1
|
Ludwig K, Scharlau U, Schneider-Koriath S. [Technique and Study Results of Laparoscopic Gastrectomy for Gastric Cancer]. Zentralbl Chir 2024; 149:169-177. [PMID: 38417815 DOI: 10.1055/a-2258-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
The aim of this paper was to describe the technique of laparoscopic gastrectomy for gastric carcinoma and to present a review of current international studies on this topic.The first part describes and documents a standard laparoscopic gastrectomy for carcinoma. In the second part, after an EMBASE and PubMed search, a total of 123 quality-relevant randomised (RCT) and non-randomised (non-RCT) studies on laparoscopic gastrectomy are identified from a primary total of 3,042 hits by systematic narrowing. The study results are then summarised conclusively for the target criteria of feasibility, outcome, oncological quality, morbidity and mortality.Both, laparoscopic subtotal resection for distal gastric carcinomas and laparoscopic gastrectomy can now be performed safely and with few complications. In a recent literature review of a total of 15 RCTs with 5,576 patients (laparoscopic 2,793 vs. open 2,756), there were no significant differences in terms of feasibility, intraoperative outcome and oncological quality (R0 and lymph node harvest). Surgical morbidity and mortality were comparable. Patients after laparoscopic surgery showed a significantly faster early postoperative recovery with a lower overall morbidity. In contrast, the operating time was significantly longer - by a mean of 45 min - compared to the open technique. The advantages of the laparoscopic technique were equally evident in studies on early gastric carcinoma and advanced carcinomas (>T2).Laparoscopic gastrectomy for gastric carcinoma is safe to perform and shows better early postoperative recovery. Complication rates, morbidity and mortality as well as long-term oncological results are comparable with open surgery.
Collapse
Affiliation(s)
- Kaja Ludwig
- Chirurgie, Klinikum Südstadt Rostock, Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Rostock, Deutschland
| | - Uwe Scharlau
- Chirurgie, Klinikum Südstadt Rostock, Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Rostock, Deutschland
| | - Sylke Schneider-Koriath
- Chirurgie, Klinikum Südstadt Rostock, Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Rostock, Deutschland
| |
Collapse
|
2
|
Dougherty K, Zhang Z, Montenegro G, Hinyard L, Xu E, Hsueh E, Luu C. Impact of Hospital Volume on Utilization of Minimally Invasive Surgery for Gastric Cancer. Am Surg 2023; 89:4569-4577. [PMID: 35999671 DOI: 10.1177/00031348221121560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) for gastric cancer is increasingly performed. The purpose of this study is to evaluate trends in utilization of laparoscopic and robotic techniques compared to open surgery as well as utilization based on hospital volume. METHODS We used the National Cancer Database to query patients who underwent gastrectomy from 2010 to 2017 for adenocarcinoma. Regression analyses were used to determine associations between MIS and clinical factors, the trend of MIS over time, and survival. RESULTS A total of 18,380 patients met inclusion criteria. The annual rates of MIS increased for all hospital volumes, though lower volume centers were less likely to undergo MIS. MIS was associated with a shorter length of stay compared to open, and robotic gastrectomy had a higher rate of obtaining at least 15 lymph nodes and lower rate of having a positive margin. CONCLUSIONS MIS utilization for resection of gastric cancer increased over time, with robotic surgery increasing at a higher rate than laparoscopic surgery. Importantly, this occurred without increased in mortality or sacrificing adequate oncologic outcomes.
Collapse
Affiliation(s)
- Kristen Dougherty
- Division of General Surgery, Department of Surgery, Saint Louis University, St. Louis, MO USA
| | - Zidong Zhang
- Advanced Health Data Research Institute (AHEAD), Saint Louis University, St. Louis, MO USA
| | - Grace Montenegro
- Division of General Surgery, Department of Surgery, Saint Louis University, St. Louis, MO USA
| | - Leslie Hinyard
- Advanced Health Data Research Institute (AHEAD), Saint Louis University, St. Louis, MO USA
| | - Evan Xu
- Division of General Surgery, Department of Surgery, Saint Louis University, St. Louis, MO USA
| | - Eddy Hsueh
- Division of General Surgery, Department of Surgery, Saint Louis University, St. Louis, MO USA
| | - Carrie Luu
- Division of General Surgery, Department of Surgery, Saint Louis University, St. Louis, MO USA
| |
Collapse
|
3
|
Milone M, D'Amore A, Alfieri S, Ambrosio MR, Andreuccetti J, Ansaloni L, Antonucci A, Arganini M, Baiocchi G, Barone M, Bencini L, Bencivenga M, Boccia L, Boni L, Braga M, Cianchi F, Cipollari C, Contine A, Cotsoglou C, D'Imporzano S, De Manzoni G, De Pascale S, De Ruvo N, Degiuli M, Donini A, Elmore U, Ercolani G, Ferrari G, Fumagalli RU, Garulli G, Gelmini R, Graziosi L, Gualtierotti M, Guglielmi A, Inama M, Maffeis F, Maione F, Manigrasso M, Marchesi F, Marrelli D, Massobrio A, Moretto G, Moukachar A, Navarra G, Nigri G, Olmi S, Palaia R, Papis D, Parise P, Pedrazzani C, Petri R, Pignata G, Pisano M, Rausei S, Reddavid R, Rocco G, Rosa F, Rosati R, Rossit L, Rottoli M, Roviello F, Santi S, Scabini S, Scaringi S, Solaini L, Staderini F, Taglietti L, Torre B, Ubiali P, Uccelli M, Uggeri F, Vertaldi S, Viganò J, De Palma GD, Giacopuzzi S. A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG. Updates Surg 2022:10.1007/s13304-022-01438-8. [PMID: 36571661 DOI: 10.1007/s13304-022-01438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/05/2022] [Indexed: 12/27/2022]
Abstract
Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.
Collapse
Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Sergio Alfieri
- Chirurgia Digestiva, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Maria Raffaella Ambrosio
- Department of Surgical Pathology and General Surgery, Azienda Sanitaria Toscana Nord Ovest, Pisa, Italy
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128, Bergamo, Italy
| | - Adelmo Antonucci
- UOC Chirurgia Generale Ospedale Sant'Anna Como Asst Lariana, San Fermo della Battaglia, Italy
| | - Marco Arganini
- Department of Surgical Pathology and General Surgery, Azienda Sanitaria Toscana Nord Ovest, Pisa, Italy
| | | | - Mirko Barone
- Department of General and Thoracic Surgery, SS. Annunziata University Hospital, Chieti, Italy
| | - Lapo Bencini
- Chirurgia Generale Azienda Ospedaliero-Universitaria Careggi Firenze, Florence, Italy
| | - Maria Bencivenga
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Luigi Boccia
- Dip Chirurgico Ortopedico UOC Chirurgia Generale Mininvasiva e d Urgenza ASST, Mantua, Italy
| | - Luigi Boni
- Department of Surgery Fondazione, IRCCS-Ca' Granda-Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Marco Braga
- Università degli Studi di Milano-Bicocca, Ospedale San Gerardo di Monza, Monza, Italy
| | - Fabio Cianchi
- Chirurgia dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Cipollari
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Alessandro Contine
- Department of General Surgery, Città di Castello Hospital, Città di Castello, Perugia, Italy
| | - Christian Cotsoglou
- General Surgery Unit, Vimercate Hospital-ASST Brianza, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
| | - Simone D'Imporzano
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Medical University of Pisa, 56124, Pisa, Italy
| | - Giovanni De Manzoni
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | | | - Nicola De Ruvo
- University of Modena and Reggio Emilia Policlinico of Modena Oncological and Emergency Surgery Unit ID, Modena, Italy
| | - Maurizio Degiuli
- Department of Oncology, University of Turin, San Luigi University Hospital, Turin, Italy
| | - Annibale Donini
- Santa Maria della Misericordia Hospital University of Perugia, Perugia, Italy
| | - Ugo Elmore
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Giovanni Ferrari
- Minimally-Invasive and Oncological Surgical Department Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | | | - Gianluca Garulli
- UOC Chirurgia Generale e d'Urgenza-Ospedale di Rimini (Novafeltria, Santarcangelo), Rimini, Italy
| | - Roberta Gelmini
- University of Modena and Reggio Emilia Policlinico of Modena Oncological and Emergency Surgery Unit ID, Modena, Italy
| | - Luigina Graziosi
- Santa Maria della Misericordia Hospital University of Perugia, Perugia, Italy
| | - Monica Gualtierotti
- Minimally-Invasive and Oncological Surgical Department Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University Hospital "G.B. Rossi", Verona, Italy
| | - Marco Inama
- Dipartimento di Chirurgia Generale Ospedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Federica Maffeis
- General Surgical Department St. Mary of Angels Hospital, Pordenone Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | | | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Andrea Massobrio
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluigi Moretto
- Dipartimento di Chirurgia Generale Ospedale Pederzoli, Peschiera del Garda, VR, Italy
| | | | - Giuseppe Navarra
- Department of Surgical Sciences, Faculty of Medicine, University of Messina, G. Martino University Hospital, Messina, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome St. Andrea University Hospital, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Stefano Olmi
- Head of General and Oncologic Surgery Center for Minimal Invasive and Laparoscopic Surgery Policlinico San Marco, Zingonia, Italy
| | - Raffaele Palaia
- Division of Abdominal Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale"-IRCCS-Via Mariano Semmola, 80131, Naples, Italy
| | - Davide Papis
- UOC Chirurgia Generale Ospedale Sant'Anna Como Asst Lariana, San Fermo della Battaglia, Italy
| | - Paolo Parise
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University Hospital "G.B. Rossi", Verona, Italy
| | - Roberto Petri
- Department of General Surgery, Azienda Ospedaliero-Universitaria of Udine Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Giusto Pignata
- General Surgery 2, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michele Pisano
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128, Bergamo, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona Gallarate, Varese, Italy
| | - Rossella Reddavid
- Department of Oncology, University of Turin, San Luigi University Hospital, Turin, Italy
| | - Giuseppe Rocco
- Università di Bologna Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Fausto Rosa
- Chirurgia Digestiva, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Riccardo Rosati
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Luca Rossit
- Department of General Surgery, Azienda Ospedaliero-Universitaria of Udine Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Matteo Rottoli
- Policlinico Sant'Orsola Bologna U.O. Chirurgia Tratto Alimentare, Bologna, Italy
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Stefano Santi
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Medical University of Pisa, 56124, Pisa, Italy
| | - Stefano Scabini
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Scaringi
- Chirurgia dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Fabio Staderini
- Chirurgia dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lucio Taglietti
- Department of Surgery, Asst Valcamonica Brescia, Brescia, Italy
| | - Beatrice Torre
- Policlinico Sant'Orsola Bologna U.O. Chirurgia Tratto Alimentare, Bologna, Italy
| | - Paolo Ubiali
- General Surgical Department St. Mary of Angels Hospital, Pordenone Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Matteo Uccelli
- Head of General and Oncologic Surgery Center for Minimal Invasive and Laparoscopic Surgery Policlinico San Marco, Zingonia, Italy
| | - Fabio Uggeri
- Università degli Studi di Milano-Bicocca, Ospedale San Gerardo di Monza, Monza, Italy
| | - Sara Vertaldi
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Jacopo Viganò
- General Surgery I, Surgery Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| |
Collapse
|
4
|
Stillman MD, Yoon SS. Open and minimally invasive gastrectomy in Eastern and Western patient populations: A review of the literature and reasons for differences in outcomes. J Surg Oncol 2022; 126:279-291. [PMID: 35416303 PMCID: PMC9276624 DOI: 10.1002/jso.26887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/08/2022]
Abstract
Randomized trials in the East have established minimally invasive gastrectomy as possibly superior for short-term outcomes and noninferior for long-term survival. Smaller randomized studies from Western countries have supported these findings. However, there are marked disparities in morbidity, mortality, and overall survival noted between Eastern and Western studies. In this article, we review the literature comparing open and minimally invasive gastrectomy in the East and West, and describe the possible reasons for differences in outcomes.
