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Annals of Surgical Oncology

, Volume 22, Issue 11, pp 3590–3596 | Cite as

Laparoscopic Versus Open Gastrectomy for Gastric Adenocarcinoma in the West: A Case–Control Study

  • Kaitlyn J. Kelly
  • Luke Selby
  • Joanne F. Chou
  • Katerina Dukleska
  • Marinela Capanu
  • Daniel G. Coit
  • Murray F. Brennan
  • Vivian E. StrongEmail author
Gastrointestinal Oncology

Abstract

Introduction

Data on laparoscopic gastrectomy in patients with gastric cancer in the Western hemisphere are lacking. This study aimed to compare outcomes following laparoscopic versus open gastrectomy for gastric adenocarcinoma at a Western center.

Methods

Eighty-seven consecutive patients who underwent laparoscopic gastrectomy from November 2005 to April 2013 were compared with 87 patients undergoing open resection during the same time period. Patients were matched for age, stage, body mass index, and procedure (distal subtotal vs. total gastrectomy). Endpoints were short- and long-term perioperative outcomes.

Results

Overall, 65 patients (37 %) had locally advanced disease, and 40 (23 %) had proximal tumors. The laparoscopic approach was associated with longer operative time (median 240 vs.165 min; p < 0.01), less blood loss (100 vs.150 mL; p < 0.01), higher rate of microscopic margin positivity (9 vs.1 %; p = 0.04), decreased duration of narcotic and epidural use (2 vs. 4 days, p = 0.04, and 3 vs. 4 days, p = 0.02, respectively), decreased minor complications in the early (27 vs. 16 %) and late (17 vs. 7 %) postoperative periods (p < 0.01), decreased length of stay (5 vs. 7 days; p = 0.01), and increased likelihood of receiving adjuvant therapy (82 vs. 51 %; p < 0.01). There was no difference in the number of lymph nodes retrieved (median 20 in both groups), major morbidity, or 30-day mortality.

Conclusions

Laparoscopic gastrectomy for gastric adenocarcinoma is safe and effective for select patients in the West.

Keywords

Gastric Cancer Total Gastrectomy Gastric Adenocarcinoma Laparoscopic Group Laparoscopic Gastrectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    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
  2. 2.
    Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Kim HH, Hyung WJ, Cho GS, et al. 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
  4. 4.
    Kim YW, Baik YH, Yun YH, et al. 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
  5. 5.
    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
  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.
    Strong VE, Devaud N, Allen PJ, Gonen M, Brennan MF, Coit D. Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case-control study. Ann Surg Oncol. 2009;16:1507–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.CrossRefPubMedGoogle Scholar
  9. 9.
    LaFemina J, Vinuela EF, Schattner MA, Gerdes H, Strong VE. Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol. 2013;20:2975–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255:446–56.CrossRefPubMedGoogle Scholar
  11. 11.
    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
  12. 12.
    Fang C, Hua J, Li J, et al. Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymphadenectomy for advanced gastric cancer. Am J Surg. 2014;208(3):391–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg. 2010;251:640–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Henson DE, Dittus C, Younes M, Nguyen H, Albores-Saavedra J. Differential trends in the intestinal and diffuse types of gastric carcinoma in the United States, 1973-2000: increase in the signet ring cell type. Arch Pathol Lab Med. 2004;128:765–70.PubMedGoogle Scholar
  15. 15.
    Baratti D, Kusamura S, Iusco D, et al. Postoperative complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy affect long-term outcome of patients with peritoneal metastases from colorectal cancer: a two-center study of 101 patients. Dis Colon Rectum. 2014;57:858–68.CrossRefPubMedGoogle Scholar
  16. 16.
    Ito H, Are C, Gonen M, et al. Effect of postoperative morbidity on long-term survival after hepatic resection for metastatic colorectal cancer. Ann Surg. 2008;247:994–1002.CrossRefPubMedGoogle Scholar
  17. 17.
    Law WL, Choi HK, Lee YM, Ho JW. The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Ann Surg Oncol. 2007;14:2559–66.CrossRefPubMedGoogle Scholar
  18. 18.
    Li QG, Li P, Tang D, Chen J, Wang DR. Impact of postoperative complications on long-term survival after radical resection for gastric cancer. World J Gastroenterol. 2013;19:4060–5.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Mrak K, Eberl T, Laske A, Jagoditsch M, Fritz J, Tschmelitsch J. Impact of postoperative complications on long-term survival after resection for rectal cancer. Dis Colon Rectum. 2013;56:20–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Sutton JM, Kooby DA, Wilson GC, et al. Perioperative blood transfusion is associated with decreased survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma: a multi-institutional study. J Gastrointest Surg. 2014;18(9):1575–87.CrossRefPubMedGoogle Scholar
  21. 21.
    Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20:1575–83.CrossRefPubMedGoogle Scholar
  22. 22.
    van der Gaag NA, Harmsen K, Eshuis WJ, Busch OR, van Gulik TM, Gouma DJ. Pancreatoduodenectomy associated complications influence cancer recurrence and time interval to death. Eur J Surg Oncol. 2014;40:551–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Papenfuss WA, Kukar M, Oxenberg J, et al. Morbidity and mortality associated with gastrectomy for gastric cancer. Ann Surg Oncol. 2014;21(9):3008–14.CrossRefPubMedGoogle Scholar
  24. 24.
    Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012;379:315–21.CrossRefPubMedGoogle Scholar
  25. 25.
    Bouche O, Ychou M, Burtin P, et al. Adjuvant chemotherapy with 5-fluorouracil and cisplatin compared with surgery alone for gastric cancer: 7-year results of the FFCD randomized phase III trial (8801). Ann Oncol. 2005;16:1488–97.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Kaitlyn J. Kelly
    • 1
  • Luke Selby
    • 1
  • Joanne F. Chou
    • 2
  • Katerina Dukleska
    • 1
  • Marinela Capanu
    • 2
  • Daniel G. Coit
    • 1
  • Murray F. Brennan
    • 1
  • Vivian E. Strong
    • 1
    Email author
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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