 0.05). Laparoscopic D2 dissection is feasible, safe and capable of fulfilling oncologic criteria for the treatment of gastric cancer.

Keywords

Gastric cancer Laparoscopy Gastrectomy D2 dissection Lymph node 

Notes

Acknowledgments

This study was funded by the National Natural Science Foundation of China (Nos. 81272766, 81450028), the National High Technology Research and Development Program of China (863 Program, No. 2014AA020603), Clinical Characteristics and Application Research of Capital (Beijing Municipal Science and Technology Commission, No. Z121107001012130), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (No. XM201309), Peking University (PKU) 985 Special Funding for Collaborative Research with PKU Hospitals (To Xiangqian Su and Fan Bai), Seeding Grant for Medicine and Life Sciences of Peking University (2014-MB-04), Science Foundation of Peking University Cancer Hospital and Institute (No. 2014-14).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The studies have been approved by the research ethics committee of Peking University Cancer Hospital and Institute, Beijing, China (Approved No. 2012071710) and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMedGoogle Scholar
  2. 2.
    Lin Y, Ueda J, Kikuchi S, Totsuka Y, Wei WQ, Qiao YL, Inoue M. Comparative epidemiology of gastric cancer between Japan and China. World J Gastroenterol. 2011;17:4421–8.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Dikken JL, van de Velde CJ, Coit DG, Shah MA, Verheij M, Cats A. Treatment of resectable gastric cancer. Ther Adv Gastroenterol. 2012;5:49–69.CrossRefGoogle Scholar
  4. 4.
    Takahashi T, Saikawa Y, Kitagawa Y. Gastric cancer: current status of diagnosis and treatment. Cancers (Basel). 2013;5:48–63.CrossRefGoogle Scholar
  5. 5.
    Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.PubMedGoogle Scholar
  6. 6.
    Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:S306–11.CrossRefPubMedGoogle Scholar
  7. 7.
    Fujii K, Sonoda K, Izumi K, Shiraishi N, Adachi Y, Kitano S. T lymphocyte subsets and Th1/Th2 balance after laparoscopy-assisted distal gastrectomy. Surg Endosc. 2003;17:1440–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005;19:168–73.CrossRefPubMedGoogle Scholar
  9. 9.
    Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc. 2005;19:1172–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim YW, Yoon HM, Yun YH, Nam BH, Eom BW, Baik YH, Lee SE, Lee Y, Kim YA, Park JY, Ryu KW. Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc. 2013;27:4267–76.CrossRefPubMedGoogle Scholar
  12. 12.
    Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Watanabe M, Okutomi T, Wang G, Bax L. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc. 2013;27:1695–705.CrossRefPubMedGoogle Scholar
  13. 13.
    Takiguchi S, Fujiwara Y, Yamasaki M, Miyata H, Nakajima K, Sekimoto M, Mori M, Doki Y. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study. World J Surg. 2013;37:2379–86.CrossRefPubMedGoogle Scholar
  14. 14.
    Du J, Zheng J, Li Y, Li J, Ji G, Dong G, Yang Z, Wang W, Gao Z. Laparoscopy-assisted total gastrectomy with extended lymph node resection for advanced gastric cancer—reports of 82 cases. Hepatogastroenterology. 2010;57:1589–94.PubMedGoogle Scholar
  15. 15.
    Huang JL, Wei HB, Zheng ZH, Wei B, Chen TF, Huang Y, Guo WP, Hu B. Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer. Dig Surg. 2010;27:291–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Cui M, Xing JD, Yang W, Ma YY, Yao ZD, Zhang N, Su XQ. D2 dissection in laparoscopic and open gastrectomy for gastric cancer. World J Gastroenterol. 2012;18:833–9.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Qiu JF, Yang B, Fang L, Li YP, Shi YJ, Yu XC, Zhang MC. Safety and efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer in the elderly. Int J Clin Exp Med. 2014;7:3562–7.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Fang C, Hua J, Li J, Zhen J, Wang F, Zhao Q, Shuang J, Du J. Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymphadenectomy for advanced gastric cancer. Am J Surg. 2014;208:391–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Lee JH, Lee CM, Son SY, Ahn SH, Park DJ, Kim HH. Laparoscopic versus open gastrectomy for gastric cancer: long-term oncologic results. Surgery. 2014;155:154–64.CrossRefPubMedGoogle Scholar
  20. 20.
    Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY. Long-term results of laparoscopic gastrectomy for gastric cancer: large-scale case-control and case-matched Korean multicenter study. J Clin Oncol. 2014;32:627–33.CrossRefPubMedGoogle Scholar
  21. 21.
    Association Japanese Gastric Cancer. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1(10–24):20.Google Scholar
  22. 22.
    Degiuli M, Sasako M, Ponti A, Calvo F. Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J Cancer. 2004;90:1727–32.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.CrossRefPubMedGoogle Scholar
  24. 24.
    Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C. 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. 2007;194:839–44.CrossRefPubMedGoogle Scholar
  25. 25.
    Pugliese R, Maggioni D, Sansonna F, Ferrari GC, Forgione A, Costanzi A, Magistro C, Pauna J, Di Lernia S, Citterio D, Brambilla C. 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. 2009;35:281–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Lee SR, Kim HO, Son BH, Shin JH, Yoo CH. Laparoscopic-assisted total gastrectomy versus open total gastrectomy for upper and middle gastric cancer in short-term and long-term outcomes. Surg Laparosc Endosc Percutan Tech. 2014;24:277–82.CrossRefPubMedGoogle Scholar
  27. 27.
    Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC. Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006;202:874–80.CrossRefPubMedGoogle Scholar
  28. 28.
    Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, Jung EJ, Joo YT, Jeong CY, Ha WS. Risk of recurrence after laparoscopy-assisted radical gastrectomy for gastric cancer performed by a single surgeon. Surg Endosc. 2011;25:872–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Cai J, Wei D, Gao CF, Zhang CS, Zhang H, Zhao T. A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig Surg. 2011;28:331–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Li HT, Han XP, Su L, Zhu WK, Xu W, Li K, Zhao QC, Yang H, Liu HB. Short-term efficacy of laparoscopy-assisted vs open radical gastrectomy in gastric cancer. World J Gastrointest Surg. 2014;6:59–64.PubMedCentralPubMedGoogle Scholar
  32. 32.
    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY. 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. 2010;251:417–20.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IVPeking University Cancer Hospital and InstituteBeijingChina
  2. 2.Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal SurgeryPeking University Cancer Hospital and InstituteBeijingChina

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