Laparoscopic Versus Open Subtotal Gastrectomy for Adenocarcinoma: A Case-Control Study
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Annals of Surgical Oncology
(Impact Factor: 3.93).
04/2009; 16(6):1507-13. DOI: 10.1245/s10434-009-0386-8
The aim of this study is to compare technical feasibility and oncologic efficacy of totally laparoscopic versus open subtotal gastrectomy for gastric adenocarcinoma.
Laparoscopic gastrectomy for adenocarcinoma is emerging in the West as a technique that may offer benefits for patients, although large-scale studies are lacking.
This study was designed as a case-controlled study from a prospective gastric cancer database. Thirty consecutive patients undergoing laparoscopic subtotal gastrectomy for adenocarcinoma were compared with 30 patients undergoing open subtotal gastrectomy. Controls were matched for stage, age, and gender via a statistically generated selection of all gastrectomies performed during the same period of time. Patient demographics, tumor-node-metastasis (TNM) stage, histologic features, location of tumor, lymph node retrieval, recurrence, margins, and early and late postoperative complications were compared.
Tumor location and histology were similar between the two groups. Median operative time for the laparoscopic approach was 270 min (range 150-485 min) compared with median of 126 min (range 85-205 min) in the open group (p < 0.01). Hospital length of stay after laparoscopic gastrectomy was 5 days (range 2-26 days), compared with 7 days (range 5-30 days) in the open group (p = 0.01). Postoperative pain, as measured by number of days of IV narcotic use, was significantly lower for laparoscopic patients, with a median of 3 days (range 0-11 days) compared with 4 days (range 1-13 days) in the open group (p < 0.01). Postoperative early complications trended towards a decrease for laparoscopic versus open surgery patients (p = 0.07); however, there were significantly more late complications for the open group (p = 0.03). Short-term recurrence-free survival and margin status was similar between the two groups (p = not significant) with adequate lymph node retrieval in both groups.
Laparoscopic subtotal gastrectomy for adenocarcinoma is comparable to the open approach with regard to oncologic principles of resection, with equivalent margin status and adequate lymph node retrieval, demonstrating technically feasibility and equivalent short-term recurrence-free survival. Additional benefits of decreased postoperative complications, decreased length of hospital stay, and decreased narcotic use make this a preferable approach for selected patients.
Available from: PubMed Central
- "However, inaccurate preoperative staging and a subsequent limited extent of surgery is an important issue. Many studies have shown that MIS does not increase peritoneal seeding or port site metastasis, even when used in cases of AGC.3,15,16,17,18,19 "
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ABSTRACT: Minimally invasive surgery, which has been extensively used to treat gastric adenocarcinoma, is now regarded as one of the standard treatments for early gastric cancer, and its suitability for advanced gastric cancer is being investigated. The use of cutting-edge techniques for minimally invasive surgery enables surgeons to deliver various treatment options to minimize a patient's distress and to maintain oncologic safety. Ongoing multicenter prospective studies aim to validate the efficacy of these surgical techniques and to expand the indications of minimally invasive surgery for the treatment of gastric cancer. In this review, we summarize the current status and issues regarding minimally invasive surgery for the treatment of gastric cancer.
Available from: PubMed Central
- "Recently, laparoscopy-assisted gastrectomy (LAG) has become an attractive treatment alternative in the East14-17 and some regions of the west18,19 as one of the minimally invasive options for early gastric cancer. First large-scale prospective randomized multicenter study of laparoscopic versus open gastrectomy for gastric cancer has been on-going by the Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) group since January 2006.14 "
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ABSTRACT: Curative surgery for patients with advanced or even early gastric cancer can be defined as resection of the stomach and dissection of the first and second level lymph nodes, including the greater omentum. The aim of this study was to evaluate the short- and long- term outcomes of partial omentectomy (PO) as compared with complete omentectomy (CO).
Seventeen consecutive open distal gastrectomies with POs were initially performed between February and July in 2006. The patients' clinicopathologic data and post-operative outcomes were retrospectively compared with 20 patients who underwent open distal gastrectomies with COs for early gastric cancer in 2005.
The operation time in PO group was significantly shorter than that in CO group (142.4 minutes vs. 165.0 minutes, p=0.018). The serum albumin concentration on the first post-operative day in PO group was significantly higher than CO group (3.8 g/dL vs. 3.5 g/dL, p=0.018). Three postoperative minor complications were successfully managed with conservative treatment. Median follow-up period between PO and CO was 38.1 and 37.7 months. All patients were alive without recurrence until December 30, 2009.
PO during open radical distal gastrectomy can be considered a more useful procedure than CO for treating early gastric cancer. To document the long-term technical and oncologic safety of this procedure, a large-scale prospective randomized trial will be needed.
Available from: Han Hong Lee
- "In Western countries, a small number of surgeons who challenged this approach did not restrict themselves to T1 stage cancer,  because most gastric cancers are diagnosed as locally advanced disease. A small number of studies comparing open and laparoscopic approaches have shown that survival data among those receiving laparoscopy were not inferior to open surgery, although there were significant reductions in pain and incidence of the late postoperative complications. "
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