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

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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.

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Cumulative curves for overall survival (OS) between the LAG and OG groups according to the TNM stage (AJCC, ver. 7). Overall 5-year survival rates of stage Ib, IIa, IIb, and IIIa were 85.38, 79.70, 57.81, and 34.60% and 88.31, 75.49, 56.84, and 33.08% in the LAG and OG groups, respectively. AJCC = American Joint Committee on Cancer, LGA = left gastric artery, OG = open gastrectomy, OS = overall survival.
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Figure 4: Cumulative curves for overall survival (OS) between the LAG and OG groups according to the TNM stage (AJCC, ver. 7). Overall 5-year survival rates of stage Ib, IIa, IIb, and IIIa were 85.38, 79.70, 57.81, and 34.60% and 88.31, 75.49, 56.84, and 33.08% in the LAG and OG groups, respectively. AJCC = American Joint Committee on Cancer, LGA = left gastric artery, OG = open gastrectomy, OS = overall survival.

Mentions: Twenty-five patients in the laparoscopic group and 23 in the open group were lost after a median follow-up time of 53.5 months. A total of 221 and 204 patients died of gastric cancer in the LAG and OG groups, respectively. The overall 5-year survival rates were 57.65 and 53.69% in the LAG and OG groups, respectively (Fig. 3). There was no statistically significant difference in the OS rate between groups (P = 0.22). The overall 5-year survival rates according to the subclassification for the TNM stage of patients 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 both groups. The details are shown in Fig. 4. There were no statistically significant differences in the OS rate for patients with the same TNM stage in the LAG and OG groups. Mortality primarily occurred because of tumor recurrence and distal metastasis. We detected 196 patients (31.2%) with tumor recurrence in the LAG group and 158 patients (27.3%) in the OG group; there was no difference in tumor recurrence between the 2 groups (P = 0.14). Recurrence patterns were compared after stratifying by pTNM stages. There were no differences in recurrence patterns between the 2 groups after we stratified them by pTNM stages (Table 5).


Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer
Cumulative curves for overall survival (OS) between the LAG and OG groups according to the TNM stage (AJCC, ver. 7). Overall 5-year survival rates of stage Ib, IIa, IIb, and IIIa were 85.38, 79.70, 57.81, and 34.60% and 88.31, 75.49, 56.84, and 33.08% in the LAG and OG groups, respectively. AJCC = American Joint Committee on Cancer, LGA = left gastric artery, OG = open gastrectomy, OS = overall survival.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4998323&req=5

Figure 4: Cumulative curves for overall survival (OS) between the LAG and OG groups according to the TNM stage (AJCC, ver. 7). Overall 5-year survival rates of stage Ib, IIa, IIb, and IIIa were 85.38, 79.70, 57.81, and 34.60% and 88.31, 75.49, 56.84, and 33.08% in the LAG and OG groups, respectively. AJCC = American Joint Committee on Cancer, LGA = left gastric artery, OG = open gastrectomy, OS = overall survival.
Mentions: Twenty-five patients in the laparoscopic group and 23 in the open group were lost after a median follow-up time of 53.5 months. A total of 221 and 204 patients died of gastric cancer in the LAG and OG groups, respectively. The overall 5-year survival rates were 57.65 and 53.69% in the LAG and OG groups, respectively (Fig. 3). There was no statistically significant difference in the OS rate between groups (P = 0.22). The overall 5-year survival rates according to the subclassification for the TNM stage of patients 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 both groups. The details are shown in Fig. 4. There were no statistically significant differences in the OS rate for patients with the same TNM stage in the LAG and OG groups. Mortality primarily occurred because of tumor recurrence and distal metastasis. We detected 196 patients (31.2%) with tumor recurrence in the LAG group and 158 patients (27.3%) in the OG group; there was no difference in tumor recurrence between the 2 groups (P = 0.14). Recurrence patterns were compared after stratifying by pTNM stages. There were no differences in recurrence patterns between the 2 groups after we stratified them by pTNM stages (Table 5).

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