Collapse
Affiliation(s)
- Mason D Stillman
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Sam S Yoon
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
5
|
Bracale U, Merola G, Pignata G, Andreuccetti J, Dolce P, Boni L, Cassinotti E, Olmi S, Uccelli M, Gualtierotti M, Ferrari G, De Martini P, Bjelović M, Gunjić D, Silvestri V, Pontecorvi E, Peltrini R, Pirozzi F, Cuccurullo D, Sciuto A, Corcione F. Laparoscopic gastrectomy for stage II and III advanced gastric cancer: long‑term follow‑up data from a Western multicenter retrospective study. Surg Endosc 2022; 36:2300-2311. [PMID: 33877411 PMCID: PMC8921054 DOI: 10.1007/s00464-021-08505-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/07/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There has been an increasing interest for the laparoscopic treatment of early gastric cancer, especially among Eastern surgeons. However, the oncological effectiveness of Laparoscopic Gastrectomy (LG) for Advanced Gastric Cancer (AGC) remains a subject of debate, especially in Western countries where limited reports have been published. The aim of this paper is to retrospectively analyze short- and long-term results of LG for AGC in a real-life Western practice. MATERIALS AND METHODS All consecutive cases of LG with D2 lymphadenectomy for AGC performed from January 2005 to December 2019 at seven different surgical departments were analyzed retrospectively. The primary outcome was diseases-free survival (DFS). Secondary outcomes were overall survival (OS), number of retrieved lymph nodes, postoperative morbidity and conversion rate. RESULTS A total of 366 patients with stage II and III AGC underwent either total or subtotal LG. The mean number of harvested lymph nodes was 25 ± 14. The mean hospital stay was 13 ± 10 days and overall postoperative morbidity rate 27.32%, with severe complications (grade ≥ III) accounting for 9.29%. The median follow-up was 36 ± 16 months during which 90 deaths occurred, all due to disease progression. The DFS and OS probability was equal to 0.85 (95% CI 0.81-0.89) and 0.94 (95% CI 0.92-0.97) at 1 year, 0.62 (95% CI 0.55-0.69) and 0.63 (95% CI 0.56-0.71) at 5 years, respectively. CONCLUSION Our study has led us to conclude that LG for AGC is feasible and safe in the general practice of Western institutions when performed by trained surgeons.
Collapse
Affiliation(s)
- Umberto Bracale
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy.
| | - Giovanni Merola
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili of Brescia, Brescia, Italy
| | - Jacopo Andreuccetti
- Department of General and Mininvasive Surgery, San Camillo Hospital of Trento, Trento, Italy
| | - Pasquale Dolce
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Olmi
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, BG, Italy
| | - Matteo Uccelli
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, BG, Italy
| | - Monica Gualtierotti
- Department of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Ferrari
- Department of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo De Martini
- Department of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Miloš Bjelović
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Gunjić
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vania Silvestri
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Emanuele Pontecorvi
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Roberto Peltrini
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria Delle Grazie Hospital, Pozzuoli, NA, Italy
| | - Diego Cuccurullo
- Department of General, Mini-Invasive and Robotic Surgery, Monaldi Hospital, Naples, NA, Italy
| | - Antonio Sciuto
- Department of General Surgery, Santa Maria Delle Grazie Hospital, Pozzuoli, NA, Italy
| | - Francesco Corcione
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| |
Collapse
|
6
|
Barranquero AG, Priego P, Muñoz P, Bajawi M, Cuadrado M, Blázquez L, Sánchez-Picot S, Galindo J, Fernández-Cebrián JM. Laparoscopic vs. Open Gastrectomy for Advanced Gastric Cancer in a Western Population: a Propensity-Score Matched Analysis of Surgical and Oncological Results. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
7
|
Teh SH, Uong S, Lin TY, Shiraga S, Li Y, Gong IY, Herrinton LJ, Li RA. Clinical Outcomes Following Regionalization of Gastric Cancer Care in a US Integrated Health Care System. J Clin Oncol 2021; 39:3364-3376. [PMID: 34339289 DOI: 10.1200/jco.21.00480] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In 2016, Kaiser Permanente Northern California regionalized gastric cancer care, introducing a regional comprehensive multidisciplinary care team, standardizing staging and chemotherapy, and implementing laparoscopic gastrectomy and D2 lymphadenectomy for patients eligible for curative-intent surgery. This study evaluated the effect of regionalization on outcomes. METHODS The retrospective cohort study included gastric cancer cases diagnosed from January 2010 to May 2018. Information was obtained from the electronic medical record, cancer registry, state vital statistics, and chart review. Overall survival was compared in patients with all stages of disease, stage I-III disease, and curative-intent gastrectomy patients using annual inception cohorts. For the latter, the surgical approach and surgical outcomes were also compared. RESULTS Among 1,429 eligible patients with gastric cancer with all stages of disease, one third were treated after regionalization, 650 had stage I-III disease, and 394 underwent curative-intent surgery. Among surgical patients, neoadjuvant chemotherapy utilization increased from 35% to 66% (P < .0001), laparoscopic gastrectomy increased from 18% to 92% (P < .0001), and D2 lymphadenectomy increased from 2% to 80% (P < .0001). Dissection of ≥ 15 lymph nodes increased from 61% to 95% (P < .0001). Surgical complication rates did not appear to increase after regionalization. Length of hospitalization decreased from 7 to 3 days (P < .001). Overall survival at 2 years was as follows: all stages, 32.8% pre and 37.3% post (P = .20); stage I-III cases with or without surgery, 55.6% and 61.1%, respectively (P = .25); and among surgery patients, 72.7% and 85.5%, respectively (P < .03). CONCLUSION Regionalization of gastric cancer care within an integrated system allowed comprehensive multidisciplinary care, conversion to laparoscopic gastrectomy and D2 lymphadenectomy, increased overall survival among surgery patients, and no increase in surgical complications.
Collapse
Affiliation(s)
- Swee H Teh
- The Permanente Medical Group, Gastric Surgery, Northern California, Oakland, CA
| | - Stephen Uong
- Division of Research, Kaiser Permanente, Oakland, CA
| | - Teresa Y Lin
- Division of Research, Kaiser Permanente, Oakland, CA
| | - Sharon Shiraga
- The Permanente Medical Group, Gastric Surgery, Northern California, Oakland, CA
| | - Yan Li
- The Permanente Medical Group, Gastrointestinal Oncology, Northern California, Oakland, CA
| | - I-Yeh Gong
- The Permanente Medical Group, Gastrointestinal Oncology, Northern California, Oakland, CA
| | | | - Robert A Li
- The Permanente Medical Group, Gastric Surgery, Northern California, Oakland, CA
| |
Collapse
|
8
|
Abstract
BACKGROUND The aim of this study was to systematically review the current evidence on laparoscopic and robotic distal and total gastrectomy in comparison to open surgery. MATERIAL AND METHODS A systematic search of EMBASE and PubMed was conducted and 197 randomized (RCT) and non-randomized (non-RCT) studies were identified. An evaluation of early gastric cancer (EGC) and advanced (AGC) gastric cancer was carried out. RESULTS For EGC and laparoscopic distal resection (LDG) and total gastrectomy (LTG) a total of 10 RCT and 6 non-RCT, including 4329 patients (laparoscopic 2010 vs. open 2319) were identified. At a high evidence level (1+, 1++) there was no significant difference in terms of feasibility, intraoperative outcome and oncological quality, mortality and long-term oncological outcome compared to open gastrectomy (OG). After LDG and LTG patients showed a significantly faster early postoperative recovery and lower total morbidity. In contrast, the operation times were significant longer compared to ODG and OTG. For distal AGC and LDG in 6 RCT, including 2806 patients (LDG 1410 vs. ODG 1369) comparable results could be found also with a high evidence level (1++). The evidence for LTG in cases of AGC was lower (2-, 2+). Currently ,only 6 non-RCT with a total of 1090 patients (LTG 539 vs. OTG 551) are available, which showed comparable results to LDG but further high-quality RCTs are necessary. Robotic gastrectomy (RG) is currently being evaluated. According to the first studies RG for EGC seems to be equivalent to LDG; however, the evidence is currently low (3 to 2-).
