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Calderón-Canseco IJ, Domínguez-Fonseca CB, Cerrillo-Miranda M, Pérez-Turrent MA, Fernández-Ananín S, Targarona Soler EM, Balagué-Ponz MC. Comparative Analysis of Laparoscopic Gastrectomy Versus Laparoscopic-Assisted Gastrectomy: Postoperative Complications. Cureus 2023; 15:e51186. [PMID: 38283490 PMCID: PMC10817766 DOI: 10.7759/cureus.51186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
The evolution of laparoscopic surgery in gastric cancer has advanced significantly, with benefits over open surgery initially demonstrated in early gastric cancer and later in advanced stages. This study aims to evaluate postoperative complications, surgical outcomes, and anastomosis safety by comparing laparoscopic gastrectomy and laparoscopic-assisted gastrectomy. This retrospective, observational, analytical study included patients diagnosed with gastric cancer who underwent laparoscopic gastrectomy at a university hospital from January 2006 to February 2018. Patients were initially divided into two groups based on the type of anastomosis: laparoscopic gastrectomy (intracorporeal anastomosis) and laparoscopic-assisted gastrectomy (extracorporeal anastomosis). Further secondary analysis was done with subgroups based on the type of gastrectomy and anastomosis performed. A total of 139 patients were analyzed, showing significant differences in postoperative complications between the two surgical approaches. The laparoscopic-assisted group exhibited a higher rate of complications. The laparoscopic approach (with intracorporeal anastomosis) was found to have a lower risk of complications and morbidity/mortality compared to the laparoscopic-assisted approach. Laparoscopic gastrectomy with intracorporeal anastomosis resulted in lower morbidity and mortality than laparoscopic-assisted gastrectomy. The technique of partial gastrectomy with intracorporeal anastomosis was associated with the lowest rate of postoperative complications.
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Affiliation(s)
- Iván Josué Calderón-Canseco
- General Surgery, Hospital General Regional No. 1 "Dr. Carlos Mac Gregor Sanchez Navarro" Instituto Mexicano del Seguro Social, Mexico City, MEX
| | - Claudia B Domínguez-Fonseca
- General Surgery, Hospital General Regional No. 1 "Dr. Carlos Mac Gregor Sanchez Navarro" Instituto Mexicano del Seguro Social, Mexico City, MEX
| | - Militza Cerrillo-Miranda
- General Surgery, Hospital General Regional No. 1 "Dr. Carlos Mac Gregor Sanchez Navarro" Instituto Mexicano del Seguro Social, Mexico City, MEX
| | - Manuel A Pérez-Turrent
- General Surgery, Hospital General Regional No. 1 "Dr. Carlos Mac Gregor Sanchez Navarro" Instituto Mexicano del Seguro Social, Mexico City, MEX
| | - Sonia Fernández-Ananín
- Gastrointestinal and Hematological Surgical Unit, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, ESP
| | - Eduardo María Targarona Soler
- Gastrointestinal and Hematological Surgical Unit, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, ESP
| | - María Carmen Balagué-Ponz
- Gastrointestinal and Hematological Surgical Unit, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, ESP
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Elmore U, Milone M, Parise P, Velotti N, Cossu A, Puccetti F, Barbieri L, Vertaldi S, Milone F, De Palma GD, Rosati R. Relaparoscopy in the management of post-operative complications after minimally invasive gastrectomy for gastric cancer. Updates Surg 2023; 75:429-434. [PMID: 35882769 PMCID: PMC9852154 DOI: 10.1007/s13304-022-01328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/05/2022] [Indexed: 01/24/2023]
Abstract
Laparoscopy has already been validated for treatment of early gastric cancer. Despite that, no data have been published about the possibility of a minimally invasive approach to surgical complications after primary laparoscopic surgery. In this multicentre study, we describe our experience in the management of complications following laparoscopic gastrectomy for gastric cancer. A chart review has been performed over data from 781 patients who underwent elective gastrectomy for gastric cancer between January 1996 and July 2020 in two high referral department of gastric surgery. A fully descriptive analysis was performed, considering all the demographic characteristics of patients, the type of primary procedure and the type of complication which required reoperation. Moreover, a logistic regression was designed to investigate if either the patients or the primary surgery characteristics could affect conversion rate during relaparoscopy. Fifty-one patients underwent reintervention after elective laparoscopic gastric surgery. Among patients who received a laparoscopic reintervention, 11 patients (34.3%) required a conversion to open surgery. Recovery outcomes were significantly better in patients who completed the reoperation through laparoscopy. Relaparoscopy is safe and effective for management of complications following laparoscopic gastric surgery and represent a useful tool both for re-exploration and treatment, in expert and skilled hands.
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Affiliation(s)
- Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini n.5, 80131 Naples, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Lavinia Barbieri
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini n.5, 80131 Naples, Italy
| | - Francesco Milone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini n.5, 80131 Naples, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
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Eom SS, Park SH, Eom BW, Yoon HM, Kim YW, Ryu KW. Short and Long-Term Surgical Outcomes of Laparoscopic Total Gastrectomy Compared with Open Total Gastrectomy in Gastric Cancer Patients. Cancers (Basel) 2022; 15:cancers15010076. [PMID: 36612073 PMCID: PMC9817857 DOI: 10.3390/cancers15010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This study aimed to compare the efficacy of laparoscopic total gastrectomy (LTG) with that of open total gastrectomy (OTG) in terms of postoperative complications and long-term survival. We retrospectively reviewed the clinicopathological data of 560 patients, who underwent total gastrectomy between 2012 and 2016 at the National Cancer Center, Korea. Propensity-score matching (PSM) was performed to correct for discrepancies between the two groups. Matched variables included sex, age, body mass index, American Society of Anesthesiologists score, and pathological Tumor-Node-Metastasis stage. After PSM, 238 patients were included in this analysis. The rate of D2 lymph node dissection was significantly higher in the OTG group than in the LTG group. The estimated blood loss was significantly lower in the LTG group than in the OTG group. The overall complication rate was not significantly different between the two groups. There was no significant difference in the 3-year disease-free and 5-year overall survival rates between the two groups. LTG and OTG had comparable efficacies in gastric cancer patients regarding short- and long-term surgical outcomes. This study suggests that LTG could be an alternative approach to the OTG.
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Caruso S, Giudicissi R, Mariatti M, Cantafio S, Paroli GM, Scatizzi M. Laparoscopic vs. Open Gastrectomy for Locally Advanced Gastric Cancer: A Propensity Score-Matched Retrospective Case-Control Study. Curr Oncol 2022; 29:1840-1865. [PMID: 35323351 PMCID: PMC8947505 DOI: 10.3390/curroncol29030151] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Minimally invasive surgery has been increasingly used in the treatment of gastric cancer. While laparoscopic gastrectomy has become standard therapy for early-stage gastric cancer, especially in Asian countries, the use of minimally invasive techniques has not attained the same widespread acceptance for the treatment of more advanced tumours, principally due to existing concerns about its feasibility and oncological adequacy. We aimed to examine the safety and oncological effectiveness of laparoscopic technique with radical intent for the treatment of patients with locally advanced gastric cancer by comparing short-term surgical and oncologic outcomes of laparoscopic versus open gastrectomy with D2 lymphadenectomy at two Western regional institutions. Methods: The trial was designed as a retrospective comparative matched case-control study for postoperative pathological diagnoses of locally advanced gastric carcinoma. Between January 2015 and September 2021, 120 consecutive patients who underwent curative-intent laparoscopic gastrectomy with D2 lymph node dissection were retrospectively recruited and compared with 120 patients who received open gastrectomy. In order to obtain a comparison that was as homogeneous as possible, the equal control group of pairing (1:1) patients submitted to open gastrectomy who matched those of the laparoscopic group was statistically generated by using a propensity matched score method. The following potential confounder factors were aligned: age, gender, Body Mass Index (BMI), comorbidity, ASA, adjuvant therapy, tumour location, type of gastrectomy, and pT stage. Patient demographics, operative findings, pathologic characteristics, and short-term outcomes were analyzed. Results: In the case-control study, the two groups were clearly comparable with respect to matched variables, as was expected given the intentional primary selective criteria. No statistically significant differences were revealed in overall complications (16.7% vs. 20.8%, p = 0.489), rate of reoperation (3.3% vs. 2.5%, p = 0.714), and mortality (4.2% vs. 3.3%, p = 0.987) within 30 days. Pulmonary infection and wound complications were observed more frequently in the OG group (0.8% vs. 4.2%, p < 0.01, for each of these two categories). Anastomotic and duodenal stump leakage occurred in 5.8% of the patients after laparoscopic gastrectomy and in 3.3% after open procedure (p = 0.072). The laparoscopic approach was associated with a significantly longer operative time (212 vs. 192 min, p < 0.05) but shorter postoperative length of stay (9.1 vs. 11.6 days, p < 0.001). The mean number of resected lymph nodes after D2 dissection (31.4 vs. 33.3, p = 0.134) and clearance of surgical margins (97.5% vs. 95.8%, p = 0.432) were equivalent between the groups. Conclusion: Laparoscopic gastrectomy with D2 nodal dissection appears to be safe and feasible in terms of perioperative morbidity for locally advanced gastric cancer, with comparable oncological equivalency with respect to traditional open surgery.
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Affiliation(s)
- Stefano Caruso
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
- Correspondence: ; Tel.: +39-55-9508373 or +39-349-8312397
| | - Rosina Giudicissi
- Department of General and Oncologic Surgery, Unit of General Surgery, Santo Stefano Hospital, Central Tuscany Local Health Company, 59100 Prato, Italy; (R.G.); (S.C.)
| | - Martina Mariatti
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
| | - Stefano Cantafio
- Department of General and Oncologic Surgery, Unit of General Surgery, Santo Stefano Hospital, Central Tuscany Local Health Company, 59100 Prato, Italy; (R.G.); (S.C.)
| | - Gian Matteo Paroli
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
| | - Marco Scatizzi
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
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Cai Z, Song H, Huang Z, Fingerhut A, Xu X, Zhong H, Li Z, Zhang Y, Sha D, Bao D, Wang H, Cai B, Hua S, Zhang Y, Sun J, Ye K, Li J, Lu Y, Feng B. Safety and feasibility of laparoscopic surgery for colorectal and gastric cancer under the Chinese multi-site practice policy: admittance standards of competence are needed. Gastroenterol Rep (Oxf) 2022; 10:goac046. [PMID: 36196254 PMCID: PMC9522381 DOI: 10.1093/gastro/goac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background The multi-site practice (MSP) policy has been practiced in China over 10 years. This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer (LSCRC) and gastric cancer (LSGC) under the Chinese MSP policy. Methods We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital (n = 573) and his MSP institutions (n = 508) between January 2017 and December 2020. Baseline demographics, intraoperative outcomes, post-operative recovery, and pathological results were compared between the original hospital and MSP institutions, as well as between MSP institutions with and without specific competence (surgical skill, operative instrument, perioperative multi-discipline team). Results In our study, 690 patients underwent LSCRC and 391 patients underwent LSGC. The prevalence of post-operative complications was comparable for LSCRC (11.5% vs 11.1%, P = 0.89) or LSGC (15.2% vs 12.6%, P = 0.46) between the original hospital and MSP institutions. However, patients in MSP institutions without qualified surgical assistant(s) and adequate instruments experienced longer operative time and greater intraoperative blood loss. The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC (11.5% vs 21.2%, P < 0.01) and LSGC (9.8% vs 20.5%, P < 0.01). Conclusion For an experienced gastrointestinal surgeon, performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible, but relies on the precondition that the MSP institutions are equipped with qualified surgical skills, adequate operative instruments, and complete perioperative management.
