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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.
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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
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Nickel F, Studier-Fischer A, Hausmann D, Klotz R, Vogel-Adigozalov SL, Tenckhoff S, Klose C, Feisst M, Zimmermann S, Babic B, Berlt F, Bruns C, Gockel I, Graf S, Grimminger P, Gutschow CA, Hoeppner J, Ludwig K, Mirow L, Mönig S, Reim D, Seyfried F, Stange D, Billeter A, Nienhüser H, Probst P, Schmidt T, Müller-Stich BP. Minimally invasivE versus open total GAstrectomy (MEGA): study protocol for a multicentre randomised controlled trial (DRKS00025765). BMJ Open 2022; 12:e064286. [PMID: 36316075 PMCID: PMC9628650 DOI: 10.1136/bmjopen-2022-064286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The only curative treatment for most gastric cancer is radical gastrectomy with D2 lymphadenectomy (LAD). Minimally invasive total gastrectomy (MIG) aims to reduce postoperative morbidity, but its use has not yet been widely established in Western countries. Minimally invasivE versus open total GAstrectomy is the first Western multicentre randomised controlled trial (RCT) to compare postoperative morbidity following MIG vs open total gastrectomy (OG). METHODS AND ANALYSIS This superiority multicentre RCT compares MIG (intervention) to OG (control) for oncological total gastrectomy with D2 or D2+LAD. Recruitment is expected to last for 2 years. Inclusion criteria comprise age between 18 and 84 years and planned total gastrectomy after initial diagnosis of gastric carcinoma. Exclusion criteria include Eastern Co-operative Oncology Group (ECOG) performance status >2, tumours requiring extended gastrectomy or less than total gastrectomy, previous abdominal surgery or extensive adhesions seriously complicating MIG, other active oncological disease, advanced stages (T4 or M1), emergency setting and pregnancy.The sample size was calculated at 80 participants per group. The primary endpoint is 30-day postoperative morbidity as measured by the Comprehensive Complications Index. Secondary endpoints include postoperative morbidity and mortality, adherence to a fast-track protocol and patient-reported quality of life (QoL) scores (QoR-15, EUROQOL EuroQol-5 Dimensions-5 Levels (EQ-5D), EORTC QLQ-C30, EORTC QLQ-STO22, activities of daily living and Body Image Scale). Oncological endpoints include rate of R0 resection, lymph node yield, disease-free survival and overall survival at 60-month follow-up. ETHICS AND DISSEMINATION Ethical approval has been received by the independent Ethics Committee of the Medical Faculty, University of Heidelberg (S-816/2021) and will be received from each responsible ethics committee for each individual participating centre prior to recruitment. Results will be published open access. TRIAL REGISTRATION NUMBER DRKS00025765.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Alexander Studier-Fischer
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - David Hausmann
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Rosa Klotz
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
- Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Sophia Lara Vogel-Adigozalov
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
- Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Solveig Tenckhoff
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
- Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Samuel Zimmermann
- Institute of Medical Biometry, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Benjamin Babic
- Department of General, Visceral and Tumor and Transplantation Surgery, University Hospital Cologne, Koln, Germany
| | - Felix Berlt
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Christiane Bruns
- Department of General, Visceral and Tumor and Transplantation Surgery, University Hospital Cologne, Koln, Germany
| | - Ines Gockel
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Universitatsklinikum Leipzig, Leipzig, Germany
| | - Sandra Graf
- Department of General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | - Peter Grimminger
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Christian A Gutschow
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jens Hoeppner
- Department of Surgery, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
| | - Kaja Ludwig
- Department of General, Visceral, Thoracic and Vascular Surgery, Klinikum Sudstadt Rostock, Rostock, Germany
| | - Lutz Mirow
- Department of General and Visceral Surgery, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Stefan Mönig
- Department of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Daniel Reim
- Department of Surgery, University Hospital Munich, Munchen, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, Central Würzburg Hospital, Wurzburg, Germany
| | - Daniel Stange
- Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden, Dresden, Germany
| | - Adrian Billeter