Collapse
Affiliation(s)
- Kaja Ludwig
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland.
| | - Christian Barz
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland
| | - Uwe Scharlau
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland
| |
Collapse
|
9
|
Comparing short-term outcomes after totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy with Billroth I anastomosis: early experience of a single institution. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:26-34. [PMID: 35601286 PMCID: PMC8965999 DOI: 10.7602/jmis.2021.24.1.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
Purpose Methods Results Conclusion
Collapse
|
10
|
Jurado Muñoz PA, Bustamante Múnera RH, Toro-Vásquez JP, Correa-Cote JC, Morales Uribe CH. Resultados tempranos en pacientes con cáncer gástrico sometidos a gastrectomía laparoscópica con intención curativa. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introducción. El manejo de pacientes con cáncer gástrico está determinado por el estadio preoperatorio y requiere de una estrategia multidisciplinaria. La cirugía radical, especialmente en pacientes con estadios tempranos, es potencialmente curativa. El abordaje por vía laparoscópica ofrece ventajas sobre la vía abierta, sin embargo, en nuestro medio no hay información en cuanto a resultados oncológicos y posoperatorios tempranos.
Métodos. Estudio retrospectivo, descriptivo, de tipo transversal, en pacientes con cáncer gástrico llevados a gastrectomía laparoscópica con intención curativa, entre el 2014 y el 2019, en tres instituciones de la ciudad de Medellín. Se analizaron los datos demográficos, los resultados posoperatorios y oncológicos a corto plazo.
Resultados. Se incluyeron 75 pacientes sometidos a gastrectomía laparoscópica. La mediana de edad fue de 64 años y el estadio más frecuente fue el III. La gastrectomía fue subtotal en 50 pacientes (66,7 %) y total en 25 pacientes (33,3 %). Se hizo disección linfática D2 en 73 pacientes (97,3 %) con una mediana en el recuento ganglionar de 27. La tasa de resección R0 fue de 97,3 %. La mediana de estancia hospitalaria fue de seis días. La tasa de complicaciones mayores fue del 20 % y la mortalidad a 90 días fue del 4 %.
Discusión. La calidad oncológica de la gastrectomía laparoscópica fue adecuada y cumple con las recomendaciones de las guías internacionales. Si bien la morbilidad sigue siendo alta, tiene una tasa de sobrevida del 96 % a 90 días.
Collapse
|
11
|
Narayan RR, Poultsides GA. Advances in the surgical management of gastric and gastroesophageal junction cancer. Transl Gastroenterol Hepatol 2021; 6:16. [PMID: 33409410 DOI: 10.21037/tgh.2020.02.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/15/2020] [Indexed: 12/21/2022] Open
Abstract
Since Theodore Billroth and Cesar Roux perfected the methods of post-gastrectomy reconstruction in the late 19th century, surgical management of gastric and gastroesophageal cancer has made incremental progress. The majority of patients with localized disease are treated with perioperative combination chemotherapy or neoadjuvant chemoradiation. Staging laparoscopy before initiation of treatment or before surgical resection has improved staging accuracy and can drastically inform treatment decisions. The longstanding and contentious debate on the optimal extent of lymph node dissection for gastric cancer appears to have settled in favor of D2 dissection with the recently published 15-year follow-up of the Dutch randomized trial. Minimally invasive gastric and gastroesophageal resections are performed routinely in most centers affording faster recovery and equivalent oncologic outcomes. Pylorus-preserving distal (central) gastrectomy has emerged as a less invasive, function-preserving option for T1N0 middle-third gastric cancers, while randomized data on its oncologic adequacy are pending. Multi-visceral resections and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has been utilized selectively for patients with locally advanced tumors who have demonstrated disease control on preoperative chemotherapy. This review summarizes the current standard of surgical care for gastroesophageal junction and gastric cancer as well as highlights recent and upcoming advances to the field.
Collapse
Affiliation(s)
- Raja R Narayan
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - George A Poultsides
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
12
|
|
13
|
Azari FS, Roses RE. Management of Early Stage Gastric and Gastroesophageal Junction Malignancies. Surg Clin North Am 2019; 99:439-456. [PMID: 31047034 DOI: 10.1016/j.suc.2019.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Esophageal and gastric carcinomas are prevalent malignancies worldwide. In contrast to the poor prognosis associated with advanced stages of disease, early stage disease has a favorable prognosis. Early stage gastric cancer (ESGC) is defined as cancer in which the depth of invasion is limited to the submucosal layer of the stomach on histologic examination, regardless of lymph node status. ESGC that meets standard or expanded criteria can be treated via endoscopic mucosal resection and endoscopic submucosal dissection. Similar indications for endoscopic interventions exist for gastroesophageal junction and esophageal malignancies."
Collapse
Affiliation(s)
- Feredun S Azari
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein Pavilion, Philadelphia, PA 19104, USA
| | - Robert E Roses
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein Pavilion, Philadelphia, PA 19104, USA.
| |
Collapse
|
14
|
Comprehensive Complication Index Predicts Cancer-Specific Survival of Patients with Postoperative Complications after Curative Resection of Gastric Cancer. Gastroenterol Res Pract 2018; 2018:4396018. [PMID: 30581463 PMCID: PMC6276389 DOI: 10.1155/2018/4396018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/13/2018] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the prognostic impact of postoperative complications for patients with gastric cancer. Methods Postoperative complications of patients undergoing radical gastrectomy for gastric cancer were reviewed. The severity of complications was graded by the CCI and C-D classification. Results A total of 5327 patients were included in the study. Complications were observed in 767 patients. When the C-D classification system was applied, for patients with grade I-II complications, the length of stay (LOS) of those with high CCI (CCI ≥ 26.2) was significantly longer than that of patients with low CCI (CCI < 26.2) (p < 0.001). The 5-year cancer-specific survival rate of patients with complications (52%) was lower than that of patients without complications (61%) (p < 0.001). Analysis of the factors associated with prognosis in patients with gastric cancer revealed that complications were independent risk factors for specific survival. When CCI was used to classify complication severity, the 5-year cancer-specific survival rate of the high-CCI group was 46.3%, which was lower than that of the low-CCI group (54.9%, p = 0.009). Conclusion Complication after radical gastrectomy is an independent prognostic factor, and the complication severity as graded by CCI reflects the difference of cancer-specific survival in gastric cancer patients with postoperative complications.
Collapse
|
15
|
Lianos GD, Hasemaki N, Glantzounis GK, Mitsis M, Rausei S. Assessing safety and feasibility of 'pure' laparoscopic total gastrectomy for advanced gastric cancer in the West. Review article. Int J Surg 2018; 53:275-278. [PMID: 29602017 DOI: 10.1016/j.ijsu.2018.03.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gastric cancer is reported to be the fourth most common cancer and the second leading cause of cancer-related death worldwide. Minimally invasive surgical treatment for gastric cancer is a very challenging approach which offers undoubtedly important advantages. MATERIALS AND METHODS There is intense debate concerning the minimally invasive surgical approach for advanced gastric cancer especially in the Western population. A careful literature search was conducted in order to clarify the feasibility and safety of pure laparoscopic total gastrectomy in the West. RESULTS Herewith we aim to summarize the current scientific evidence assessing the feasibility and short-term outcomes of laparoscopic gastrectomy for advanced gastric cancer in the West. A lack of data from Western institutions regarding minimally invasive surgical approach for gastric cancer is yet a reality. Nevertheless, the laparoscopic procedure appears to provide satisfactory short-term oncologic outcomes and improved postoperative outcomes. CONCLUSION It is obvious that future well-conducted trials on long-term results are necessary for Western patients in order safe conclusions to be reached regarding a potential definitive 'place' for laparoscopy in the curative gastric cancer treatment.
Collapse
Affiliation(s)
- Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina and University of Ioannina, Ioannina, 45110, Greece; Department of Surgery, General Hospital of Preveza, Preveza, Greece.
| | - Natasha Hasemaki
- Department of Surgery, General Hospital of Preveza, Preveza, Greece
| | - Georgios K Glantzounis
- Department of Surgery, University Hospital of Ioannina and University of Ioannina, Ioannina, 45110, Greece
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina and University of Ioannina, Ioannina, 45110, Greece
| | - Stefano Rausei
- Department of Surgery, University of Insubria, Varese, Italy
| |
Collapse
|
16
|
Short-term outcomes in minimally invasive versus open gastrectomy: the differences between East and West. A systematic review of the literature. Gastric Cancer 2018; 21:19-30. [PMID: 28730391 PMCID: PMC5741797 DOI: 10.1007/s10120-017-0747-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/06/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Minimally invasive surgical techniques for gastric cancer are gaining more interest worldwide. Several Asian studies have proven the benefits of minimally invasive techniques over the open techniques. Nevertheless, implementation of this technique in Western countries is gradual. The aim of this systematic review is to give insight in the differences in outcomes and patient characteristics in Asian countries in comparison to Western countries. METHODOLOGY An extensive systematic search was conducted using the Medline, Embase, and Cochrane databases. Analysis of the outcomes was performed regarding operative results, postoperative recovery, complications, mortality, lymph node yield, radicality of the resected specimen, and survival. A total of 12 Asian and 8 Western studies were included. RESULTS Minimally invasive gastrectomy shows faster postoperative recovery, fewer complications, and similar outcomes regarding mortality in both the Eastern and Western studies. However, patient characteristics such as age and BMI differ between these populations. Comparison of overall outcomes in minimally invasive and open procedures between East and West showed differences in complications, mortality, and number of resected lymph nodes in favor of the Asian population. CONCLUSION Improved outcomes are observed following minimally invasive gastrectomy in comparison to open procedures in both Western and Asian studies. There are differences in patient characteristics between the Western and Asian populations. Overall outcomes seem to be in favor of the Asian population. These differences may fade with centralization of care for gastric cancer patients in the West and increasing surgical experience.