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Affiliation(s)
| | | | | | - Abraham Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Ximo Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Hao Zhong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Zhigang Li
- Department of General Surgery, Wuxi Huishan District People’s Hospital, Jiangsu, P. R. China
| | - Yingjie Zhang
- Department of General Surgery, Zhoushan Hospital, Zhejiang, P. R. China
| | - Dachong Sha
- Department of General Surgery, Cixi Third People’s Hospital, Zhejiang, P. R. China
| | - Dandan Bao
- Department of General Surgery, People’s Hospital of Wenzhou, Zhejiang, P. R. China
| | - Haibo Wang
- Department of General Surgery, Chinese PLA 107 Hospital, Shandong, P. R. China
| | - Binghua Cai
- Department of General Surgery, Rudong People’s Hospital, Jiangsu, P. R. China
| | - Shangbo Hua
- Department of General Surgery, Kunshan Hospital of Chinese Medicine, Jiangsu, P. R. China
| | - Yanhui Zhang
- Department of General Surgery, Jingjiang Chinese Medicine Hospital, Jiangsu, P. R. China
| | - Jianguang Sun
- Department of General Surgery, Haiyan People’s Hospital, Zhejiang, P. R. China
| | - Ke Ye
- Department of General Surgery, Yueqing People’s Hospital, Zhejiang, P. R. China
| | - Jianwen Li
- Corresponding author. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64370045; ; Department of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China; Tel: +86-21-64370045; ; Shanghai Minimally Invasive Surgery Center, No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64458887;
| | - Yong Lu
- Corresponding author. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64370045; ; Department of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China; Tel: +86-21-64370045; ; Shanghai Minimally Invasive Surgery Center, No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64458887;
| | - Bo Feng
- Corresponding author. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64370045; ; Department of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China; Tel: +86-21-64370045; ; Shanghai Minimally Invasive Surgery Center, No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64458887;
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Laparoscopic gastrectomy for gastric cancer: has the time come for considered it a standard procedure? Surg Oncol 2022; 40:101699. [PMID: 34995972 DOI: 10.1016/j.suronc.2021.101699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/29/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022]
Abstract
Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer. A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage gastric cancer. At present, laparoscopic gastrectomy is considered a standard procedure for early-stage gastric cancer, especially in Asian countries. On the other hand, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Additional high-quality studies comparing laparoscopic gastrectomy versus open gastrectomy for gastric cancer have been recently published, in particular concerning the latest results obtained by laparoscopic approach to advanced gastric cancer. It seems very useful to update the review of literature in light of these new evidences for this subject and draw some considerations.
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Yüksel A, Coşkun M, Turgut HT, Sümer F. Comparison of open and laparoscopic gastrectomy for gastric cancer: a low volume center experience. Turk J Surg 2021; 37:33-40. [PMID: 34585092 DOI: 10.47717/turkjsurg.2021.5048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/12/2021] [Indexed: 12/24/2022]
Abstract
Objectives In gastric cancer, laparoscopic gastrectomy is commonly performed in Asian countries. In other regions where tumor incidence is relatively low and patient characteristics are different, developments in this issue have been limited. In this study, we aimed to compare the early results for patients who underwent open or laparoscopic gastrectomy for gastric cancer in a low volume center. Material and Methods We retrospectively analyzed the data of patients who underwent curative gastric resection (open gastrectomy n: 30; laparoscopic gastrectomy n: 30) by the same surgical team between 2014 and 2019. Results The tumor was localized in 60% (36/60) of the patients in the proximal and middle 1/3 stomach. In laparoscopic gastrectomy group, the operation time was significantly longer (median, 297.5 vs 180 minutes; p <0.05). In open gastrectomy group, intraoperative blood loss (median 50 vs 150 ml; p <0.05) was significantly higher. Tumor negative surgical margin was achieved in all cases. Although the mean number of lymph nodes harvested in laparoscopic gastrectomy group was higher than the open surgery group, the difference was not statistically significant (28.2 ± 11.48 vs 25.8 ± 9.78, respectively; p= 0.394). The rate of major complications (Clavien-Dindo ≥ grade 3) was less common in the laparoscopic group (6.7% vs 16.7%; p= 0.642). Mortality was observed in four patients (2 patients open, 2 patients laparoscopic). Conclusion In low-volume centers with advanced laparoscopic surgery experience, laparoscopic gastrectomy for gastric cancer can be performed with the risk of morbidity-mortality similar to open gastrectomy.
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Affiliation(s)
- Adem Yüksel
- Clinic of Gastroenterological Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Murat Coşkun
- Clinic of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Hamdi Taner Turgut
- Clinic of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Fatih Sümer
- Department of Gastroenterological Surgery, Inonu University School of Medicine, Malatya, Turkey
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Sakurazawa N, Harada J, Ando F, Arai H, Kuge K, Matsumoto S, Kawano Y, Matsuda A, Suzuki H, Yoshida H. Evaluation of the safety and efficacy of suction-tip forceps, a new tool for laparoscopic surgery, for gastric cancer. Asian J Endosc Surg 2021; 14:232-240. [PMID: 32911571 PMCID: PMC8048834 DOI: 10.1111/ases.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/20/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Laparoscopic surgery is a minimally invasive surgery; however, obstacles to its functional optimization remain. Surgical ports can accommodate only one instrument at a time so complex exchange manipulations are necessary during surgery which increases operation times and patient risk. We developed a new laparoscopic instrument that functions as both forceps and a suction tube, which renders intraoperative tool exchange unnecessary. This pilot study was undertaken to evaluate the safety and efficacy of this novel dual-function device in laparoscopic surgery for gastric cancer. METHODS This single-center pilot study assessed patient safety during and after laparoscopic distal gastrectomy for gastric cancer with the suction-forceps using intraoperative video and clinical follow-up, respectively. To evaluate instrument efficacy, we measured the time interval between the start of any bleeding and the start of aspiration ("suction access time") and compared this time with that of a conventional surgical setup. RESULTS In total 15 patients participated, with all procedures being successful. No excess tissue damage occurred during surgery. Suction access time was significantly shorter in cases of bleeding when the suction-tip forceps were used for aspiration (2.01 seconds) compared to an ordinary suction tube (12.5 seconds; P < .01). CONCLUSION These findings suggest that our new suction-tip forceps are a useful, safe, and efficacious operative tool. This surgical innovation may considerably simplify gastric laparoscopic surgery. This pilot study was registered with Japan Clinical Trial Registration on 22 June 2017 (registration number: UMIN000027879).
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Affiliation(s)
| | | | - Fumihiko Ando
- Department of Digestive SurgeryNippon Medical SchoolTokyoJapan
| | - Hiroki Arai
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Komei Kuge
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Satoshi Matsumoto
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Youichi Kawano
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Akihisa Matsuda
- Department of Digestive SurgeryNippon Medical SchoolTokyoJapan
| | - Hideyuki Suzuki
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Hiroshi Yoshida
- Department of Digestive SurgeryNippon Medical SchoolTokyoJapan
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Zhu G, Hu J, Lu L, Wei S, Xiong Z. A Comparison of the Short-Term Clinical Effects Between Totally Laparoscopic Radical Gastrectomy With Modified Roux-en-Y Anastomosis and Laparoscopic-Assisted Radical Gastrectomy With Roux-en-Y Anastomosis. Technol Cancer Res Treat 2020; 19:1533033820973281. [PMID: 33172344 PMCID: PMC7672738 DOI: 10.1177/1533033820973281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To compare the short-term clinical effects between totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis, and laparoscopic-assisted radical gastrectomy with Roux-en-Y anastomosis; to explore the safety, feasibility and short-term effect of totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis. Methods: Data of 75 patients who underwent totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis, and 95 patients who underwent laparoscopic-assisted radical gastrectomy with Roux-en-Y anastomosis by the same surgical team were analyzed. During the modified Roux-en-Y anastomosis, the stomach separation and regional lymph node dissection were completed under a laparoscope; the specimen was placed in a bag; gastrojejunostomy was completed; the subumbilicus hole was enlarged to 3 cm; the specimen was taken out; then, the proximal and distal ends of the small intestine were moved outside of the abdominal wall to complete the small intestine-small intestine end-to-side anastomosis. Results: All 170 operations were successful. The differences in the time of anastomosis and the number of dissected lymph nodes between the 2 groups were not statistically significant (P > 0.05), but in the totally-MA group the amount of bleeding and the length of incision significantly decreased (P < 0.05). The recovery time as measured by breathing unassisted, drinking fluids and getting out of bed was significantly shorter than those in the laparoscopic-assisted group (P < 0.05), and the pain score 1 day after surgery was significantly lower than that of the laparoscopic-assisted group (P < 0.05). One case of duodenal stump leakage and 1 case of esophagojejunostomy leakage were found in the laparoscopic-assisted group. In the totally-MA group, there were no complications such as anastomotic leakage, anastomotic stenosis or anastomotic bleeding, but 2 patients with double primary carcinoma underwent joint radical resection. Conclusion: Compared with laparoscopic-assisted surgery, totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis has the advantages of being safer and less traumatic, with associated reductions in bleeding and pain.
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Affiliation(s)
- Guangsheng Zhu
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
| | - Junjie Hu
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
| | - Li Lu
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
| | - Shaozhong Wei
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
| | - Zhiguo Xiong
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
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10
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Zhu Z, Li L, Xu J, Ye W, Zeng J, Chen B, Huang Z. Laparoscopic versus open approach in gastrectomy for advanced gastric cancer: a systematic review. World J Surg Oncol 2020; 18:126. [PMID: 32534587 PMCID: PMC7293787 DOI: 10.1186/s12957-020-01888-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Additional studies comparing laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for advanced gastric cancer (AGC) have been published, and it is necessary to update the systematic review of this subject. OBJECTIVE We conducted the meta-analysis to find some proof for the use of LG in AGC and evaluate whether LG is an alternative treatment for AGC. METHOD Randomized controlled trials (RCT) and high-quality retrospective studies (NRCT) compared LG and OG for AGC, which were published in English between January 2010 and May 2019, were search in PubMed, Embase, and Web of Knowledge by three authors independently and thoroughly. Some primary endpoints were compared between the two groups, including intraoperative time, intraoperative blood loss, harvested lymph nodes, first flatus, first oral intake, first out of bed, post-operative hospital stay, postoperative morbidity and mortality, rate of disease recurrence, and 5-year over survival (5-y OS). Besides, considering for this 10-year dramatical surgical material development between 2010 and 2019, we furtherly make the same analysis based on recent studies published between 2016 and 2019. RESULT Thirty-six studies were enrolled in this systematic review and meta-analysis, including 5714 cases in LAG and 6094 cases in OG. LG showed longer intraoperative time, less intraoperative blood loss, and quicker recovery after operations. The number of harvested lymph nodes, hospital mortality, and tumor recurrence were similar. Postoperative morbidity and 5-y OS favored LG. Furthermore, the systemic analysis of recent studies published between 2016 and 2019 revealed similar result. CONCLUSION A positive trend was indicated towards LG. LG can be performed as an alternative to OG for AGC.
