1
|
Di Carlo S, Siragusa L, Fassari A, Fiori E, La Rovere F, Izzo P, Usai V, Cavallaro G, Franceschilli M, Dhimolea S, Sibio S. Laparoscopic versus Open Total Gastrectomy for Locally Advanced Gastric Cancer: Short and Long-Term Results. Curr Oncol 2022; 29:8442-8455. [PMID: 36354725 PMCID: PMC9689079 DOI: 10.3390/curroncol29110665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy for early gastric cancer is widely accepted and routinely performed. However, it is still debated whether the laparoscopic approach is a valid alternative to open gastrectomy in advanced gastric cancer (AGC). The aim of this study is to compare short-and long-term outcomes of laparoscopic (LG) and open (OG) total gastrectomy with D2 lymphadenectomy in patients with AGC. METHODS A retrospective comparative study was conducted on patients who underwent LG and OG for ACG between January 2015 and December 2021. Primary endpoints were the following: recurrence rate, 3-year disease-free survival, 3-year and 5-year overall survival. Univariate and multivariate analysis was conducted to compare variables influencing outcomes and survival. RESULTS Ninety-two patients included: fifty-three OG and thirty-nine LG. No difference in morbidity and mortality. LG was associated with lower recurrence rates (OG 22.6% versus LG 12.8%, p = 0.048). No differences in 3-year and 5-year overall survival; 3-year disease-free survival was improved in the LG group on the univariate analysis but not after the multivariate one. LG was associated with longer operative time, lower blood loss and shorter hospital stay. Lymph node yield was higher in LG. CONCLUSION LG for AGC seems to provide satisfactory clinical and oncological outcomes in medium volume centers, improved postoperative results and possibly lower recurrence rates.
Collapse
Affiliation(s)
- Sara Di Carlo
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Alessia Fassari
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Enrico Fiori
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca La Rovere
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Valeria Usai
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marzia Franceschilli
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Sirvjo Dhimolea
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Simone Sibio
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
- Correspondence:
| |
Collapse
|
2
|
Xie F, Wang ZH, Wu SS, Gang TR, Gao GX, Qu X, Zhang ZT. Comparing outcomes of single-port insufflation endoscopic breast-conserving surgery and conventional open approach for breast cancer. World J Surg Oncol 2022; 20:335. [PMID: 36203177 PMCID: PMC9535932 DOI: 10.1186/s12957-022-02798-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/24/2022] [Indexed: 12/09/2022] Open
Abstract
Background In the surgical treatment of breast cancer, the goal of surgeons is to continually create and improve minimally invasive surgical techniques to increase patients’ quality of life. Currently, routine breast-conserving surgery is often performed using two obvious incisions. Here, we compare the clinical efficacy and aesthetic outcomes of a novel technique using one incision, called ‘single-port insufflation endoscopic breast-conserving surgery’ (SIE-BCS), vs. conventional breast-conserving surgery (C-BCS) in patients with early-stage breast cancer. Methods A total of 180 patients with stage I or stage II breast cancer participated in this study, of whom 63 underwent SIE-BCS and 117 underwent C-BCS. Logistic regression analysis was conducted to assess the risk of local recurrence and metastasis. Aesthetic outcomes were evaluated using the BREAST-Q scale. Results The mean operation time was significantly longer for SIE-BCS (194.9 ± 71.5 min) than for C-BCS (140.3 ± 56.9 min), but the mean incision length was significantly shorter for SIE-BCS than for C-BCS (3.4 ± 1.2 cm vs. 8.6 ± 2.3 cm). While both surgeries yielded similar BREAST-Q ratings for satisfaction with breasts and sexual well-being, SIE-BCS was associated with significantly better ratings for physical well-being (chest area) and psychological well-being. Additionally, SIE-BCS was associated with decreased rates of adverse effects of radiation. The preliminary analysis showed that SIE-BCS did not increase the risk of local recurrence or metastasis. Conclusion The novel single-port insufflation endoscopic assisted BCS technique is feasible, safe, and improves patients’ postoperative comfort and psychological well-being, as compared to the conventional technique.