Collapse
|
17
|
A propensity score matched case-control comparative study of totally laparoscopic distal gastrectomy and laparoscopic-assisted distal gastrectomy for early gastric cancer. Eur Surg 2017. [DOI: 10.1007/s10353-017-0495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
Affiliation(s)
- Gabriel Herrera-Almario
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| |
Collapse
|
19
|
Minimally invasive gastrectomy for gastric cancer: A national perspective on oncologic outcomes and overall survival. Surg Oncol 2017; 26:324-330. [DOI: 10.1016/j.suronc.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023]
|
20
|
Russo A, Strong VE. Minimally invasive surgery for gastric cancer in USA: current status and future perspectives. Transl Gastroenterol Hepatol 2017; 2:38. [PMID: 28529992 DOI: 10.21037/tgh.2017.03.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/15/2017] [Indexed: 12/26/2022] Open
Abstract
The World Health Organization (WHO) has declared gastric carcinoma a global health concern and gastric cancer remains the third leading cause of cancer deaths worldwide. With the rising incidence of gastric cancer, a body of both retrospective and randomized data has emerged since the early 1990's evaluating the role of minimally invasive platforms in the management of gastric cancer. While Eastern studies have shown that the laparoscopic approach is safe and feasible for advanced gastric cancer in Eastern patients, it is not clear whether this is true for patients in the West. Differences in tumor biology, stage at presentation, institutional volume, and surgeon experience all may impact the efficacy and widespread utilization of minimally invasive approaches in regions where gastric cancer is less prevalent. The majority of studies have pointed to a number of improvements associated with minimally invasive approaches including decreased blood loss, shorter length of hospital stay, lower analgesic requirements, decreased minor complications, and faster recovery without any significant difference in overall or disease specific survival (DSS). The benefits associated with minimally invasive approaches and evidence supporting similar oncologic outcomes compared to the traditional open approach will hopefully expand the indications for minimally invasive surgery in the management of gastric cancer. In the United States, results following initial experiences with minimally invasive techniques, including robotic platforms, have revealed promising results. Well-established laparoscopic and robotic techniques are emerging, particularly from high volume United States institutions, which will hopefully pave the way for increased utilization of minimally invasive surgery for gastric cancer in the West.
Collapse
Affiliation(s)
- Ashley Russo
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
21
|
|
22
|
Complications and failure to rescue following laparoscopic or open gastrectomy for gastric cancer: a propensity-matched analysis. Surg Endosc 2016; 31:2325-2337. [PMID: 27620911 DOI: 10.1007/s00464-016-5235-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/30/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND To investigate the incidence of and factors associated with postoperative complications and failure to rescue following laparoscopic and open gastrectomy for gastric cancer. STUDY DESIGN We analyzed the records of 4124 patients who underwent a laparoscopic or open gastrectomy for gastric cancer. One-to-one propensity score matching was performed to compare the difference between the two groups. RESULTS A total of 4124 patients were included in the study, 627 of whom (15.2 %) developed postoperative complications. Postoperative deaths occurred in 23 (0.6 %) patients with serious complications. In the propensity score matching analysis with 1361 pairs, no significant differences in the rates of overall complications (14.2 vs. 16.5 %, p = 0.093) were observed between laparoscopic and open gastrectomy group. In-hospital mortality decreased in patients who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy (0.3 vs. 1.2 %, p = 0.004). Failure to rescue rates were lower in patients who underwent laparoscopic gastrectomy (2.1 vs. 7.6 %, p = 0.008). Multivariate analysis showed that older age, tumor location, TNM stage classification, extent of gastric resection, operative time and intra-operative blood loss were adverse risk factors for postoperative complications. Laparoscopic gastrectomy was found to be a protective factor for failure to rescue. Complications associated with failure to rescue included abdominal bleeding, anastomotic leakage and cardiac events. In-hospital mortality increased as the number of complications per patient increased. CONCLUSIONS Assuming equal competence with open and laparoscopic approaches of a surgeon, the proportion of patients with postoperative complications were similar among those who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy. However, when complications occurred, patients with open gastrectomy were more likely to die.
Collapse
|
23
|
Takahashi K, Ito H, Katsube T, Tsuboi A, Hashimoto M, Ota E, Mita K, Asakawa H, Hayashi T, Fujino K. Associations between antithrombotic therapy and the risk of perioperative complications among patients undergoing laparoscopic gastrectomy. Surg Endosc 2016; 31:567-572. [PMID: 27287908 DOI: 10.1007/s00464-016-4998-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/19/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study was to identify factors associated with perioperative morbidity among patients who underwent laparoscopic gastrectomy while receiving antithrombotic therapy (ATT). PATIENTS AND METHOD This retrospective cohort study included 46 patients (14 females and 32 males) who underwent laparoscopic gastrectomy, including 12 (26.1 %) who received perioperative ATT, between January 2012 and November 2015 in our institution. Among patients receiving only aspirin as antiplatelet therapy, none were on anticoagulation therapy. All patients took aspirin as antiplatelet therapy for cardiac indications. The clinical findings and surgical outcomes of patients who did (ATT group) and did not (control group) receive ATT were compared. RESULTS The intraoperative mortality was 0 % for both groups. There was no significant difference in the incidence of postoperative morbidity by univariate analysis between the control and ATT groups (8.8 vs. 8.3 %, p = 0.39). CONCLUSION The risk of postoperative morbidity of laparoscopic gastrectomy can be equivalent between the ATT and non-ATT (control) groups.
Collapse
Affiliation(s)
- Kodai Takahashi
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan.
| | - Hideto Ito
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan
| | - Toshio Katsube
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan
| | - Ayaka Tsuboi
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan
| | - Masatoshi Hashimoto
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan
| | - Emi Ota
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan
| | - Kazuhito Mita
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan
| | - Hideki Asakawa
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan
| | - Takashi Hayashi
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan
| | - Keiichi Fujino
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya Matsudo-city, Chiba, 270-2232, Japan
| |
Collapse
|
24
|
Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer: Short-term Outcomes From a Multicenter Randomized Controlled Trial (KLASS-01). Ann Surg 2016; 263:28-35. [PMID: 26352529 DOI: 10.1097/sla.0000000000001346] [Citation(s) in RCA: 461] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the safety of laparoscopy-assisted distal gastrectomy (LADG) compared with open distal gastrectomy (ODG) in patients with clinical stage I gastric cancer in Korea. BACKGROUND There is still a lack of large-scale, multicenter randomized trials regarding the safety of LADG. METHODS A large-scale, phase 3, multicenter, prospective randomized controlled trial was conducted. The primary end point was 5-year overall survival. Morbidity within 30 postoperative days and surgical mortality were compared to evaluate the safety of LADG as a secondary end point RESULTS : A total of 1416 patients were randomly assigned to the LADG group (n = 705) or the ODG group (n = 711) between February 1, 2006, and August 31, 2010, and 1384 patients were analyzed for modified intention-to-treat analysis (ITT) and 1256 were eligible for per protocol (PP) analysis (644 and 612, respectively). In the PP analysis, 6 patients (0.9%) needed open conversion in the LADG group. The overall complication rate was significantly lower in the LADG group (LADG vs ODG; 13.0% vs 19.9%, P = 0.001). In detail, the wound complication rate of the LADG group was significantly lower than that of the ODG group (3.1% vs 7.7%, P < 0.001). The major intra-abdominal complication (7.6% vs 10.3%, P = 0.095) and mortality rates (0.6% vs 0.3%, P = 0.687) were similar between the 2 groups. Modified ITT analysis showed similar results with PP analysis. CONCLUSIONS LADG for patients with clinical stage I gastric cancer is safe and has a benefit of lower occurrence of wound complication compared with conventional ODG.
Collapse
|
25
|
Chen K, Pan Y, Cai JQ, Wu D, Yan JF, Chen DW, Yu HM, Wang XF. Totally laparoscopic versus laparoscopic-assisted total gastrectomy for upper and middle gastric cancer: a single-unit experience of 253 cases with meta-analysis. World J Surg Oncol 2016; 14:96. [PMID: 27036540 PMCID: PMC4815120 DOI: 10.1186/s12957-016-0860-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/24/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Laparoscopic-assisted total gastrectomy (LATG) is the most commonly used methods of laparoscopic gastrectomy for upper and middle gastric cancer. However, totally laparoscopic total gastrectomy (TLTG) is unpopular because reconstruction is difficult, especially for the intracorporeal esophagojejunostomy. We adopted TLTG with various types of intracorporeal esophagojejunostomy. In this study, we compared LATG and TLTG to evaluate their outcomes. METHODS From March 2006 to September 2015, 253 patients with upper and middle gastric cancer underwent laparoscopic total gastrectomy (LTG), 145 patients underwent LATG, and 108 patients underwent TLTG. The clinicopathological characteristics and postoperative outcomes were retrospectively compared between the two groups. Furthermore, a systematic review and meta-analysis were conducted. RESULTS The operation time and estimated blood loss were similar between the groups. There were no significant differences in first flatus, diet initiation, and postoperative hospital stay. The surgical complication rates were 17.2% (25/145) and 13.9% (15/108) in the LATG and TLTG groups, respectively. The meta-analysis also revealed no significant differences in the operation time, estimated blood loss, time to first flatus, length of hospital stay, overall, and anastomosis-related complications among the groups. CONCLUSIONS TLTG is a feasible choice for gastric cancer patients, with comparable results to the LATG approach.