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Affiliation(s)
- Zhipeng Zhu
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China
| | - Lulu Li
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China
| | - Jiuhua Xu
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, Fujian, People's Republic of China
| | - Weipeng Ye
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, Fujian, People's Republic of China
| | - Junjie Zeng
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China
| | - Borong Chen
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China
| | - Zhengjie Huang
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China. .,Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, Fujian, People's Republic of China.
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Gambhir S, Inaba CS, Whealon M, Sujatha-Bhaskar S, Pejcinovska M, Nguyen NT. Short- and long-term survival after laparoscopic versus open total gastrectomy for gastric adenocarcinoma: a National database study. Surg Endosc 2020; 35:1872-1878. [PMID: 32394166 DOI: 10.1007/s00464-020-07591-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of laparoscopic total gastrectomy for gastric cancer remains controversial. Our objective was to compare outcomes of laparoscopic total gastrectomy (LTG) vs. open total gastrectomy (OTG) for gastric adenocarcinoma using a national cancer database. METHODS The National Cancer Database (2010-2014) was analyzed for total gastrectomy cases performed for gastric adenocarcinoma. Patient demographics and surgical outcomes were stratified by stage and compared based on laparoscopic vs. open surgical approach. Primary outcome measures included 30-day and 90-day mortality and Kaplan-Meier curves to estimate long-term survival. RESULTS There were 2584 cases analyzed, including 592 (22.9%) stage I, 710 (27.5%) stage II, and 1282 (49.6%) stage III cases. The distribution of LTG vs. OTG cases was 156 (26.4%) vs. 436 (73.6%) for stage I, 163 (23.0%) vs. 547 (77.0%) for stage II, and 241 (18.8%) vs. 1041 (81.2%) for stage III. For all stages analyzed, there was no difference between laparoscopic vs. open approach for adjusted 30-day mortality (stage I: adjusted odds ratio (AOR) 0.52, p = 0.75; stage II: AOR 1.36, p > 0.99; stage III: AOR 0.46, p = 0.29) or 90-day mortality (stage I: AOR 0.46, p = 0.99; stage II: AOR 1.17, p = 0.99; stage III: 0.57, p = 0.29). There was no difference between LTG vs. OTG 5-year Kaplan-Meier estimated survival curves for any stage (stage I: p = 0.20; stage II: p = 0.83; stage III: p = 0.46). When compared to OTG, LTG had a similar hazard ratio (HR) for mortality (HR 0.89 p = 0.20). CONCLUSIONS Laparoscopic total gastrectomy and OTG have comparable 30-day mortality, 90-day mortality, and long-term survival.
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Affiliation(s)
- Sahil Gambhir
- Department of Surgery, University of California Irvine Medical Center, 333 City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - Colette S Inaba
- Department of Surgery, University of California Irvine Medical Center, 333 City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - Matthew Whealon
- Department of Surgery, University of California Irvine Medical Center, 333 City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - Sarath Sujatha-Bhaskar
- Department of Surgery, University of California Irvine Medical Center, 333 City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - Marija Pejcinovska
- Center for Statistical Consulting, University of California Irvine, Irvine, CA, 92697, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, 333 City Blvd West, Suite 1600, Orange, CA, 92868, USA.
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12
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Yan JF, Chen K, Pan Y, Maher H, Zhu HP, Lou SM, Wang Y. Laparoscopic gastrectomy using intracorporeally hand-sewn anastomosis of esophagojejunostomy, gastroduodenostomy, or gastrojejunostomy for gastric cancer. Medicine (Baltimore) 2020; 99:e19002. [PMID: 32000441 PMCID: PMC7004744 DOI: 10.1097/md.0000000000019002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Laparoscopic gastrectomy (LG) using intracorporeal anastomosis has recently become more prevalent due to the advancements of laparoscopic surgical instruments. However, intracorporeally hand-sewn anastomosis (IHSA) is still uncommon because of technical difficulties. In this study, we evaluated various types of IHSA following LG with respect to the technical aspects and postoperative outcomes.Seventy-six patients who underwent LG using IHSA for treatment of gastric cancer between September 2014 and June 2018 were enrolled in this study. We described the details of IHSA in step-by-step manner, evaluated the clinicopathological data and surgical outcomes, and summarized the clinical experiences.Four types of IHSA have been described: one for total gastrectomy (Roux-en-Y) and 3 for distal gastrectomy (Roux-en-Y, Billroth I, and Billroth II). The mean operation time and anastomotic time was 288.7 minutes and 54.3 minutes, respectively. Postoperative complications were observed in 13 patients. All of the patients recovered well with conservative surgical management. There was no case of conversion to open surgery, anastomotic leakage, or mortality.LG using IHSA was safe and feasible and had several advantages compared to mechanical anastomosis. The technique lengthened operating time, but this could be mitigated by increased surgical training and experience.
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Affiliation(s)
- Jia-Fei Yan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,
| | - Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,
| | - Hendi Maher
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - He-Pan Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,
| | - Song-Mei Lou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,
| | - Yong Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,
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Ito Y, Kanda M, Ito S, Mochizuki Y, Teramoto H, Ishigure K, Murai T, Asada T, Ishiyama A, Matsushita H, Tanaka C, Kobayashi D, Fujiwara M, Murotani K, Kodera Y. Prognosis After Laparoscopic Gastrectomy in Patients with Pathological Stage II or III Gastric Cancer Who Were Preoperatively Diagnosed with Clinical Stage I: Propensity Score Matching Analysis of a Multicenter Dataset. Ann Surg Oncol 2019; 27:268-275. [PMID: 31493125 DOI: 10.1245/s10434-019-07781-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) is a standard approach for patients with clinical stage I gastric cancer in East Asia; however, following surgery, these patients may be pathologically diagnosed with stage II or III cancer. The prognosis of patients with gastric cancer migration from clinical stage I to pathological stage II or III after LG has not been completely clarified. METHODS To compare the prognosis following LG and open gastrectomy (OG) in patients with pathological stage II or III gastric cancer who were preoperatively diagnosed with stage I cancer, we conducted a retrospective analysis using a multicenter dataset comprising details of 3480 patients who underwent gastrectomy between 2010 and 2014 at nine participating institutions. We used propensity score matching to reduce selection bias. RESULTS After propensity score matching, 146 patients were finally selected. There were no significant differences in the number of dissected lymph nodes. Morbidity rates, length of postoperative hospital stay, and time between surgery and initiation of adjuvant chemotherapy were comparable between the two groups. Moreover, there were no significant differences in the overall, disease-specific, and relapse-free survival rates between the LG and OG groups. The LG group tended to have more patients with hematogenous recurrence, whereas the OG group tended to have more patients with peritoneal recurrence. CONCLUSIONS Our multicenter dataset analysis indicated that the prognosis of patients with gastric cancer migration from clinical stage I to pathological stage II or III was independent of the surgical approach.
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Affiliation(s)
- Yuki Ito
- Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.,Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Chuo Hospital, Nagoya, Japan
| | | | - Hitoshi Teramoto
- Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | | | - Toshifumi Murai
- Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takahiro Asada
- Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | | | | | - Chie Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Kobayashi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Murotani
- Division of Biostatistics, Clinical Research Center, Aichi Medical University Hospital, Nagakute, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
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14
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Zhao S, Zheng K, Zheng JC, Hou TT, Wang ZN, Xu HM, Jiang CG. Comparison of totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy: A systematic review and meta-analysis. Int J Surg 2019; 68:1-10. [PMID: 31189084 DOI: 10.1016/j.ijsu.2019.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/19/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic-assisted total gastrectomy (LATG) has been extensively employed for the removal of gastric tumors, although it has several limitations. Totally laparoscopic total gastrectomy (TLTG) is a new technique that has rapidly been gaining popularity, and may help overcome the limitations of LATG; however, its safety and therapeutic effect remain controversial. In the present study, we aimed to assess the safety and efficacy of TLTG, and compare the short-term outcomes of TLTG and LATG. METHODS We searched for studies comparing TLTG and LATG published up to April 2018 from databases such as PubMed and Embase. The study results, including time of surgery, blood loss, anastomosis time, retrieved lymphatic nodes, proximal and distal resection edges, incision length, time to first fluid and soft diet, hospitalization duration, time to first flatus, and postsurgical and anastomotic complications, were compared between the procedures. RESULTS A total of 10 studies were included. TLTG led to reduced intraoperative blood loss (P < 0.01), greater number of retrieved lymphatic nodes (P < 0.01), decreased hospitalization duration (P < 0.01), reduced incision length (P = 0.05), and shorter time to first fluid diet (P < 0.05), as compared to LATG. The surgery and anastomosis times, time to first soft diet, resection edge, time to first flatus, overall postsurgical complications, and anastomosis-related complications were similar between TLTG and LATG (P > 0.05). CONCLUSIONS TLTG is a safe procedure that yields better cosmesis lower invasiveness, and faster recovery as compared to LATG.
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Affiliation(s)
- Shuai Zhao
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Kai Zheng
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jian-Chun Zheng
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tao-Tao Hou
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhen-Ning Wang
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hui-Mian Xu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Cheng-Gang Jiang
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
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16
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Dias AR, Jacob CE, Ramos MFKP, Pereira MA, Szor DJ, Yagi OK, Barchi LC, Ribeiro U, Zilberstein B, Cecconello I. Laparoscopic D2 Gastrectomy for Gastric Cancer: Mid-Term Results and Current Evidence. J Laparoendosc Adv Surg Tech A 2019; 29:495-502. [PMID: 30526290 DOI: 10.1089/lap.2018.0474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Although the first laparoscopic gastrectomy was performed in 1991, there was a long delay until it was incorporated into the regular practice of western surgeons. In Brazil, there are only few case series reported and data on its safety and efficacy along with mid- and long-term results are desired. OBJECTIVE Present the mid-term results of laparoscopic gastrectomy with curative intent in the treatment of gastric adenocarcinoma and review the current evidence on the therapy of this neoplasia with the laparoscopic access. METHODS Patients who underwent D2 laparoscopic gastrectomy for gastric adenocarcinoma were retrospectively reviewed. RESULTS Sixty-nine patients met the inclusion criteria. The mean age was 59.2 years and the mean body mass index was 24.2 kg/m2. Subtotal gastrectomy was performed in 73.9%. The mean number of harvested lymph nodes was 36.7, increased lymph node count and shorter operative time were observed in the last 34 cases. Median hospital stay was 8 days. Postoperative complications occurred in 22 (31.9%) cases. Surgical mortality was 4.3%. CONCLUSION Laparoscopic gastrectomy can be performed safely with excellent short- and mid-term results. As experience increases, surgical duration is reduced and lymph node count rises.
