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Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer

View Article: PubMed Central - PubMed

ABSTRACT

Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79.70%, 57.81%, 34.60% and 88.31%, 75.49%, 56.84%, 33.08% in patients with stage Ib, IIa, IIb, and IIIa, respectively, in the LAG and OG groups. There were no statistically significant differences in the OS rate for patients with the same TNM stage between the 2 groups. LAG with radical LN dissection is a safe and technically feasible procedure for the treatment of AGC staged below T3.

No MeSH data available.


Related in: MedlinePlus

The soft tissues containing LNs no. 6 were removed to reveal the bordering vessels, the right gastroepiploic vein (RGEV), right colic vein (RCV), and Henle's trunk. The area of the no. 14 v LNs was also dissected with the superior mesenteric vein (SMV) exposed. RCV = right colic vein, RGEV = right gastroepiploic vein, SMV = superior mesenteric vein.
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Figure 1: The soft tissues containing LNs no. 6 were removed to reveal the bordering vessels, the right gastroepiploic vein (RGEV), right colic vein (RCV), and Henle's trunk. The area of the no. 14 v LNs was also dissected with the superior mesenteric vein (SMV) exposed. RCV = right colic vein, RGEV = right gastroepiploic vein, SMV = superior mesenteric vein.

Mentions: For the LADG and D2 LN dissection, first we divided the greater omentum from the transverse colon toward the spleen's lower pole using a Harmonic ACE (Ethicon Endo-Surgery, Cincinnati, OH), and then exposed the left gastroepiploic artery and vein near the tail of the pancreas and cleared the no. 4sb LNs. The second dissection region was inferior to the pylorus. Continuing to divide the greater omentum rightward to the hepatic flexure, the dissecting plane was maintained along the middle colic artery. The superior mesenteric vein, right colic vein, Henle's trunk, and right gastroepiploic vein were exposed, and then the LNs no. 14 v was dissected (Fig. 1). The right gastroepiploic artery was skeletonized, and divided at its origin. The no. 4d and no. 6 LNs were cleared. The third dissection region was superior to the pancreas, which was the most important dissection region. The proximal splenic artery was exposed and the no. 11p LNs were cleared. Then continued to clear the celiac trunk, the left gastric artery, and the common hepatic artery (nos. 9, 7, and 8a) LNs (Fig. 2). Exposed the right gastric artery and proper hepatic artery along the gastroduodenal artery. Cut the right gastric artery, then cleared the no. 5 and no.12a LNs. Finally, cleared the no. 1 and no. 3 LNs along the lesser curvature and the right of esophagocardial junction.


Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer
The soft tissues containing LNs no. 6 were removed to reveal the bordering vessels, the right gastroepiploic vein (RGEV), right colic vein (RCV), and Henle's trunk. The area of the no. 14 v LNs was also dissected with the superior mesenteric vein (SMV) exposed. RCV = right colic vein, RGEV = right gastroepiploic vein, SMV = superior mesenteric vein.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998323&req=5

Figure 1: The soft tissues containing LNs no. 6 were removed to reveal the bordering vessels, the right gastroepiploic vein (RGEV), right colic vein (RCV), and Henle's trunk. The area of the no. 14 v LNs was also dissected with the superior mesenteric vein (SMV) exposed. RCV = right colic vein, RGEV = right gastroepiploic vein, SMV = superior mesenteric vein.
Mentions: For the LADG and D2 LN dissection, first we divided the greater omentum from the transverse colon toward the spleen's lower pole using a Harmonic ACE (Ethicon Endo-Surgery, Cincinnati, OH), and then exposed the left gastroepiploic artery and vein near the tail of the pancreas and cleared the no. 4sb LNs. The second dissection region was inferior to the pylorus. Continuing to divide the greater omentum rightward to the hepatic flexure, the dissecting plane was maintained along the middle colic artery. The superior mesenteric vein, right colic vein, Henle's trunk, and right gastroepiploic vein were exposed, and then the LNs no. 14 v was dissected (Fig. 1). The right gastroepiploic artery was skeletonized, and divided at its origin. The no. 4d and no. 6 LNs were cleared. The third dissection region was superior to the pancreas, which was the most important dissection region. The proximal splenic artery was exposed and the no. 11p LNs were cleared. Then continued to clear the celiac trunk, the left gastric artery, and the common hepatic artery (nos. 9, 7, and 8a) LNs (Fig. 2). Exposed the right gastric artery and proper hepatic artery along the gastroduodenal artery. Cut the right gastric artery, then cleared the no. 5 and no.12a LNs. Finally, cleared the no. 1 and no. 3 LNs along the lesser curvature and the right of esophagocardial junction.

View Article: PubMed Central - PubMed

ABSTRACT

Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79.70%, 57.81%, 34.60% and 88.31%, 75.49%, 56.84%, 33.08% in patients with stage Ib, IIa, IIb, and IIIa, respectively, in the LAG and OG groups. There were no statistically significant differences in the OS rate for patients with the same TNM stage between the 2 groups. LAG with radical LN dissection is a safe and technically feasible procedure for the treatment of AGC staged below T3.

No MeSH data available.


Related in: MedlinePlus