Collapse
Affiliation(s)
- 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
| | - 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
| | - 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
| | - Di Wu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016 Zhejiang Province China
| | - Jia-Fei Yan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016 Zhejiang Province China
| | - Ding-Wei Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016 Zhejiang Province China
| | - Hong-Mei Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016 Zhejiang Province China
| | - Xian-Fa Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016 Zhejiang Province China
| |
Collapse
|
26
|
Jin K, Lan H, Tao F, Zhang R. Totally laparoscopic D2 radical distal gastrectomy using Billroth II anastomosis: A case report. Oncol Lett 2016; 11:1855-1858. [PMID: 26998089 DOI: 10.3892/ol.2016.4107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 01/06/2016] [Indexed: 01/07/2023] Open
Abstract
Here, we present our first case of totally laparoscopic D2 radical distal gastrectomy using Billroth II anastomosis and evaluate its effectiveness in terms of minimal invasiveness, technical feasibility and safety for the resection of early gastric cancer. In the present case, only laparoscopic linear staplers were used for intracorporeal anastomosis. The time taken was 180 min, the anastomotic time was 15 min, the number of staples used was five, and the estimated blood loss was 30 ml. The first flatus was observed at 3 days, and a liquid diet was started at 6 days. The postoperative hospital stay was 8 days. No postoperative complications were noted with our case. In conclusion, totally laparoscopic Billroth II anastomosis using laparoscopic linear staplers for early gastric cancer is considered to be safe and feasible.
Collapse
Affiliation(s)
- Ketao Jin
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang 312000, P.R. China; Department of Gastrointestinal Surgery and Laboratory of Translational Oncology, Public Research Platform, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang 317000, P.R. China
| | - Huanrong Lan
- Department of Breast and Thryoid Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang 312000, P.R. China
| | - Feng Tao
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang 312000, P.R. China
| | - Ruili Zhang
- Department of Gastrointestinal Surgery and Laboratory of Translational Oncology, Public Research Platform, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang 317000, P.R. China
| |
Collapse
|
27
|
Jian-Cheng T, Bo Z, Jian F, Liang Z. Delta-Shaped Gastroduodenostomy in Fully Laparoscopic Distal Gastrectomy: A Retrospective Study. Medicine (Baltimore) 2015; 94:e1153. [PMID: 26181558 PMCID: PMC4617079 DOI: 10.1097/md.0000000000001153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 12/18/2022] Open
Abstract
This study aims to explore the technical feasibility, safety, and clinical efficacy of delta-shaped anastomosis for digestive tract reconstruction during totally laparoscopic distal gastrectomy. Clinical data of 24 patients who received totally laparoscopic distal gastrectomy with delta-shaped anastomosis (laparoscopic gastrectomy group, LG group) and 30 patients who received open distal gastrectomy for gastric cancer (open gastrectomy group, OG group) from April 2013 to April 2014 were retrospectively analyzed. Operation time, intraoperative blood loss, postoperative time to intestinal function recovery, postoperative pain, postoperative hospital stay, and incidence of postoperative complications (infection, obstruction, and delayed gastric emptying) were compared between these 2 groups. Patients in both groups were discharged without marked complications. No patients who initially selected laparoscopy were converted to laparotomy. Patients in the LG group had longer operation times (175.3 ± 64.7 minutes versus 120.1 ± 43.4 minutes, P < 0.05), lower intraoperative blood loss (50.8 ± 25.3 mL versus 95.6 ± 20.7 mL, P < 0.05), faster recovery of intestinal function (1.2 ± 0.5 days versus 2.6 ± 1.0 days, P < 0.05), less postoperative pain (5.6 ± 0.7 versus 9.5 ± 0.3, P < 0.05), and shorter length of postoperative hospital stay (8.5 ± 2.2 days versus 12.2 ± 3.8 days, P < 0.05), compared with patients in the OG group. There were no significant differences with respect to surgical margins achieved, the number of lymph nodes retrieved or incidence of postoperative complications (infection, obstruction, and delayed gastric emptying) between the 2 groups (P > 0.05). Laparoscopic reconstruction of the digestive tract through delta-shaped anastomosis appears to be safe, feasible, and associated to rapid recovery. These data argue for more wide-spread implementation of this procedure.
Collapse
Affiliation(s)
- Tu Jian-Cheng
- From the Department of General Surgery, Zhangjiagang Hospital Affiliated to Soochow University, Jiangsu Province, P.R. China (TJ-C, ZB, FJ, ZL)
| | | | | | | |
Collapse
|
28
|
Internal hernia after laparoscopic-assisted proximal gastrectomy with jejunal interposition for gastric cancer: a case report. Surg Case Rep 2015; 1:49. [PMID: 26366346 PMCID: PMC4560147 DOI: 10.1186/s40792-015-0051-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/03/2015] [Indexed: 12/29/2022] Open
Abstract
Internal hernia after gastrectomy is a rare complication. It can progress rapidly to vascular disturbance, necrosis, and perforation, therefore early diagnosis and surgical treatment is essential. We present a case of internal hernia following laparoscopic-assisted proximal gastrectomy with jejunal interposition reconstruction in a 68-year-old man, who presented with acute abdominal pain and vomiting. Computed tomography showed a whirl sign, ascites, and a closed-loop formation of the small intestine. We diagnosed an internal hernia and performed emergency surgery. Laparotomy revealed chyle-like ascites and extensive small intestine with poor color. We recognized that about 20 cm of jejunum from the ligament of Treitz was strangulated behind the pedicle of the jejunum lifted during laparoscopic-assisted proximal gastrectomy. We relieved the strangulation, whereupon the color of the strangulated intestine was restored. Therefore, we did not perform intestinal resection and reconstruction. Finally, we fixed the jejunal pedicle and mesentery of the transverse colon. We report this case as there are few reported cases of internal hernia after laparoscopic-assisted proximal gastrectomy.
Collapse
|
29
|
Man-I M, Suda K, Kikuchi K, Tanaka T, Furuta S, Nakauchi M, Ishikawa K, Ishida Y, Uyama I. Totally intracorporeal delta-shaped B-I anastomosis following laparoscopic distal gastrectomy using the Tri-Staple™ reloads on the manual Ultra handle: a prospective cohort study with historical controls. Surg Endosc 2015; 29:3304-12. [PMID: 25732753 DOI: 10.1007/s00464-015-4085-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/15/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND A delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy could be performed easily and sufficiently using only laparoscopic linear staplers. However, the restricted maneuverability and severe blurring of these staplers along with their limited hemostability induced strain. In this study, we determined the feasibility and safety of performing delta-shaped anastomosis using the Endo GIA™ Reloads with Tri-Staple™ Technology combined with Endo GIA™ Ultra Universal stapler (Tri-Staple) with a particular focus on short-term surgical outcomes. METHODS We performed a single-institutional prospective interventional study (UMIN 000008014). The Tri-Staple was prospectively used on 23 consecutive patients who underwent a curative totally laparoscopic Billroth I gastrectomy with delta-shaped anastomosis. These patients were matched with the 19 patients previously treated using the ENDOPATH(®) ETS Articulating Linear Cutters (ETS) on clinical and demographic characteristics. RESULTS There were no differences between the groups in anastomosis-related local complications, morbidity, non-anastomosis-related local complications, total systemic complications, and short-term outcomes with the exception of significantly reduced blood loss in the Tri-Staple group (ETS vs. Tri-Staple: 37 [10-306] vs. 15 [5-210] mL, p = 0.02). Intraoperative bleeding from the staple line was significantly reduced in the Tri-Staple group. The postoperative drain indwelling period (ETS vs. Tri-Staple, 6 [4-10] vs. 4 [2-43] days, p = 0.032), fasting period (5 [3-7] vs. 3 [3-24] days, p = 0.022), and hospital stay (14 [10-47] vs. 11 [6-58] days, p = 0.025) were significantly shorter in the Tri-Staple group. There was no mortality in this series. Acceleration assessed as indices of blurring of stapler tip might have a significant adverse influence on staple-line bleeding at stapling sites. CONCLUSION Totally laparoscopic Billroth I distal gastrectomy using Tri-Staple was feasible and safe with favorable short-term surgical outcomes. Reduced blurring while stapling may be a novel endpoint which newly developed stapling devices should target.
Collapse
Affiliation(s)
- Mariko Man-I
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Koichi Suda
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Kenji Kikuchi
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Tsuyoshi Tanaka
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Shimpei Furuta
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masaya Nakauchi
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ken Ishikawa
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoshinori Ishida
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| |
Collapse
|
30
|
Is Laparoscopic Surgery the Standard of Care for GI Luminal Cancer? Indian J Surg 2015; 76:444-52. [PMID: 25614719 DOI: 10.1007/s12262-014-1126-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/16/2014] [Indexed: 12/18/2022] Open
Abstract
As surgeons in India strive to keep pace with the technical advances in the field of laparoscopic surgery, we endeavor to evaluate the mounting global evidence regarding laparoscopic gastric and colorectal resections for cancer. We seem to be riding on the crest of excellence in traditional open surgery for gastrointestinal malignancies, opening avenues for research and for the establishment of practice guidelines in laparoscopic surgery. Results from available trials along with those from ongoing studies are paving the path toward the acceptance and standardization of these procedures. What must be ascertained is whether sound oncological principles, which are ultimately exhibited by long-term outcomes, are being preserved while garnering the established benefits of minimally invasive surgery.
Collapse
|
31
|
Marjanovic G, Kuvendziska J, Holzner PA, Glatz T, Sick O, Seifert G, Kulemann B, Küsters S, Fink J, Timme S, Hopt UT, Wellner U, Keck T, Karcz WK. A prospective clinical study evaluating the development of bowel wall edema during laparoscopic and open visceral surgery. J Gastrointest Surg 2014; 18:2149-54. [PMID: 25326126 DOI: 10.1007/s11605-014-2681-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/10/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND To examine bowel wall edema development in laparoscopic and open major visceral surgery. METHODS In a prospective study, 47 consecutively operated patients with gastric and pancreatic resections were included. Twenty-seven patients were operated in a conventional open procedure (open group) and 20 in a laparoscopic fashion (lap group). In all procedures, a small jejunal segment was resected during standard preparation, of which we measured the dry-wet ratio. Furthermore, HE staining was performed for measuring of bowel wall thickness and edema assessment. RESULTS Mean value (±std) of dry-wet ratio was significantly lower in the open than in the lap group (0.169 ± 0.017 versus 0.179 ± 0.015; p = 0.03) with the same amount of fluid administration in both groups and a longer infusion interval during laparoscopic surgery. Subgroup analyses (only pancreatic resections) still showed similar results. Histologic examination depicted a significantly larger bowel wall thickness in the open group. CONCLUSIONS Laparoscopic surgery does not seem to lead to the bowel wall edema observed to occur in open surgery regardless of the degree of intravenous fluid administration, thus supporting its use even in major visceral surgery.