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Affiliation(s)
- Andre Roncon Dias
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos Eduardo Jacob
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Marina Alessandra Pereira
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniel Jose Szor
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Osmar Kenji Yagi
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Leandro Cardoso Barchi
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ulysses Ribeiro
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Zilberstein
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ivan Cecconello
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Laparoscopy-assisted versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: Results From a Randomized Phase II Multicenter Clinical Trial (COACT 1001). Ann Surg 2019; 267:638-645. [PMID: 28187041 DOI: 10.1097/sla.0000000000002168] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This randomized, phase II, multicenter clinical trial was conducted to evaluate the feasibility of laparoscopy-assisted distal gastrectomy (LADG) with D2 lymph node dissection compared with open distal gastrectomy (ODG) for the treatment of advanced gastric cancer (AGC). SUMMARY OF BACKGROUND DATA D2 lymph node dissection has been accepted as standard treatment for AGC. Although LADG is widely performed in early gastric cancer (EGC), the feasibility of LADG in AGC has not been proven yet. METHODS Patients with cT2-T4a and cN0-2 (AJCC 7 staging system) distal gastric cancer were randomly but not blindingly assigned to LADG or ODG groups using fixed block sizes with a 1:1 allocation ratio. The primary endpoint was the noncompliance rate of the lymph node dissection, which was used to evaluate feasibility. Secondary endpoints included 3-year disease-free survival (DFS), 5-year overall survival, complications, and surgical stress response. RESULTS Between June 2010 and October 2011, 204 patients enrolled and underwent either LADG (n = 105) or ODG (n = 99). Of these, 196 patients (100 in LADG and 96 in ODG) were included in the intention-to-treat analysis. There were no significant differences in the overall noncompliance rate of lymph node dissection between LADG and ODG groups (47.0% and 43.2%, respectively; P = 0.648). In the subgroup analysis, the noncompliance rate in the LADG group was significantly higher than the ODG group for clinical stage III disease (52.0% vs 25.0%, P = 0.043). No difference was found in the 3-year DFS rate between the groups (LADG, 80.1%; ODG, 81.9%; P = 0.448). Differences in postoperative complication rates and surgical stress response were found to be insignificant between the 2 arms. CONCLUSIONS LADG was feasible for AGC treatment based on the noncompliance rate of D2 lymph node dissection. Subgroups analysis data suggest that further studies are needed for stage III gastric cancer.
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Li Z, Liu Y, Hao Y, Bai B, Yu D, Zhao Q. Surgical and long-term oncologic outcomes of laparoscopic and open gastrectomy for serosa-positive (pT4a) gastric cancer: A propensity score-matched analysis. Surg Oncol 2019; 28:167-173. [DOI: 10.1016/j.suronc.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/13/2018] [Accepted: 01/01/2019] [Indexed: 12/17/2022]
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Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach. J Gastric Cancer 2019; 19:1-48. [PMID: 30944757 PMCID: PMC6441770 DOI: 10.5230/jgc.2019.19.e8] [Citation(s) in RCA: 273] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
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Li Z, Zhao Y, Lian B, Liu Y, Zhao Q. Long-term oncological outcomes in laparoscopic versus open gastrectomy for advanced gastric cancer: A meta-analysis of high-quality nonrandomized studies. Am J Surg 2019; 218:631-638. [PMID: 30712863 DOI: 10.1016/j.amjsurg.2019.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multicenter randomized controlled trials (RCTs) and several meta-analyses have confirmed that laparoscopic gastrectomy (LG) is a safe and feasible procedure for patients with locally advanced gastric cancer (AGC) in terms of short-term outcomes. However, the long-term oncological outcomes of LG for AGC are still needed for further evaluation. This study aimed to compare the long-term oncological outcomes of LG with open gastrectomy (OG) for patients with AGC. METHODS We performed a systematic literature search in various databases from January 1997 to August 2018. Studies comparing the long-term oncological outcomes between LG with OG were evaluated and data were extracted accordingly. We performed the meta-analysis using RevMan 5.3 software. RESULTS Fifteen studies with 4494 patients (2273 in LG group and 2221 in OG group) were included. The 5-year overall survival (OS) rate (HR 0.95, 95% CI 0.86 to 1.05, P = 0.28), disease-free survival (DFS) rate (HR 0.93, 95% CI 0.81 to 1.06, P = 0.27), and recurrence rate (OR 0.87, 95% CI 0.72 to 1.04, P = 0.13) were comparable in LG and OG. Subgroup analysis showed the publication year, study region, sample size, extent of resection, extent of lymphadenectomy, retrieved lymph nodes, proportion of stage III, and patients with serosa-positive (pT4a) did not influence the estimates. CONCLUSIONS For patients with AGC, LG is a feasible surgical procedure alternative to OG in terms of long-term oncological outcomes.
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Affiliation(s)
- Zhengyan Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
| | - Yan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Bo Lian
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Yezhou Liu
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Qingchuan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
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Learning curve of totally laparoscopic distal gastrectomy for gastric cancer: a single teaching hospital study. Wideochir Inne Tech Maloinwazyjne 2018; 13:442-447. [PMID: 30524613 PMCID: PMC6280086 DOI: 10.5114/wiitm.2018.78965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/26/2018] [Indexed: 01/28/2023] Open
Abstract
Introduction Totally laparoscopic distal gastrectomy (TLDG) for gastric cancer has gradually gained popularity. However, the learning curve of TLDG is rarely reported. Aim To determine the learning curve of TLDG for gastric cancer. Material and methods We retrospectively reviewed and analyzed the medical records of 80 patients with gastric cancer who underwent TLDG with lymph node dissection from January 2016 to December 2017. We divided the patients into four groups based on when they underwent TLDG: group A (cases 1–20), group B (cases 21–40), group C (cases 41–60), and group D (cases 61–80). Comparative analyses of clinical data, including clinicopathologic characteristics, operative data, and postoperative course, were performed for these groups. Results No significant difference was observed between the groups in various clinicopathologic characteristics. Total operative time for group A (168.3 ±14.6 min) was significantly longer than for groups B (152.5 ±10.5 min), C (154.2 ±11.6 min), and D (155.3 ±10.8 min), but there was no significant difference between groups B, C, and D. Anastomosis time for group A (27.5 ±12.4 min) was significantly longer than for groups B (15.3 ±4.6 min), C (16.6 ±5.7 min), and D (15.4 ±4.5 min), but there was no significant difference between groups B, C, and D. Non-anastomosis time, estimated blood loss, retrieved lymph nodes, time to first flatus, time to first oral intake, and postoperative hospital stay and complications showed no difference between the four groups. Conclusions An experience of approximately 20 cases of TLDG was required to complete the learning curve.
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Management of advanced gastric cancer: An overview of major findings from meta-analysis. Oncotarget 2018; 7:78180-78205. [PMID: 27655725 PMCID: PMC5363654 DOI: 10.18632/oncotarget.12102] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022] Open
Abstract
This study aims to provide an overview of different treatment for advanced gastric cancer. In the present study, we systematically reviewed the major findings from relevant meta-analyses. A total of 54 relevant papers were searched via the PubMed, Web of Science, and Google scholar databases. They were classified according to the mainstay treatment modalities such as surgery, chemotherapy and others. Primary outcomes including overall survival, response rate, disease-free survival, recurrence-free survival, progression-free survival, time-to-progression, time-to failure, recurrence and safety were summarized. The recommendations and uncertainties regarding the treatment of advanced gastric cancer were also proposed. It was suggested that laparoscopic gastrectomy was a safe and technical alternative to open gastrectomy. Besides, neoadjuvant chemotherapy and adjuvant chemotherapy were thought to benefit the survival over surgery alone. And it was demonstrated in the study that targeted therapy like anti-angiogenic and anti-HER2 agents but anti-EGFR agent might have a significant survival benefit.
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Application of Laparoscopic Gastrectomy in Obese Patients (BMI≥30 kg/m2) with Gastric Cancer: A Comparison With Open Gastrectomy Regarding Short-term Outcomes. Surg Laparosc Endosc Percutan Tech 2017; 28:e18-e23. [PMID: 29176372 DOI: 10.1097/sle.0000000000000497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Few studies have compared the surgical outcomes of laparoscopic (LG) and open (OG) gastrectomy in obese patients (BMI≥30 kg/m) with gastric cancer. The current study aimed to investigate the short-term outcomes of LG in this group of patients. METHODS A total of 33 LG cases and 23 OG cases (BMI≥30 kg/m) were identified from our gastric cancer database. Clinicopathologic features, operative details, laboratory examination, and postoperative outcomes were compared between both groups. Regression analysis was used to determine the effects of BMI on intraoperative outcomes. RESULTS The 2 groups had comparable clinicopathologic characteristics. LG was associated with significantly lesser blood loss, whereas both also groups had a similar operative time, and number of harvested lymph nodes. However, regression analysis indicated that increased BMI affected the operative time and blood loss in patients that underwent OG but had little effect on patients who received LG. The elevation of inflammatory factors (WBC, CRP) was lower in LG than in OG, postoperatively. Postoperative hepatic (alanine aminotransferase, total bilirubin, albumin) and renal (creatinine, blood urea nitrogen) functions in the LG group were not worse than in the OG group. The time to first flatus, initiation of diet, hospitalization, and postoperative complications seemed superior in LG than in OG, but these differences were not statistically significant. CONCLUSION LG can be safely performed in obese gastric cancer patients. Compared with conventional OG, LG is less invasive and is characterized by less blood loss and milder surgical trauma. LG is also less adversely affected by increased BMI.