Collapse
Affiliation(s)
- Fang Xie
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.,Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, 23 Mei shu guan Back Street, Dong-Cheng District, Beijing, 100010, China
| | - Zi-Han Wang
- Department of Breast Disease, Peking University People's Hospital, 11 Xi zhi men South Street, Xi-Cheng District, Beijing, 100044, China
| | - Shan-Shan Wu
- Department of Clinical Epidemiology and Evidence-Based Medicine, Beijing Friendship Hospital, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Tian-Ran Gang
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Guo-Xuan Gao
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Xiang Qu
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
| | - Zhong-Tao Zhang
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
| |
Collapse
|
3
|
Garbarino GM, Laracca GG, Lucarini A, Piccolino G, Mercantini P, Costa A, Tonini G, Canali G, Muttillo EM, Costa G. Laparoscopic versus Open Surgery for Gastric Cancer in Western Countries: A Systematic Review and Meta-Analysis of Short- and Long-Term Outcomes. J Clin Med 2022; 11:3590. [PMID: 35806877 PMCID: PMC9267365 DOI: 10.3390/jcm11133590] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background. The advantages of a laparoscopic approach for the treatment of gastric cancer have already been demonstrated in Eastern Countries. This review and meta-analysis aims to merge all the western studies comparing laparoscopic (LG) versus open gastrectomies (OG) to provide pooled results and higher levels of evidence. Methods. A systematic literature search was performed in MEDLINE(PubMed), Embase, WebOfScience and Scopus for studies comparing laparoscopic versus open gastrectomy in western centers from 1980 to 2021. Results. After screening 355 articles, 34 articles with a total of 24,098 patients undergoing LG (5445) or OG (18,653) in western centers were included. Compared to open gastrectomy, laparoscopic gastrectomy has a significantly longer operation time (WMD = 47.46 min; 95% CI = 31.83−63.09; p < 0.001), lower blood loss (WMD = −129.32 mL; 95% CI = −188.11 to −70.53; p < 0.0001), lower analgesic requirement (WMD = −1.824 days; 95% CI = −2.314 to −1.334; p < 0.0001), faster time to first oral intake (WMD = −1.501 days; 95% CI = −2.571 to −0.431; p = 0.0060), shorter hospital stay (WMD = −2.335; 95% CI = −3.061 to −1.609; p < 0.0001), lower mortality (logOR = −0.261; 95% the −0.446 to −0.076; p = 0.0056) and a better 3-year overall survival (logHR 0.245; 95% CI = 0.016−0.474; p = 0.0360). A slight significant difference in favor of laparoscopic gastrectomy was noted for the incidence of postoperative complications (logOR = −0.202; 95% CI = −0.403 to −0.000 the = 0.0499). No statistical difference was noted based on the number of harvested lymph nodes, the rate of major postoperative complication and 5-year overall survival. Conclusions. In Western centers, laparoscopic gastrectomy has better short-term and equivalent long-term outcomes compared with the open approach, but more high-quality studies on long-term outcomes are required.
Collapse
Affiliation(s)
- Giovanni Maria Garbarino
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Giovanni Guglielmo Laracca
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Alessio Lucarini
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Gianmarco Piccolino
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Paolo Mercantini
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Alessandro Costa
- UniCamillus School of Medicine, Saint Camillus International University of Health and Medical Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy;
| | - Giuseppe Tonini
- Oncology Department, Fondazione Policlinico Campus Bio-Medico, University Campus Bio-Medico Hospital, Via Àlvaro del Portillo 200, 00128 Rome, Italy;
| | - Giulia Canali
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Edoardo Maria Muttillo
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Gianluca Costa
- Surgery Center, Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, University Campus Bio-Medico Hospital, Via Àlvaro del Portillo 200, 00128 Rome, Italy;
| |
Collapse
|
4
|
GOKSOY B, KİYAK M, YILMAZ G, AZAMAT İ, ERTORUL D, İNANÇ Ö, ARICAN Ç, CİL I, BİTİRİM M. Comparison of short-term results of open and laparoscopic surgery in gastric cancer at a new regional hospital: a single surgeon experience. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.977204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|