Collapse
Affiliation(s)
- Goran Marjanovic
- Department of General and Digestive Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany,
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Oki E, Tsuda Y, Saeki H, Ando K, Imamura Y, Nakashima Y, Ohgaki K, Morita M, Ikeda T, Maehara Y. Book-Binding Technique for Billroth I Anastomosis During Totally Laparoscopic Distal Gastrectomy. J Am Coll Surg 2014; 219:e69-73. [PMID: 25283741 DOI: 10.1016/j.jamcollsurg.2014.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/21/2014] [Accepted: 09/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yasuo Tsuda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Saeki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Ando
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Imamura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Nakashima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kippei Ohgaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaru Morita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuo Ikeda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
33
|
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.
Collapse
|
34
|
Umemura A, Koeda K, Sasaki A, Fujiwara H, Kimura Y, Iwaya T, Akiyama Y, Wakabayashi G. Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg 2014; 38:102-12. [PMID: 25458736 DOI: 10.1016/j.asjsur.2014.09.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 04/01/2014] [Accepted: 09/23/2014] [Indexed: 12/12/2022] Open
Abstract
There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG) for gastric cancer. However, there is no scientific evidence to determine which esophagojejunostomy (EJS) technique is the best. In addition, both short- and long-term oncological results of TLTG are inconsistent. We reviewed 25 articles about TLTG for gastric cancer in which at least 10 cases were included. We analyzed the short-term results, relationships between EJS techniques and complications, long-term oncological results, and comparative study results of TLTG. TLTG was performed in a total of 1170 patients. The mortality rate was 0.7%, and the short-term results were satisfactory. Regarding EJS techniques and complications, circular staplers (CSs) methods were significantly associated with leakage (4.7% vs. 1.1%, p < 0.001) and stenosis (8.3% vs. 1.8%, p < 0.001) of the EJS as compared with the linear stapler method. The long-term oncological prognosis was acceptable in patients with early gastric cancers and without metastases to lymph nodes. Although TLTG tended to increase surgical time compared with open total gastrectomy and laparoscopy-assisted total gastrectomy, it reduced intraoperative blood loss and was expected to shorten postoperative hospital stay. TLTG is found to be safer and more feasible than open total gastrectomy and laparoscopy-assisted total gastrectomy. At present, there is no evidence to encourage performing TLTG for patients with advanced gastric cancer from the viewpoint of long-term oncological prognosis. Although the current major EJS techniques are CS and linear stapler methods, in this review, CS methods are significantly associated with leakage and stenosis of the EJS.
Collapse
Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, Morioka, Japan.
| | - Keisuke Koeda
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | | | - Yusuke Kimura
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Takeshi Iwaya
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Yuji Akiyama
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Go Wakabayashi
- Department of Surgery, Iwate Medical University, Morioka, Japan
| |
Collapse
|
35
|
Abstract
Totally laparoscopic gastrectomy appears to be a reasonable option for the treatment of gastric malignancy, with early data demonstrating acceptable survival rates and perioperative outcomes. Background and Objectives: Recent studies have supported minimally invasive techniques as a viable alternative to open surgery in the treatment of gastric cancer. The goal of this study is to review our institution's experience with totally laparoscopic gastrectomy for the treatment of both early- and advanced-stage gastric cancer. Methods: A retrospective study was conducted to examine the short-term outcomes of laparoscopic gastrectomy performed at Monmouth Medical Center between May 2003 and June 2012. We reviewed postoperative complications, surgical margins, number of resected lymph nodes, estimated blood loss, length of stay, narcotic use, and recurrence rate. Results: Forty patients were included in the study. There were 21 cases of adenocarcinoma, 15 cases of gastrointestinal stromal tumor, 2 cases of carcinoid, 1 case of small cell neuroendocrine tumor, and 1 case of squamous cell carcinoma. The mean operative time was 220 minutes (range, 67–450 minutes). The median length of stay was 6 days (range, 1–37 days). The mean number of harvested lymph nodes was 11. Early postoperative complications occurred in 7 patients and included anastomotic stricture, wound infection, intra-abdominal abscess, bowel obstruction, and esophageal pneumatosis. There were two deaths. The Kaplan-Meier 5-year overall and recurrence-free survival rate for all cases of adenocarcinoma was 63.2%. Conclusions: Totally laparoscopic gastrectomy is a reasonable option for the treatment of gastric malignancy, with early data showing acceptable survival rates and perioperative outcomes. Large-scale randomized trials are still needed to confirm oncologic equivalency to open gastrectomy in patients with advanced disease.
Collapse
Affiliation(s)
| | - William W Train
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | | | - Frank J Borao
- Department of Surgery, Monmouth Medical Center, 10 Industrial Way E, Ste 104, Eatontown, NJ 07724, USA.
| |
Collapse
|
36
|
Ott K, Blank S, Büchler M. Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Magen - Kontra-Position. Visc Med 2013. [DOI: 10.1159/000357062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
37
|
Sugimoto M, Kinoshita T, Shibasaki H, Kato Y, Gotohda N, Takahashi S, Konishi M. Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer. Surg Endosc 2013; 27:4291-6. [PMID: 23793806 DOI: 10.1007/s00464-013-3045-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/28/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic distal gastrectomy for gastric cancer has been firmly established in recent decades but still is a difficult procedure, especially for obese patients, as with open surgery. This study aimed to evaluate the perioperative outcome of total laparoscopic distal gastrectomy (TLDG) for early gastric cancer patients with a body mass index (BMI) exceeding 25 kg/m(2) and to consider countermeasures to this. METHODS Perioperative outcomes were compared between 42 patients with a BMI exceeding 25 kg/m(2) [overweight or obese group (OWG)] and 174 patients with a BMI lower than 25 kg/m(2) [normal or underweight group (NWG)] who underwent TLDG between September 2010 and December 2012. RESULTS The BMI was 26.0 ± 1.4 kg/m(2) in the OWG group and 22.0 ± 2.1 kg/m(2) in the NWG group (P < 0.001). The groups did not differ in terms of age, sex, American Society of Anesthesiologists score, presence of diabetes, number of retrieved lymph nodes, number of metastatic lymph nodes, or metastatic lymph node ratio. The two groups did not differ significantly with respect to the extent of lymph node dissection [OWG: D1 (11.9 %), D1+ (66.7 %), D2 (21.4 %) vs NWG: D1 (5.2 %), D1+ (51.7 %), D2 (43.1 %); P = 0.020] or tumor size (OWG: 25.5 ± 20.2 mm vs NWG: 33.0 ± 17.2 mm; P = 0.037). Differences in operation time (OWG: 212 ± 31 min vs NWG: 200 ± 35 min; P = 0.005) and estimated blood loss (OWG: 15 ± 22 ml vs NWG: 10 ± 34 ml; P = 0.013) seemed to have a minimal impact clinically. Postoperative complications including infectious complications and recovery after surgery did not differ between the two groups. CONCLUSIONS For overweight and obese patients, TLDG was managed safely. The procedure was considered to be difficult but sufficiently feasible.
Collapse
Affiliation(s)
- Motokazu Sugimoto
- Department of Digestive Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan,
| | | | | | | | | | | | | |
Collapse
|
38
|
Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc 2013; 27:4267-76. [PMID: 23793805 DOI: 10.1007/s00464-013-3037-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/20/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate laparoscopy-assisted distal gastrectomy (LADG) compared to open distal gastrectomy (ODG) in the treatment of early gastric cancer with respect to survival, surgical outcomes, complications, and quality of life (QOL). METHODS One hundred sixty-four patients with cT1N0M0 and cT1N1M0 distal gastric cancer were randomly assigned to either the LADG group or the ODG group. The primary end point was the 5-year disease-free survival (DFS) rate. Complications were classified using the accordion severity classification of postoperative complications scheme. QOL was measured using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-STO22 preoperatively and postoperatively during regular follow-up visits. This trial is registered at ClinicalTrials.gov (NCT00546468). RESULTS The median (range) follow-up period was 74.3 (24.8-90.8) months. The LADG and ODG groups showed similar survival [5-year DFS rate: 98.8 % vs. 97.6 %, respectively (P = 0.514), 5-year overall survival (OS) rate: 97.6 vs. 96.3 %, respectively (P = 0.721)] or overall complication rate (29.3 vs. 42.7 %, respectively; P = 0.073). Mild complications were significantly less frequent in the LADG group than in the ODG group (23.2 vs. 41.5 %; P = 0.012). The rates of moderate, severe, and long-term complications (i.e., 31 days to 5 years after surgery) did not differ significantly between groups. No clinically meaningful differences were detected between the two groups in long-term QOL. CONCLUSION LADG showed similar DFS and OS compared to ODG in treating early gastric cancer. Marginal benefits in mild complications were observed with LADG. LADG did not show advantages over ODG regarding other complications and long-term QOL.