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Li Z, Wang Q, Li B, Bai B, Zhao Q. Influence of enhanced recovery after surgery programs on laparoscopy-assisted gastrectomy for gastric cancer: a systematic review and meta-analysis of randomized control trials. World J Surg Oncol 2017; 15:207. [PMID: 29169362 PMCID: PMC5701340 DOI: 10.1186/s12957-017-1271-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022] Open
Abstract
Background This meta-analysis is aimed to evaluate the feasibility and safety of enhanced recovery after surgery (ERAS) programs in gastric cancer patients undergoing laparoscopy-assisted gastrectomy (LAG). Methods We performed a meta-analysis of randomized control trials involving either enhanced recovery after surgery (ERAS)/fast track surgery (FTS) for patients underwent LAG. EMBASE, Pubmed, Web of science, and Cochrane Library were searched. Primary outcomes included the length of postoperative hospital stay, cost of hospitalization, postoperative complications, and readmission rate. Results Five randomized control trials were eligible for analysis. There were 159 cases in FTS group and 156 cases in conventional care group. Compared with conventional care group, FTS group relates to shorter postoperative hospital stay (WMD − 2.16; 95% CI − 3.05 to − 1.26, P < 0.00001), less cost of hospitalization (WMD − 4.72; 95% CI − 6.88 to − 2.55, P < 0.00001), shorter time to first flatus (WMD − 9.72; 95% CI − 13.75 to − 5.81, P < 0.00001), lower level of C-reaction protein on postoperative days 3 or 4 (WMD − 19.66; 95% CI − 28.98 to − 10.34, P < 0.00001), higher level of albumin on postoperative day 4 (WMD 3.45; 95% CI 2.01 to 4.89, P < 0.00001), and postoperative day 7 (WMD 5.63; 95% CI 1.01 to 10.24, P = 0.02). Regarding postoperative complications, no significant differences were observed between FTS group and conventional care group (OR 0.63, 95% CI 0.37 to 1.09, P = 0.10). The readmission rate of FTS group was comparable to conventional care group (WMD 3.14; 95% CI 0.12 to 81.35, P = 0.49). Conclusions Among patients undergoing LAG, FTS is associated with shorter postoperative hospital stay, rapid postoperative recovery, and decreased cost without increasing complications or readmission rate. The combined effects of the two methods could further accelerate clinical recovery of gastric cancer patients.
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Affiliation(s)
- Zhengyan Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China
| | - Qian Wang
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China
| | - Bofei Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China
| | - Bin Bai
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China
| | - Qingchuan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China.
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Chen K, Pan Y, Zhai ST, Cai JQ, Chen QL, Chen DW, Zhu YP, Zhang Y, Zhang YP, Maher H, Wang XF. Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods. BMC Gastroenterol 2017. [PMID: 28629379 PMCID: PMC5477413 DOI: 10.1186/s12876-017-0638-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Obesity is a growing epidemic around the world, and obese patients are generally regarded as high risk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of obesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer. Methods We reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004 and December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were compared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used methods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more suitable for obese patients. Results A total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study period. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 ± 29.7 vs. 227.2 ± 25.7 min, P < 0.01), and intraoperative blood loss was significantly lower in the non-obese group (113.4 ± 34.1 vs. 136.9 ± 36.7 ml, P < 0.01). Time to first flatus, time to oral intake, and postoperative hospital stay were significantly shorter in the non-obese group than in the obese group (3.3 ± 0.8 vs. 3.6 ± 0.9 days; 4.3 ± 1.0 vs. 4.6 ± 1.0 days; and 9.0 ± 2.2 vs. 9.6 ± 2.2 days, respectively; P < 0.01). 119 (9.5%) of the non-obese patients had postoperative complications as compared to 44 (10.1%) of the obese patients (P = 0.71). In the subgroup analysis of all patients, TLG showed improved results for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients. Conclusions Obesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic gastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese patients than LAG due to a variety of reasons. Our analysis shows that TLG is more advantageous, with regard to early surgical outcomes, for obese patients.
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Affiliation(s)
- Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Shu-Ting Zhai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Jia-Qin Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Qi-Long Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Ding-Wei Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Yi-Ping Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Yu Zhang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Ya-Ping Zhang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Hendi Maher
- School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
| | - Xian-Fa Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China.
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Minimally Invasive Versus Open Total Gastrectomy for Gastric Cancer: A Systematic Review and Meta-analysis of Short-Term Outcomes and Completeness of Resection : Surgical Techniques in Gastric Cancer. World J Surg 2016; 40:148-57. [PMID: 26350821 PMCID: PMC4695500 DOI: 10.1007/s00268-015-3223-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Minimally invasive surgical techniques for gastric cancer are gaining more acceptance worldwide as an alternative to open resection. In order to assess the role of minimally invasive and open techniques in total gastrectomy for cancer, a systematic review and meta-analysis was performed. Articles comparing minimally invasive versus open total gastrectomy were reviewed, collected from the Medline, Embase, and Cochrane databases. Two different authors (JS and NW) independently selected and assessed the articles. Outcomes regarding operative results, postoperative recovery, morbidity, mortality, and oncological outcomes were analyzed. Statistical analysis portrayed the weighted mean difference (WMD) with a 95 % confidence interval and odds ratio (OR). Out of 1242 papers, 12 studies were selected, including a total of 1360 patients, of which 592 underwent minimally invasive total gastrectomy (MITG). Compared to open total gastrectomy (OTG), MITG showed a longer operation time (WMD: 48.06 min, P < 0.00001), less operative blood loss (WMD: −160.70 mL, P < 0.00001), faster postoperative recovery, measured as shorter time to first flatus (WMD −1.05 days, P < 0.00001), shorter length of hospital stay (WMD: −2.43 days, P = 0.0002), less postoperative complications (OR 0.66, P = 0.02), similar mortality rates (OR 0.60, P = 0.52), and similar rates in lymph node yield (WMD −2.30, P = 0.06). Minimally invasive total gastrectomy showed faster postoperative recovery and less postoperative complications, whereas completeness of the resection was similar in both groups. Duration of surgery was longer in the minimally invasive group. Only comparative non-randomized studies were available, further emphasizing the need for a prospective randomized trial comparing MITG and OTG.
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Quan Y, Huang A, Ye M, Xu M, Zhuang B, Zhang P, Yu B, Min Z. Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer 2016. [PMID: 26216579 DOI: 10.1007/s10120-015-0516-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. METHODS Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. RESULTS Overall, 26 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD, -3.63, 95 % CI, -4.66 to -2.60; P < 0.01), less blood loss (WMD, -161.37, 95 % CI, -192.55 to -130.18; P < 0.01), faster bowel recovery (WMD, -0.78, 95 % CI, -1.05 to -0.50; P < 0.01), and earlier ambulation (WMD, -0.95, 95 % CI, -1.47 to -0.44; P < 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.49, 95 % CI, -1.78 to 0.81; P = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P < 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. CONCLUSIONS For AGCs, LG appeared comparable with OG in short- and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.
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Affiliation(s)
- Yingjun Quan
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ao Huang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Min Ye
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ming Xu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Biao Zhuang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Bo Yu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Zhijun Min
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
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Lu W, Gao J, Yang J, Zhang Y, Lv W, Mu J, Dong P, Liu Y. Long-term clinical outcomes of laparoscopy-assisted distal gastrectomy versus open distal gastrectomy for early gastric cancer: A comprehensive systematic review and meta-analysis of randomized control trials. Medicine (Baltimore) 2016; 95:e3986. [PMID: 27399073 PMCID: PMC5058802 DOI: 10.1097/md.0000000000003986] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this study was to compare long-term surgical outcomes and complications of laparoscopy-assisted distal gastrectomy (LADG) with open distal gastrectomy (ODG) for the treatment of early gastric cancer (EGC) based on a review of available randomized controlled trials (RCTs) evaluated using the Cochrane methodology.RCTs comparing LADG and ODG were identified by a systematic literature search in PubMed, Cochrane Library, MEDLINE, EMBASE, Scopus, and the China Knowledge Resource Integrated Database, for papers published from January 1, 2003 to July 30, 2015. Meta-analyses were performed to compare the long-term clinical outcomes.Our systematic literature search identified 8 eligible RCTs including 732 patients (374 LADGs and 358 ODGs), with low overall risk of bias. Long-term mortality and relapse rate were comparable for both techniques. The long-term complication rate was 8.47% in LADG groups and 13.62% in the ODG group, indicating that LADG was associated with lower risk for long-term complications (RR = 0.63; 95%CI = 0.39-1.00; P = 0.03).In the treatment of EGC, LADG lowered the rate of long- and short-term complications and promoted earlier recovery, with comparable oncological outcomes to ODG.
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Affiliation(s)
- Wei Lu
- Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine
- Institute of Biliary Tract Diseases Research, Shanghai Jiao Tong University School of Medicine
- Correspondence: Yingbin Liu, Wei Lu, Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital affiliated with Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Road, Room 513, Science and Technology Building, Shanghai 200092, China (e-mail: , )
| | - Jian Gao
- Department of Nutrition, Zhongshan hospital, Affiliated to Fudan University
- Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China
| | - Jingyun Yang
- Rush Alzheimer's Disease Center
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Yijian Zhang
- Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine
- Institute of Biliary Tract Diseases Research, Shanghai Jiao Tong University School of Medicine
| | - Wenjie Lv
- Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Jiasheng Mu
- Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Ping Dong
- Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Yingbin Liu
- Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine
- Institute of Biliary Tract Diseases Research, Shanghai Jiao Tong University School of Medicine
- Correspondence: Yingbin Liu, Wei Lu, Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital affiliated with Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Road, Room 513, Science and Technology Building, Shanghai 200092, China (e-mail: , )
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29
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Aurello P, Sagnotta A, Terrenato I, Berardi G, Nigri G, D'Angelo F, Ramacciato G. Oncologic value of laparoscopy-assisted distal gastrectomy for advanced gastric cancer: A systematic review and meta-analysis. J Minim Access Surg 2016; 12:199-208. [PMID: 27279389 PMCID: PMC4916744 DOI: 10.4103/0972-9941.181283] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND: The oncologic validity of laparoscopic-assisted distal gastrectomy (LADG) in the treatment of advanced gastric cancer (AGC) remains controversial. This study is a systematic review and meta-analysis of the available evidence. MATERIALS AND METHODS: A comprehensive search was performed between 2008 and 2014 to identify comparative studies evaluating morbidity/mortality, oncologic surgery-related outcomes, recurrence and survival rates. Data synthesis and statistical analysis were carried out using RevMan 5.2 software. RESULTS: Eight studies with a total of 1456 patients were included in this analysis. The complication rate was lower in LADG [odds ratio (OR) 0.59; 95% confidence interval (CI) = 0.42-0.83; P < 0.002]. The in-hospital mortality rate was comparable (OR 1.22; 95% CI = 0.28-5-29, P = 0.79). There was no significant difference in the number of harvested lymph nodes, resection margins, cancer recurrence rate, cancer-related mortality or overall and disease-free survival (OS and DFS, respectively) rates between the laparoscopic and the open groups (P > 0.05). CONCLUSION: The current study supports the view that LADG for AGC is a feasible, safe and effective procedure in selected patients. Adequate lymphadenectomy, resection margins, recurrence, cancer-related mortality and long-term outcomes appear equivalent to open distal gastrectomy (ODG).
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Affiliation(s)
- Paolo Aurello
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Sagnotta
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Irene Terrenato
- Biostatistic Unit, Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Giammauro Berardi
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Nigri
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Francesco D'Angelo
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Ramacciato
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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de Campos ECR, Ribeiro S, Higashi R, Manfredini R, Kfouri D, Cavalcanti TCS. Hereditary diffuse gastric cancer: laparoscopic surgical approach associated to rare mutattion of CDH1 gene. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:149-51. [PMID: 26176257 PMCID: PMC4737342 DOI: 10.1590/s0102-67202015000200017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 01/20/2015] [Indexed: 01/26/2023]
Affiliation(s)
| | - Saturnino Ribeiro
- Department of General Surgery and Oncology, Hospital of the Military Police of Paraná State, Curitiba, PR, Brazil
| | - Rafaella Higashi
- Department of General Surgery and Oncology, Hospital of the Military Police of Paraná State, Curitiba, PR, Brazil
| | - Ricardo Manfredini
- Department of General Surgery and Oncology, Hospital of the Military Police of Paraná State, Curitiba, PR, Brazil
| | - Diogo Kfouri
- Department of General Surgery and Oncology, Hospital of the Military Police of Paraná State, Curitiba, PR, Brazil
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Bushan K, Sharma S, Attarde N. Minimal invasive gastric surgery: A systematic review. South Asian J Cancer 2016; 4:140-2. [PMID: 26942146 PMCID: PMC4756490 DOI: 10.4103/2278-330x.173173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: As an alternate to open surgery, laparoscopic gastrectomy (LG) is currently being performed in many centers, and has gained a wide clinical acceptance. The aim of this review article is to compare oncologic adequacy and safety of LG with open surgery for gastric adenocarcinomas with respect to lymphadenectomy, short-term outcomes (postoperative morbidity and mortality) and long-term outcome (5 years overall survival and disease-free survival). Materials and Methods: PubMed was searched using query “LG” for literature published in English from January 2000 to April 2014. A total of 875 entries were retrieved. These articles were screened and 59 manuscripts ultimately formed the basis of current review. Results: There is high-quality evidence to support short-term efficacy, safety and feasibility of LG for gastric adenocarcinomas, although accounts on long-term survivals are still infrequent.
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Affiliation(s)
- Kirti Bushan
- Asian Institute of Oncology, Mumbai, Maharashtra, India
| | - Sanjay Sharma
- Consultant, Department of Surgical Oncology, Aio, Mumbai, Maharashtra, India
| | - Niket Attarde
- Consultant, Department of Surgical Oncology, Aio, Mumbai, Maharashtra, India
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32
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Dias AR, Pereira MA, Mello ES, Zilberstein B, Cecconello I, Ribeiro Junior U. Carnoy's solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial. Gastric Cancer 2016; 19:136-42. [PMID: 25410474 DOI: 10.1007/s10120-014-0443-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/28/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pathological examination of a minimum of 16 lymph nodes is recommended following surgery for gastric adenocarcinoma, despite this a longer survival is expected when 30 or more lymph nodes are examined. Small lymph nodes are difficult to identify, and fat-clearing solutions have been proposed to improve this, but there is no evidence of their clinical benefit. METHODS Fifty D2 subtotal gastrectomy specimens were randomized for fixation in Carnoy's solution (CS) or 10% neutral buffered formalin (NBF), with subsequent fat dissection. After dissection, the residual fat from the NBF group, instead of being discarded, was immersed in CS and dissected again. Data from 25 D2 subtotal gastrectomies performed before the study were also analyzed. RESULTS The mean number of examined lymph nodes was 50.4 and 34.8 for CS and NBF, respectively (p < 0.001). Missing lymph nodes were found in all cases from the residual fat group (mean of 16.9), and in eight of them (32%) metastatic lymph nodes were present; this allowed the upstaging of two patients. Lymph nodes in the CS group were smaller than those in the NBF group (p = 0.01). The number of retrieved lymph nodes was similar among the NBF and Retrospective groups (p = 0.802). CONCLUSIONS Compared with NBF, CS increases lymph node detection following gastrectomy and allows a more accurate pathological staging. No influence of the research protocol on the number of examined lymph nodes was observed.
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Affiliation(s)
- Andre Roncon Dias
- São Paulo State Cancer Institute, University of São Paulo, São Paulo, SP, 01410-000, Brazil.
- , Alameda Ministro Rocha Azevedo, 644. ap 161, São Paulo, Brazil.
| | | | - Evandro Sobroza Mello
- São Paulo State Cancer Institute, University of São Paulo, São Paulo, SP, 01410-000, Brazil
| | - Bruno Zilberstein
- São Paulo State Cancer Institute, University of São Paulo, São Paulo, SP, 01410-000, Brazil
| | - Ivan Cecconello
- São Paulo State Cancer Institute, University of São Paulo, São Paulo, SP, 01410-000, Brazil
| | - Ulysses Ribeiro Junior
- São Paulo State Cancer Institute, University of São Paulo, São Paulo, SP, 01410-000, Brazil
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Chen H, Gao S, Yang XZ, Chen LJ, Liu P, Xu HF. Comparison of Safety and Efficacy of Different Models of Target Vessel Regional Chemotherapy for Gastric Cancer with Liver Metastases. Chemotherapy 2015; 61:99-107. [PMID: 26618449 DOI: 10.1159/000440945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We previously demonstrated the safety and efficacy of low-dose, short-interval target vessel regional chemotherapy (TVRC(LDSI)) delivered through the hepatic artery with transarterial embolization (TAE) in patients with advanced gastric cancer (AGC). The present study aimed to compare the efficacy of TAE + TVRC(LDSI) with that of standard TAE + TVRC in AGC patients with liver metastases who failed to respond to first- or second-line systemic chemotherapy. METHODS This study recruited a total of 58 GC patients with liver metastases after failure of first- or second-line systemic chemotherapy. Twenty-eight patients were assigned to the TAE + TVRC(LDSI) group and 30 patients to the TAE + TVRC group. The primary end point was overall survival (OS(TVRC)), which was defined as the time from the initiation of TVRC until the last follow-up or death. RESULTS OS(TVRC), time to progression (TTP) until appearance of intra- and extrahepatic metastases, and overall TTP and treatment periods in the TAE + TVRC(LDSI) group were all significantly longer than in the TAE + TVRC group (all p < 0.001). CONCLUSION TAE + TVRC(LDSI) had a higher efficacy and safety, which was reflected by OS rates, progression-free survival rates, longer duration of treatment and milder side effects compared to standard TAE + TVRC.
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He W, Tu J, Huo Z, Li Y, Peng J, Qiu Z, Luo D, Ke Z, Chen X. Surgical interventions for gastric cancer: a review of systematic reviews. Int J Clin Exp Med 2015; 8:13657-13669. [PMID: 26550311 PMCID: PMC4612996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/28/2015] [Indexed: 06/05/2023]
Abstract
AIM To evaluate methodological quality and the extent of concordance among meta-analysis and/or systematic reviews on surgical interventions for gastric cancer (GC). METHODS A comprehensive search of PubMed, Medline, EMBASE, the Cochrane library and the DARE database was conducted to identify the reviews comparing different surgical interventions for GC prior to April 2014. After applying included criteria, available data were summarized and appraised by the Oxman and Guyatt scale. RESULTS Fifty six reviews were included. Forty five reviews (80.4%) were well conducted, with scores of adapted Oxman and Guyatt scale ≥ 14. The reviews differed in criteria for avoiding bias and assessing the validity of the primary studies. Many primary studies displayed major methodological flaws, such as randomization, allocation concealment, and dropouts and withdrawals. According to the concordance assessment, laparoscopy-assisted gastrectomy (LAG) was superior to open gastrectomy, and laparoscopy-assisted distal gastrectomy was superior to open distal gastrectomy in short-term outcomes. However, the concordance regarding other surgical interventions, such as D1 vs. D2 lymphadenectomy, and robotic gastrectomy vs. LAG were absent. CONCLUSION Systematic reviews on surgical interventions for GC displayed relatively high methodological quality. The improvement of methodological quality and reporting was necessary for primary studies. The superiority of laparoscopic over open surgery was demonstrated. But concordance on other surgical interventions was rare, which needed more well-designed RCTs and systematic reviews.
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Affiliation(s)
- Weiling He
- Department of Gastrointestinal and Pancreatic Surgery, Centre of Gastric Cancer, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, Guangdong Province, P. R. China
| | - Jian Tu
- Musculoskeletal Center, Department of Orthopaedic Surgery, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou City 510080, Guangdong Province, China
| | - Zijun Huo
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou City 510080, Guangdong Province, China
| | - Yuhuang Li
- Department of Molecular & Medical Genetics, Oregon Health & Science University3181 S.W. Sam Jackson Park Rd. Portland, Oregon 97239, USA
| | - Jintao Peng
- The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhou City 510080, Guangdong Province, China
| | - Zhenwen Qiu
- The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, Guangdong Province, P. R. China
| | - Dandong Luo
- The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, Guangdong Province, P. R. China
| | - Zunfu Ke
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, Guangdong Province, China
| | - Xinlin Chen
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega CenterGuangzhou 510006, Guangdong Province, P. R. China
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Wang W, Liu Z, Xiong W, Zheng Y, Luo L, Diao D, Wan J. Totally laparoscopic spleen-preserving splenic hilum lymph nodes dissection in radical total gastrectomy: an omnibearing method. Surg Endosc 2015. [PMID: 26201417 DOI: 10.1007/s00464-015-4438-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the feasibility and safety of laparoscopic spleen-preserving splenic hilum lymph nodes (LNs) dissection for advanced proximal gastric cancer using an omnibearing method. METHODS Between August 2013 and December 2014, 16 patients with advanced proximal gastric cancer treated in Guangdong Province Hospital of Chinese Medicine, were enrolled and subsequently underwent laparoscopic radical total gastrectomy (TG) with spleen-preserving splenic hilum LNs dissection. During dissecting Nos. 10 and 11 LNs, we divided them into two parts, namely LNs anterosuperior and posterior to the splenic vessel. The clinicopathological characteristics, intraoperative outcomes and postoperative courses were retrospectively collected and analyzed in the study. RESULTS Laparoscopic surgery was successfully completed in all 16 patients without conversion to open surgery, and no perioperative death occurred. The mean operating time was 328.75 ± 46.96 min, and the mean estimated blood loss was 135.63 ± 62.07 ml. One patient experienced intraoperative bleeding due to the splenic vein injury which was successfully handled with laparoscopic vessel suturing, and one postoperative pulmonary infection was recorded. The mean time to first flatus was 3.56 ± 1.03 days with a mean 9.63 ± 1.50 days of postoperative hospital stay. The mean number of retrieved LNs was 28.31 ± 5.99, in which LNs anterosuperior to splenic artery was 2.88 ± 2.66 and LNs posterior was 1.38 ± 1.75. CONCLUSION Laparoscopic TG with spleen-preserving splenic hilum LNs dissection using an omnibearing method for advanced proximal gastric cancer was safe and technically feasible in experienced hands. Further studies in terms of its clinical significance are needed.
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Affiliation(s)
- Wei Wang
- Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China
| | - Zhiwei Liu
- Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China
| | - Wenjun Xiong
- Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China.
| | - Yansheng Zheng
- Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China
| | - Lijie Luo
- Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China
| | - Dechang Diao
- Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China
| | - Jin Wan
- Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, Guangzhou, 510512, China.