Collapse
|
39
|
Cianchi F, Qirici E, Trallori G, Macrì G, Indennitate G, Ortolani M, Paoli B, Biagini MR, Galli A, Messerini L, Mallardi B, Badii B, Staderini F, Perigli G. Totally laparoscopic versus open gastrectomy for gastric cancer: a matched cohort study. J Laparoendosc Adv Surg Tech A 2012; 23:117-22. [PMID: 23216509 DOI: 10.1089/lap.2012.0310] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The role of laparoscopic surgery for the treatment of gastric cancer is still controversial, particularly in terms of oncologic efficacy. The aim of this study was to compare short-term outcomes of laparoscopic and open resection for gastric cancer at a single Western institution. SUBJECTS AND METHODS This study was designed as a matched cohort study from a prospective gastric cancer database. Forty-one patients undergoing laparoscopic gastrectomy for gastric cancer between June 2008 and January 2012 were matched with 41 patients undergoing open gastrectomy in the same time period. Patient pairing was done according to age, gender, type of gastrectomy (subtotal or total), and tumor stage via a randomized statistical method. The short-term outcomes and oncologic adequacy of the laparoscopic and open procedures were compared. A D2 lymph node dissection was performed in the majority of patients in both groups. RESULTS The two study groups were similar with respect to patient and tumor characteristics. Laparoscopic procedures were associated with a decreased blood loss (118.7 versus 312.4 mL, P<.005), incidence of surgery-unrelated complications (3 versus 9 patients, P<.05), and duration of hospital stay (8.1 versus 11.5 days, P<.05) but increased operative time for both subtotal (223.5 versus 158.2 minutes, P<.001) and total (298.1 versus 185.5 minutes, P<.001) gastrectomies. The mean number of retrieved lymph nodes after D2 dissection was similar: 30.0 for laparoscopic and 29.7 for open patients. CONCLUSIONS Within the limitations of a nonrandomized analysis, this study shows that the laparoscopic approach is a safe and oncologically adequate option for the treatment of gastric cancer, which compares favorably with open gastrectomy in short-term outcomes.
Collapse
Affiliation(s)
- Fabio Cianchi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Gastric cancer is common worldwide. Tumor location and disease stage differ between Asian and Western countries. Western patients often have higher BMIs and comorbidities that may make laparoscopic resections challenging. Multiple trials from Asian countries demonstrate the benefits of laparoscopic gastrectomy for early gastric cancer while maintaining equivalent short-term and long-term oncologic outcomes compared with open surgery. The outcomes of laparoscopy seem to offer equivalent results to open surgery. In the United States, laparoscopic gastrectomy remains in its infancy and is somewhat controversial. This article summarizes the literature on the epidemiology, operative considerations and approaches, and outcomes for laparoscopic gastrectomy.
Collapse
Affiliation(s)
- Joseph D Phillips
- Department of Surgery, Feinberg School of Medicine, Northwestern University, East Huron Street, Galter 3-150, Chicago, IL 60611, USA
| | | | | |
Collapse
|
41
|
Arrington AK, Nelson R, Chen SL, Ellenhorn JD, Garcia-Aguilar J, Kim J. The Evolution of Surgical Technique for Total Gastrectomy over a 12-Year Period: A Single Institution's Experience. Am Surg 2012. [DOI: 10.1177/000313481207801009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the wide acceptance of laparoscopic surgical techniques, its use for gastric cancer has been limited. Laparoscopic total gastrectomy poses many technical challenges when compared with open gastrectomy. Our objective was to evaluate our institutional experience and surgical technique for total gastrectomy. Through a review of patients undergoing total gastrectomy (1999 to 2011), 50 patients were identified. During the first decade, 25 per cent of total gastrectomies were performed laparoscopically compared with 77 per cent since 2009. Compared with open cases, laparoscopic cases yielded a significantly higher number of examined lymph nodes (29 vs 19), lower estimated blood loss (200 vs 450 mL), and shorter length of stay (8 vs 14 days). Median operative time, average tumor size, and number of positive lymph nodes were not different. Morbidity rates were much lower in the laparoscopic series; and 30-day mortality rates were similar in both groups. Laparoscopic total gastrectomy and D2 lymphadenectomy are comparable in safety and have improved efficacy than our open total gastrectomy experience. After initiation of a laparoscopic total gastrectomy program in 2009, the majority of cases in our institution are now performed by laparoscopic techniques.
Collapse
Affiliation(s)
| | - Rebecca Nelson
- Departments of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California
| | | | | | | | - Joseph Kim
- Departments of Oncologic Surgery Duarte, California
| |
Collapse
|
42
|
Bamboat ZM, Strong VE. Minimally invasive surgery for gastric cancer. J Surg Oncol 2012; 107:271-6. [PMID: 22903454 DOI: 10.1002/jso.23237] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/10/2012] [Indexed: 12/13/2022]
Abstract
Application of minimally invasive techniques to gastric cancer in the West has been curbed by concerns of feasibility and oncologic adequacy. Growing evidence supports improved short-term and equivalent oncologic outcomes in selected patients undergoing laparoscopic surgery for early-stage disease. Laparoscopic resection for advanced gastric cancer remains controversial due to few reliable studies on long-term outcomes. We focus on important studies from Asia and highlight the Western experience with laparoscopic and robotic surgery for gastric carcinoma.
Collapse
Affiliation(s)
- Zubin M Bamboat
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
| | | |
Collapse
|
43
|
Oki E, Sakaguchi Y, Ohgaki K, Saeki H, Chinen Y, Minami K, Sakamoto Y, Toh Y, Kusumoto T, Okamura T, Maehara Y. The impact of obesity on the use of a totally laparoscopic distal gastrectomy in patients with gastric cancer. J Gastric Cancer 2012; 12:108-12. [PMID: 22792523 PMCID: PMC3392321 DOI: 10.5230/jgc.2012.12.2.108] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Since a patient's obesity can affect the mortality and morbidity of the surgery, less drastic surgeries may have a major benefit for obese individuals. This study evaluated the feasibility of performing a totally laparoscopic distal gastrectomy, with intracorporeal anastomosis, in obese patients suffering from gastric cancer. MATERIALS AND METHODS This was a retrospective analysis of the 138 patients, who underwent a totally laparoscopic distal gastrectomy from April 2005 to March 2009, at the National Kyushu Cancer Center. The body mass index of 20 patients was ≥25, and in 118 patients, it was <25 kg/m(2). RESULTS The mean values of body mass index in the 2 groups were 27.3±2.2 and 21.4±2.3. Hypertension was significantly more frequent in the obese patients than in the non-obese patients. The intraoperative blood loss, duration of surgery, post-operative complication rate, post-operative hospital stay, and a number of retrieved lymph nodes were not significantly different between the two groups. CONCLUSIONS Intracorporeal anastomosis seemed to have a benefit for obese individuals. Totally laparoscopic gastrectomy is, therefore, considered to be a safe and an effective modality for obese patients.
Collapse
Affiliation(s)
- Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihisa Sakaguchi
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kippei Ohgaki
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Hiroshi Saeki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiki Chinen
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kazuhito Minami
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yasuo Sakamoto
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Testuya Kusumoto
- Department of Gastroenterological Surgery, National Beppu Medical Center, Beppu, Japan
| | - Takeshi Okamura
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
44
|
Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 2012; 255:446-56. [PMID: 22330034 DOI: 10.1097/sla.0b013e31824682f4] [Citation(s) in RCA: 288] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To perform a meta-analysis of high-quality published trials, randomized and observational, comparing laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) for gastric cancer. BACKGROUND Controversy persists about the clinical utility of minimally invasive techniques for the treatment of gastric cancer. Prospective data is limited to a few small randomized trails. METHODS : Studies published from January 1992 to March 2010 that compare LDG and ODG were identified. No restrictions in pathologic stage were applied. All randomized controlled trials (RCTs) were included. Selection of high-quality, nonrandomized comparative studies (NRCTs) was based on a validated tool (Methodological Index for Nonrandomized Studies). Mortality, complications, harvested lymph nodes, operative time, blood loss, and hospital stay were compared using weighted mean differences (WMDs) and odds ratios (ORs). RESULTS Twenty-five studies were included in the analyses, 6 RCTs and 19 NRCTs, compromising 3055 patients (1658 LDG, 1397 ODG). LDG was associated with longer operative times (WMD 48.3 minutes; P < 0.001) and lower overall complications (OR 0.59; P < 0.001), medical complications (OR 0.49; P = 0.002), minor surgical complications (OR 0.62; P = 0.001), estimated blood loss (WMD -118.9 mL; P < 0.001), and hospital stay (WMD -3.6 days; P < 0.001). Mortality and major complications were similar. Patients in the ODG group had a significantly higher number of lymph nodes harvested (WMD 3.9 nodes; P < 0.001), although the estimated proportion of patients with less than 15 retrieved nodes was similar (OR 1.26, P = 0.09). CONCLUSIONS LDG can be performed safely with a shorter hospital stay and fewer complications than open surgery. The long-term significance of a difference of less than 5 nodes in the number of harvested lymph nodes remains unclear. Lymph node staging appears to be unaffected. These results need to be validated in Western patients with advanced gastric cancer.
Collapse
Affiliation(s)
- Eduardo F Viñuela
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | | |
Collapse
|
45
|
Abstract
There has been much speculation regarding differences in outcome for patients who have gastric cancer in the Eastern versus Western world. Among other factors, these differences have contributed to a unique cohort of patients and experience in the Western staging/evaluation of gastric cancer and in the application of minimally invasive approaches for treatment. This review summarizes the current state of laparoscopic approaches for the staging and treatment of gastric adenocarcinoma for patients presenting in Western countries, with their associated unique presentation, comorbidities, and outcomes.