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Mönig SP, Chon SH, Weindelmayer J, de Manzoni G, Hölscher AH. [Spectrum of laparoscopic surgery for gastric tumors]. Chirurg 2015; 85:675-82. [PMID: 25052815 DOI: 10.1007/s00104-014-2753-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Minimally invasive operative procedures are increasingly being used for treating tumors of the upper gastrointestinal tract. While minimally invasive surgery (MIS) has become established as a standard procedure for benign tumors and gastrointestinal stromal tumors (GIST) based on current studies, the significance of MIS in the field of gastric cancer is the topic of heated debate. Until now the majority of studies and meta-analyses on gastric cancer have come from Asia and these indicate the advantages of MIS in terms of intraoperative blood loss, minor surgical complications and swifter convalescence although without any benefits in terms of long-term oncological results and quality of life. Unlike in Germany, gastric cancer in Asia with its unchanged high incidence rate, 50 % frequency of early carcinoma and predominantly distal tumor localization is treated at high-volume centres. Due to the proven marginal advantages of MIS over open resection described in the published studies no general recommendation for laparoscopic surgery of gastric cancer can currently be given.
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Affiliation(s)
- S P Mönig
- Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland,
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Cai JQ, Chen K, Mou YP, Pan Y, Xu XW, Zhou YC, Huang CJ. Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a single-center 8-year retrospective cohort study of 156 patients with long-term follow-up. BMC Surg 2015; 15:58. [PMID: 25956520 PMCID: PMC4438531 DOI: 10.1186/s12893-015-0040-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 04/27/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of this study was to compared laparoscopic (LWR) and open wedge resection (OWR) for the treatment of gastric gastrointestinal stromal tumors (GISTs). METHODS The data of 156 consecutive GISTs patients underwent LWR or OWR between January 2006 and December 2013 were collected retrospectively. The surgical outcomes and the long-term survival rates were compared. Besides, a rapid systematic review and meta-analysis were conducted. RESULTS Clinicopathological characteristics of the patients were similar between the two groups. The LWR group was associated with less intraoperative blood loss (67.3 vs. 142.7 ml, P < 0.001), earlier postoperative flatus (2.3 vs. 3.2 days, P < 0.001), earlier oral intake (3.2 vs. 4.1 days, P < 0.001) and shorter postoperative hospital stay (6.0 vs. 8.0 days, P = 0.001). The incidence of postoperative complications was lower in LWR group but did not reach statistical significance (4/90, 4.4% vs. 8/66, 12.1%, P = 0.12). No significant difference was observed in 3-year relapse-free survival rate between the two groups (98.6% vs. 96.4%, P > 0.05). The meta-analysis revealed similar results except less overall complications in the LWR group (RR = 0.49, 95% CI, 0.25 to 0.95, P = 0.04). And the recurrence risk was similar in two group (RR = 0.80, 95% CI, 0.28 to 2.27, P > 0.05). CONCLUSIONS LWR is a technically and oncologically safe and feasible approach for gastric GISTs compared with OWR. Moreover, LWR appears to be a preferable choice with mini-invasive benefits.
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Affiliation(s)
- Jia-Qin Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Yi-Ping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China.
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Xiao-Wu Xu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Yu-Cheng Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Chao-Jie Huang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
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Zhang YX, Wu YJ, Lu GW, Xia MM. Systematic review and meta-analysis of totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer. World J Surg Oncol 2015; 13:116. [PMID: 25889971 PMCID: PMC4384388 DOI: 10.1186/s12957-015-0532-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 03/02/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Totally laparoscopic distal gastrectomy (TLDG) has been developed in the hope of improving surgical quality and overcoming the limitations of conventional laparoscopic assisted distal gastrectomy (LADG) for gastric cancer. The aim of this study was to determine the extent of evidence in support of these ideals. METHODS A systematic review of the two operation types (LADG and TLDG) was carried out to evaluate short-term outcomes including duration of operation, retrieved lymph nodes, estimated blood loss, resection margin status, technical postoperative complications, and hospital stay. RESULTS Twelve non-randomized observational clinical studies involving 2,255 patients satisfied the eligibility criteria. Operative time was not statistically different between groups (P > 0.05). The number of retrieved lymph nodes and the resection margin length in TLDG were comparable with those in LADG. Estimated blood loss was significantly less in TLDG than that in LAG (P < 0.01). Compared to LADG, TLDG also involved lesser postoperative hospital stay (P < 0.01) and earlier time to soft diet intake (P < 0.05). Time to flatus and postoperative complications were similar for those two operative approaches. CONCLUSIONS TLDG may be a technically safe, feasible, and favorable approach in terms of better cosmesis, less blood loss, and faster recovery compared with LADG.
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Affiliation(s)
- Yi-Xin Zhang
- Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China.
| | - Ying-Jie Wu
- Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China.
| | - Guo-Wen Lu
- Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China.
| | - Min-Ming Xia
- Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China.
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Glenn JA, Turaga KK, Gamblin TC, Hohmann SF, Johnston FM. Minimally invasive gastrectomy for cancer: current utilization in US academic medical centers. Surg Endosc 2015; 29:3768-75. [PMID: 25791064 DOI: 10.1007/s00464-015-4152-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Internationally, the utilization of minimally invasive techniques for gastric cancer resection has been increasing since first introduced in 1994. In the USA, the feasibility and safety of these techniques for cancer have not yet been demonstrated. METHODS The University HealthSystem Consortium database was queried for gastrectomies performed between 2008 and 2013. Any adult patient with an abdominal visceral malignancy that necessitated gastric resection was included in the cohort. Clinicopathological and in-hospital outcome metrics were collected for open, laparoscopic, and robotic procedures. RESULTS Open gastrectomies comprised 89.5% of the total study group, while 8.2% of procedures were performed laparoscopically, and 2.3% were performed with robotic assistance. When accounting for disparities in patient severity of illness and risk of mortality subclass designations, there were no significant differences in mean length of stay, 30-day readmission, and in-hospital mortality between the three groups; however, mean total cost was highest in the robotic-assisted group (P = 0.017). Overall, complication rates were also similar; however, there was a higher incidence of superficial infection in the laparoscopic group (P = 0.013) and a higher incidence of venous thromboembolism in the robotic group (P = 0.038). CONCLUSION Despite widespread adoption for benign indications, minimally invasive gastrectomy for cancer remains underutilized in the USA. In these patients, laparoscopic and robot-assisted gastrectomies appear to be comparable to open resection with respect to overall complications, length of stay, 30-day readmission, and in-hospital mortality. However, when employing minimally invasive techniques, infection and thromboembolism risk reduction strategies should be emphasized in the operative and postoperative periods.
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Affiliation(s)
- Jason A Glenn
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Kiran K Turaga
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Samuel F Hohmann
- University HealthSystem Consortium, 155 N Upper Wacker Dr, Chicago, IL, 60606, USA
| | - Fabian M Johnston
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
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Lianos GD, Rausei S, Ruspi L, Galli F, Mangano A, Roukos DH, Dionigi G, Boni L. Laparoscopic gastrectomy for gastric cancer: Current evidences. Int J Surg 2014; 12:1369-73. [DOI: 10.1016/j.ijsu.2014.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 09/25/2014] [Accepted: 10/16/2014] [Indexed: 02/07/2023]
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Chen K, Pan Y, Cai JQ, Xu XW, Wu D, Mou YP. Totally laparoscopic gastrectomy for gastric cancer: A systematic review and meta-analysis of outcomes compared with open surgery. World J Gastroenterol 2014; 20:15867-15878. [PMID: 25400474 PMCID: PMC4229555 DOI: 10.3748/wjg.v20.i42.15867] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/09/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To systematically review the surgical outcomes of totally laparoscopic gastrectomy (TLG) vs open gastrectomy (OG) for gastric cancer.
METHODS: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted. All original studies comparing TLG with OG were included for critical appraisal. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.
RESULTS: One RCT and 13 observational studies involving 1532 patients were included (721 TLG and 811 OG). TLG was associated with longer operation time [weighted mean difference (WMD) = 58.04 min, 95%CI: 37.77-78.32, P < 0.001], less blood loss [WMD = -167.57 min, 95%CI: -208.79-(-126.34), P < 0.001], shorter hospital stay [WMD = -3.75 d, 95%CI: -4.88-(-2.63), P < 0.001] and fewer postoperative complications (RR = 0.71, 95%CI: 0.58-0.86, P < 0.001). The number of harvested lymph nodes, surgical margin, mortality and cancer recurrence rate were similar between the two groups.
CONCLUSION: TLG may be a technically safe, feasible and favorable approach in terms of better cosmesis, less blood loss and faster recovery compared with OG.
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Chen K, Mou YP, Xu XW, Pan Y, Zhou YC, Cai JQ, Huang CJ. Comparison of short-term surgical outcomes between totally laparoscopic and laparoscopic-assisted distal gastrectomy for gastric cancer: a 10-y single-center experience with meta-analysis. J Surg Res 2014; 194:367-374. [PMID: 25488721 DOI: 10.1016/j.jss.2014.10.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 09/21/2014] [Accepted: 10/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) are two commonly used methods of laparoscopic gastrectomy for gastric cancer. This study aimed to compare the short-term surgical outcomes of these two methods. METHODS A prospectively maintained gastric cancer database between October 2004 and February 2014 was reviewed and 115 patients underwent LADG and 198 patients underwent TLDG were included. The clinical characteristics and perioperative clinical outcomes of two groups were compared. Moreover, a systematic review and meta-analysis were conducted. RESULTS The mean operation time and blood loss were similar in two groups, as was the number of retrieved lymph nodes. There was no significant difference in time to first flatus, the time to restart oral intake, the length of the hospital stay after surgery, and postoperative complications. The meta-analysis revealed no significant differences in the operative time, surgical margin, time to first flatus, length of hospital stay, mortality, overall, and anastomosis-related complications among the groups. However, the intraoperative blood loss was lower in TLDG (weighted mean difference = 21.50 mL; 95% confidence interval: 9.79-33.22; P < 0.01), and number of retrieved lymph nodes was higher in TLDG (weighted mean difference = -1.56; 95% confidence interval: -2.69 to -0.44; P < 0.01). CONCLUSIONS TLDG is safe and feasible compared with LADG. However, it is difficult to identify the clinical advantages of TLDG over LADG based on our study. Thus, the choice of surgical approach mainly depends on the patient conditions and the preference of the patients or surgeons.
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Affiliation(s)
- Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Yi-Ping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China.
| | - Xiao-Wu Xu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Yu-Cheng Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Jia-Qin Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Chao-Jie Huang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
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Qiu JF, Yang B, Fang L, Li YP, Shi YJ, Yu XC, Zhang MC. Safety and efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer in the elderly. Int J Clin Exp Med 2014; 7:3562-3567. [PMID: 25419398 PMCID: PMC4238507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/25/2014] [Indexed: 06/04/2023]
Abstract
To evaluate safety and efficacy of laparoscopy-assisted radical gastrectomy (LARG) for advanced gastric cancer patients aged 70 years or older. Clinical data were retrospectively collected from patients with IIA-IIIC gastric cancer who underwent LARG (n = 30) and open radical gastrectomy (ORG, n = 34) in Department of Gastrointestinal Surgery in the Ningbo First Hospital from January 2012 to December 2013. The mean operative time was longer in the LARG group than in the ORG group but there was no statistical difference between the two groups. The intraoperative blood loss (120 ± 52.7 ml vs 227.3 ± 146.9 ml), incidence of postoperative complication (23.0% vs 47%) were lower in the LARG group than those in the ORG group. In addition, the time to first flatus (2.9 ± 0.8 d vs 4.6 ± 1.2 d), time to first ambulation (1.2 ± 0.4 vs 4.1 ± 1.0 d), time of nasogastric intubation (2.5 ± 1.0 d vs 3.5 ± 1.4 d), and postoperative hospital stay (13.0 ± 4.2 d vs 16.9 ± 4.1 d) were significantly shorter in the LARG group than in the ORG group, respectively. No statistical difference in the number of harvested lymph nodes was noted between the two groups (30.2 ± 12.0 vs 28.1 ± 11.8, P > 0.05). LARG is safer, more effective and less invasive for the elderly patients with advanced gastric cancer.
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Affiliation(s)
- Jiang-Feng Qiu
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Bing Yang
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Lei Fang
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Yi-Ping Li
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Yi-Jiu Shi
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Xiu-Chong Yu
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Mou-Cheng Zhang
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
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Shum H, Rajdev L. Multimodality management of resectable gastric cancer: A review. World J Gastrointest Oncol 2014; 6:393-402. [PMID: 25320655 PMCID: PMC4197430 DOI: 10.4251/wjgo.v6.i10.393] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/01/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
Adenocarcinoma of the stomach carries a poor prognosis and is the second most common cause of cancer death worldwide. It is recommended that surgical resection with a D1 or a modified D2 gastrectomy (with at least 15 lymph nodes removed for examination) be performed in the United States, though D2 lymphadenectomies should be performed at experienced centers. A D2 lymphadenectomy is the recommended procedure in Asia. Although surgical resection is considered the definitive treatment, rates of recurrences are high, necessitating the need for neoadjuvant or adjuvant therapy. This review article aims to outline and summarize some of the pivotal trials that have defined optimal treatment options for non-metastatic non-cardia gastric cancer. Some of the most notable trials include the INT-0116 trial, which established a benefit in concurrent chemoradiation and adjuvant chemotherapy. This was again confirmed in the ARTIST trial, especially in patients with nodal involvement. Later, the Medical Research Council Adjuvant Gastric Infusional Chemotherapy trial provided evidence for the use of perioperative chemotherapy. Targeted agents such as ramucirumab and trastuzumab are also being investigated for use in locally advanced gastric cancers after demonstrating a benefit in the metastatic setting. Given the poor response rate of this difficult disease to various treatment modalities, numerous studies are currently ongoing in an attempt to define a more effective therapy, some of which are briefly introduced in this review as well.
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Lee DY, Lee CH, Seo MJ, Lee SH, Ryu JS, Lee JJ. Performance of (18)F-FDG PET/CT as a postoperative surveillance imaging modality for asymptomatic advanced gastric cancer patients. Ann Nucl Med 2014; 28:789-95. [PMID: 24965850 DOI: 10.1007/s12149-014-0871-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/19/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the diagnostic performance of postoperative fluorine-18 fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) as a surveillance modality for advanced gastric cancer patients who were asymptomatic and negative by conventional follow-up. METHODS We retrospectively collected 46 advanced gastric cancer patients who received approximately 1-year-postoperative (18)F-FDG PET/CT surveillance following curative resection (mean age 60.6 ± 11.5 years). (18)F-FDG PET/CT was interpreted by nuclear medicine physicians who were blind to the clinical information. Final confirmation was determined by clinical follow-up using tumor markers, conventional CT scan, upper gastrointestinal endoscopy and with/without subsequent histopathologic diagnosis. RESULTS Four patients developed recurrence (8.7 %; 1 local and 3 distant recurrences). For local recurrence, (18)F-FDG PET/CT found four hypermetabolic lesions and one was local recurrence. For distant recurrence, seven hypermetabolic lesions were found in six patients and true-positive was three lesions. False-positive cases were mainly turned out to be physiologic small bowel uptake. Regardless of the recurrence site, the sensitivity, specificity, positive predictive value and negative predictive value of (18)F-FDG PET/CT were 100 % (4/4, 95 % confidence interval (CI) 39.6-100 %), 88.1 % (37/42, 95 % CI 73.6-95.5 %), 44.4 % (4/9, 95 % CI 15.3-77.3 %) and 100 % (37/37, 95 % CI 88.3-100 %), respectively in the patient-based analysis. CONCLUSION Our study showed good specificity of postoperative surveillance (18)F-FDG PET/CT for detecting recurrence. Careful caution should be made for interpreting some false-positive hypermetabolic lesions in postoperative (18)F-FDG PET/CT, especially at the local anastomosis site.
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Affiliation(s)
- Dong Yun Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Küper MA, Eisner F, Königsrainer A, Glatzle J. Laparoscopic surgery for benign and malign diseases of the digestive system: Indications, limitations, and evidence. World J Gastroenterol 2014; 20:4883-4891. [PMID: 24803799 PMCID: PMC4009519 DOI: 10.3748/wjg.v20.i17.4883] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/23/2013] [Accepted: 02/17/2014] [Indexed: 02/06/2023] Open
Abstract
The laparoscopic technique was introduced in gastrointestinal surgery in the mid 1980s. Since then, the development of this technique has been extraordinary. Triggered by technical innovations (stapling devices or coagulation/dissecting devices), nowadays any type of gastrointestinal resection has been successfully performed laparoscopically and can be performed laparoscopically dependent on the patient’s condition. This summary gives an overview over 30 years of laparoscopic surgery with focus on today’s indications and evidence. Main indications remain the more common procedures, e.g., appendectomy, cholecystectomy, bariatric procedures or colorectal resections. For all these indications, the laparoscopic approach has become the gold standard with less perioperative morbidity. Regarding oncological outcome there have been several high-quality randomized controlled trials which demonstrated equivalency between laparoscopic and open colorectal resections. Less common procedures like esophagectomy, oncological gastrectomy, liver and pancreatic resections can be performed successfully as well by an experienced surgeon. However, the evidence for these special indications is poor and a general recommendation cannot be given. In conclusion, laparoscopic surgery has revolutionized the field of gastrointestinal surgery by reducing perioperative morbidity without disregarding surgical principles especially in oncological surgery.
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Chen K, Mou YP, Xu XW, Cai JQ, Wu D, Pan Y, Zhang RC. Short-term surgical and long-term survival outcomes after laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer. BMC Gastroenterol 2014; 14:41. [PMID: 24568165 PMCID: PMC3939636 DOI: 10.1186/1471-230x-14-41] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 02/17/2014] [Indexed: 12/24/2022] Open
Abstract
Background Laparoscopic distal gastrectomy (LDG) for gastric cancer has gradually gained popularity. However, the long-term oncological outcomes of LDG have rarely been reported. This study aimed to investigate the survival outcomes of LDG, and evaluate the early surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG). Methods Clinical outcomes of 240 consecutive patients with gastric cancer who underwent LDG at our institution between October 2004 and April 2013 were analyzed. Early surgical outcomes of LADG and TLDG were compared and operative experiences were evaluated. Results Of the 240 patients, 93 underwent LADG and 147 underwent TLDG. There were 109 T1, 36 T2, 31 T3, and 64 T4a lesions. The median follow-up period was 31.5 months (range: 4–106 months). Tumor recurrence was observed in 40 patients and peritoneal recurrence was observed most commonly. The 5-year disease-free survival (DFS) and overall survival (OS) rates according to tumor stage were 90.3% and 93.1% in stage I, 72.7% and 67.6% in stage II, and 34.8% and 41.5% in stage III, respectively. No significant differences in early surgical outcomes were noted such as operation time, blood loss and postoperative recovery between LADG and TLDG (P >0.05). Conclusions LDG for gastric cancer had acceptable long-term oncologic outcomes. The early surgical outcomes of the two commonly used LDG methods were similar.
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Affiliation(s)
| | - Yi-Ping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China.
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Bencini L, Bernini M, Farsi M. Laparoscopic approach to gastrointestinal malignancies: Toward the future with caution. World J Gastroenterol 2014; 20:1777-1789. [PMID: 24587655 PMCID: PMC3930976 DOI: 10.3748/wjg.v20.i7.1777] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/07/2013] [Accepted: 11/30/2013] [Indexed: 02/06/2023] Open
Abstract
After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts, some surgeons started to treat malignancies by the same way. However, if the limits of laparoscopy for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies. Cancerous patients represent an important group with peculiar aspects including reduced survival expectancy, worsened quality of life due to surgery itself and adjuvant therapies, and challenging psychological impact. All these issues could, potentially, receive a better management with a laparoscopic surgical approach. In order to confirm such aspects, similarly to testing the newest weapons (surgical or pharmacologic) against cancer, long-term follow-up is always recommendable to assess the real benefits in terms of overall survival, cancer-free survival and quality of life. Furthermore, it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive technologies. Therefore, laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences, as compared to those achieved for inflammatory bowel diseases, gastroesophageal reflux disease or diverticular disease. This review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.
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Wullstein C. Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Magen - Pro-Position. Visc Med 2013. [DOI: 10.1159/000357061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Güner A, Hyung WJ. Minimally invasive surgery for gastric cancer. ULUSAL CERRAHI DERGISI 2013; 30:1-9. [PMID: 25931879 DOI: 10.5152/ucd.2014.2607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/09/2014] [Indexed: 12/13/2022]
Abstract
The interest in minimally invasive surgery (MIS) has rapidly increased in recent decades and surgeons have adopted minimally invasive techniques due to its reduced invasiveness and numerous advantages for patients. With increased surgical experience and newly developed surgical instruments, MIS has become the preferred approach not only for benign disease but also for oncologic surgery. Recently, robotic systems have been developed to overcome difficulties of standard laparoscopic instruments during complex procedures. Its advantages including three-dimensional images, tremor filtering, motion scaling, articulated instruments, and stable retraction have created the opportunity to use robotic technology in many procedures including cancer surgery. Gastric cancer is one of the most common causes of cancer-related deaths worldwide. While its overall incidence has decreased worldwide, the proportion of early gastric cancer has increased mainly in eastern countries following mass screening programs. The shift in the paradigm of gastric cancer treatment is toward less invasive approaches in order to improve the patient's quality of life while adhering to oncological principles. In this review, we aimed to summarize the operative strategy and current literature in laparoscopic and robotic surgery for gastric cancer.
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Affiliation(s)
- Ali Güner
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea ; Department of General Surgery, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey ; Yonsei University Health System, Robot and MIS Center, Seoul, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea ; Yonsei University Health System, Robot and MIS Center, Seoul, South Korea ; Yonsei University Health System, Gastric Cancer Clinic, Seoul, South Korea
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