Collapse
Affiliation(s)
- Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, 1275 York Avenue, H-1217, New York, NY 10065, USA.
| |
Collapse
|
46
|
Comparative analysis of station-specific lymph node yield in laparoscopic and open distal gastrectomy for early gastric cancer. Surg Laparosc Endosc Percutan Tech 2012; 21:424-8. [PMID: 22146165 DOI: 10.1097/sle.0b013e3182367dee] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Randomized trials and cohort studies show that laparoscopic distal gastrectomy (LDG) achieves similar oncological results to open distal gastrectomy (ODG). However, studies have consistently demonstrated lower lymph node yield (LNY) for laparoscopic lymphadenectomy. Analysis of station-specific LNY may be useful in evaluating the reasons behind this difference. OBJECTIVES Comparison of station-specific LNY, surgical, and oncological outcomes between LDG and ODG for early gastric cancer. METHODS Patients who underwent R0 distal gastrectomy with histologically confirmed early gastric cancer were eligible for the study. All consecutive cases of LDG since the beginning of our experience with laparoscopic gastrectomy and synchronous cases of ODG with R0 resection were included in the study. Demographic, operative, histopathologic, and follow-up data were recorded in all patients. RESULTS A total of 259 cases of LDG and 95 cases of ODG were performed between 2000 and 2009. Patients undergoing LDG had longer operations but less bleeding (P<0.05). Postoperative complications were similar in both groups. The preoperatively planned extent of lymphadenectomy was D1 (stations 1, 3, 4sb, 4d, 5, 6, and 7), D1+ (D1with stations 8a and 9), or D2 (D1+ with stations 11p and 12a). During surgery, dissection of stations 3, 4d, 5, 6, and 7 was performed in all cases of LDG and ODG. Dissection of stations 1, 4sb, 8a, 9, 11p, and 12a was performed more frequently during ODG than during LDG. Consequently, the total LNY was 26.71 and 31.43 for LDG and ODG, respectively. Station-specific LNY was significantly lower for LDG than for ODG in the common hepatic artery nodes only (P<0.05). The mean follow-up was 43.6 months. Lymph node metastases, metastatic-to-resected lymph node ratio, recurrence, and cancer-related deaths were similar for LDG and ODG. CONCLUSIONS LDG was associated with less extensive lymph node dissection compared with ODG. Station-specific LNY was similar in all nodal stations except for the common hepatic artery nodes. In our experience, laparoscopic sub-D2 lymphadenectomy was adequate in the context of early gastric cancer and represents the future of gastric cancer resection in Japan.
Collapse
|
47
|
Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection. Surg Endosc 2012; 26:1813-21. [PMID: 22350227 DOI: 10.1007/s00464-011-2118-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 10/06/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic gastrectomy has gained acceptance as treatment for early gastric cancer. However, its role for advanced gastric cancer remains unclear. This study aimed to compare the oncologic outcomes between laparoscopic and open gastrectomy in the management of advanced gastric cancer for patients receiving adjuvant chemoradiotherapy. METHODS This study reviewed consecutive patients treated with gastric cancer resection and adjuvant chemoradiation (45 Gy/25 with 5-fluorouracil [FU]-based chemotherapy), at a quaternary care comprehensive cancer center between 1 Jan 2000 and 30 Nov 2009. Of 203 patients, 21 were treated with laparoscopic gastrectomy. These patients were compared with patients who had open surgery and evaluated for overall survival, relapse-free survival, and site of first disease recurrence. RESULTS The 21 patients in the laparoscopic group had a median age of 61.3 years (range, 28.2-76.6 years) and a median follow-up period of 21.3 months (range, 6.7-50.4 months). The majority of the patients (71%) were men. Most of these patients had tumor node metastasis (TNM) v6 stage 2 (33%) or 3 (52%) disease as classified by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). The demographic characteristics of the laparoscopic and open groups were similar. The incidence of recurrence was 38.1% (8/21) in the laparoscopic group and 36.8% (67/182) in the open group. In the laparoscopic group, the site of first recurrence was distant in three patients, peritoneal in four patients, and mixed in one patient (locoregional and distant). The recurrence patterns did not differ significantly between the laparoscopic and open surgery groups. In the open group, recurrence was distant in 26 patients, peritoneal in 12 patients, and locoregional in 15 patients. At presentation, 14 patients showed a mixed pattern. The 3-year relapse-free survival rate was 58% (range, 50-66%), and the difference between the two groups by Gray's test was not significant (P = 0.32). The 3-year overall survival rate was 65.9% (range, 58-73%) and did not differ significantly between the two groups in the univariate (P = 0.92) or multivariate (P = 0.54) analysis. CONCLUSION The study findings suggest that laparoscopic gastrectomy is an oncologically safe procedure for advanced gastric cancer with outcomes similar to those for open resection.
Collapse
|
48
|
Ludwig K, Scharlau U, Schneider-Koriath S, Bernhardt J. [Minimally invasive gastric surgery]. Chirurg 2011; 83:16-22. [PMID: 22090020 DOI: 10.1007/s00104-011-2148-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The interest in minimally invasive surgery (MIS) for the treatment of gastric carcinoma has increased in recent years worldwide. In particular, for early gastric carcinoma (EGC) many retrospective comparative trials and some prospective randomized trials have confirmed that laparoscopy-assisted distal gastrectomy shows a better short-term outcome in terms of lower morbidity, less pain, faster recovery and shorter hospital stay in contrast to open surgery. In this group of selected patients MIS is safe and feasible but at present not widely accepted because of a limited evaluation in oncologic long-term follow-up. In cases of EGC limited to the mucosal layer and under the condition that endoscopic resection is not suitable, laparoscopic local wedge resection or intragastric resection can be an alternative option with good results in long-term follow-up. The data for laparoscopic total gastrectomy and MIS for advanced gastric cancer have confirmed that both are technically feasible and extended lymph node dissection can also be laparoscopically performed. However, laparoscopic total gastrectomy is much more complex and even in expert hands more complications and a higher morbidity have been observed in contrast to laparoscopic distal resections.
Collapse
Affiliation(s)
- K Ludwig
- Klinik für Chirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland.
| | | | | | | |
Collapse
|
49
|
Koeda K, Nishizuka S, Wakabayashi G. Minimally invasive surgery for gastric cancer: the future standard of care. World J Surg 2011; 35:1469-77. [PMID: 21476116 DOI: 10.1007/s00268-011-1051-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Laparoscopy-assisted distal gastrectomy for gastric cancer was first reported by Kitano et al. in 1991. Laparoscopic wedge resection (LWR) and intragastric mucosal resection (IGMR) were quickly adapted for gastric cancer limited to the mucosal layer and having no risk of lymph node metastasis. Following improvements in endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), the use of LWR and IGMR for these indications decreased, and patients with gastric cancer, including those with a risk of lymph node metastases, were more likely to be managed with laparoscopic gastrectomy (LG) with lymph node dissection. Many retrospective comparative trials and randomized-controlled trials (RCT) have confirmed that LG is safe and feasible, and that short-term outcomes are better than those of open gastrectomy (OG) in patients with early gastric cancer (EGC). However, these trials did not include a satisfactory number of patients to establish clinical evidence. Thus, additional multicenter randomized-controlled trials are needed to delineate significantly quantifiable differences between LG and OG. As laparoscopic experience has accumulated, the indications for LG have been broadened to include older and overweight patients and those with advanced gastric cancer. Moreover, advanced techniques, such as laparoscopy-assisted total gastrectomy, laparoscopy-assisted proximal gastrectomy, laparoscopy-assisted pylorus-preserving gastrectomy (PPG), and extended lymph node dissection (D2) have been widely performed.In the near future, sentinel node navigation and robotic surgery will become additional options in minimally invasive surgery (MIS) involving LG. Such developments will improve the quality of life of patients following gastric cancer surgery.
Collapse
Affiliation(s)
- Keisuke Koeda
- Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Japan.
| | | | | |
Collapse
|
50
|
Moisan F, Norero E, Slako M, Varas J, Palominos G, Crovari F, Ibañez L, Pérez G, Pimentel F, Guzmán S, Jarufe N, Boza C, Escalona A, Funke R. Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study. Surg Endosc 2011. [PMID: 22011940 DOI: 10.1007/s00464-011-1933-5.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
INTRODUCTION The application of laparoscopic gastric surgery has rapidly increased for the treatment of early gastric cancer. However, laparoscopic gastrectomy for advanced tumor remains controversial, particularly in terms of oncologic outcomes. This study was designed to compare 3-year survival of laparoscopic versus open curative gastrectomy in early and advanced gastric cancer. METHODS This was a retrospective matched cohort study. We included patients between 2003 and 2010 with an R0 resection. A totally laparoscopic technique was used and D2 lymph node dissection was practiced routinely. We performed an intracorporeal hand-sewn esophagojejunostomy in all laparoscopic total gastrectomy cases. We matched all laparoscopic cases 1:1 with open cases according to TNM AJCC seventh edition. We used Mann-Whitney or t test and Chi-square test to compare both groups. Kaplan-Meier analysis with log-rank test was performed to compare survival. RESULTS We included 31 open and 31 laparoscopic cases (mean age 63 ± 14 years; 66% males). Both groups were identical in type of gastrectomy (71% total and 29% subtotal). There were no statistical difference between laparoscopic and open groups in age, sex, N category, tumor location and size, histological differentiation, and T category (48% T1, 13% T2, 16% T3, and 23% T4 in both groups), with 48% early and 52% advanced tumors. The median number of resected lymph nodes was similar: 35 (23-53) for laparoscopic and 39 (23-45) for open cases (P = 0.81). The median follow-up was 50 months. The overall 3-year survival was 82% for laparoscopic surgery and 87% for the open surgery group (P = 0.56). There were no difference in 3-year survival for the laparoscopic versus the open surgery groups for advanced tumors (74 vs. 75%, P = 0.88), N+ tumors (73 vs. 73%, P = 0.99) and for the different AJCC stages (stage 1: 94 vs. 100%, stage 2: 89 vs. 82%, and stage 3: 50 vs. 50%, P = 0.32, 0.83, and 0.98 respectively). CONCLUSIONS In this preliminary report, with 52% of advanced tumor, the 3-year overall and stage-by-stage survival was comparable for laparoscopic and open curative gastrectomy.
Collapse
Affiliation(s)
- Fabrizio Moisan
- Department of Digestive Surgery, Hospital Clínico, Pontificia Universidad Católica de Chile, Marcoleta 367, P.O. Box 114-D, Santiago, 8330024, Chile
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|