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Department of Surgery, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Thomas Schmidt
- Department of General, Visceral and Tumor and Transplantation Surgery, University Hospital Cologne, Koln, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
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Garbarino GM, Laracca GG, Lucarini A, Piccolino G, Mercantini P, Costa A, Tonini G, Canali G, Muttillo EM, Costa G. Laparoscopic versus Open Surgery for Gastric Cancer in Western Countries: A Systematic Review and Meta-Analysis of Short- and Long-Term Outcomes. J Clin Med 2022; 11:3590. [PMID: 35806877 PMCID: PMC9267365 DOI: 10.3390/jcm11133590] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background. The advantages of a laparoscopic approach for the treatment of gastric cancer have already been demonstrated in Eastern Countries. This review and meta-analysis aims to merge all the western studies comparing laparoscopic (LG) versus open gastrectomies (OG) to provide pooled results and higher levels of evidence. Methods. A systematic literature search was performed in MEDLINE(PubMed), Embase, WebOfScience and Scopus for studies comparing laparoscopic versus open gastrectomy in western centers from 1980 to 2021. Results. After screening 355 articles, 34 articles with a total of 24,098 patients undergoing LG (5445) or OG (18,653) in western centers were included. Compared to open gastrectomy, laparoscopic gastrectomy has a significantly longer operation time (WMD = 47.46 min; 95% CI = 31.83−63.09; p < 0.001), lower blood loss (WMD = −129.32 mL; 95% CI = −188.11 to −70.53; p < 0.0001), lower analgesic requirement (WMD = −1.824 days; 95% CI = −2.314 to −1.334; p < 0.0001), faster time to first oral intake (WMD = −1.501 days; 95% CI = −2.571 to −0.431; p = 0.0060), shorter hospital stay (WMD = −2.335; 95% CI = −3.061 to −1.609; p < 0.0001), lower mortality (logOR = −0.261; 95% the −0.446 to −0.076; p = 0.0056) and a better 3-year overall survival (logHR 0.245; 95% CI = 0.016−0.474; p = 0.0360). A slight significant difference in favor of laparoscopic gastrectomy was noted for the incidence of postoperative complications (logOR = −0.202; 95% CI = −0.403 to −0.000 the = 0.0499). No statistical difference was noted based on the number of harvested lymph nodes, the rate of major postoperative complication and 5-year overall survival. Conclusions. In Western centers, laparoscopic gastrectomy has better short-term and equivalent long-term outcomes compared with the open approach, but more high-quality studies on long-term outcomes are required.
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Affiliation(s)
- Giovanni Maria Garbarino
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Giovanni Guglielmo Laracca
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Alessio Lucarini
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Gianmarco Piccolino
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Paolo Mercantini
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Alessandro Costa
- UniCamillus School of Medicine, Saint Camillus International University of Health and Medical Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy;
| | - Giuseppe Tonini
- Oncology Department, Fondazione Policlinico Campus Bio-Medico, University Campus Bio-Medico Hospital, Via Àlvaro del Portillo 200, 00128 Rome, Italy;
| | - Giulia Canali
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Edoardo Maria Muttillo
- Surgical and Medical Department of Translational Medicine, Sant’Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; (G.G.L.); (A.L.); (G.P.); (P.M.); (G.C.); (E.M.M.)
| | - Gianluca Costa
- Surgery Center, Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, University Campus Bio-Medico Hospital, Via Àlvaro del Portillo 200, 00128 Rome, Italy;
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Wang F, Zhang S, Zhao W, Wang D, Tang S, Zhang Q. Open distal gastrectomy versus laparoscopic distal gastrectomy for early gastric cancer: a retrospective study. J Gastrointest Oncol 2021; 12:2743-2748. [PMID: 35070403 PMCID: PMC8748056 DOI: 10.21037/jgo-21-782] [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: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Laparoscopic distal gastrectomy (LDG) is gaining popularity because its early postoperative effect has been shown to be better than open distal gastrectomy (ODG). However, to our knowledge, there are no studies demonstrating ODG is oncologically equivalent to LDG. METHODS This is a retrospective study based on the prospectively maintained database of the People's Hospital of Jinan City. Patients with operable, pathologically confirmed early-stage gastric cancer were included, while those with advanced disease or carcinoma in situ were excluded. Extracted data included age, body mass index (BMI), sex, clinical TNM stage, and pathologic stage. The primary outcome was 5-year overall survival, and the secondary outcomes included cancer-specific survival, cost-effectiveness, and quality of life. RESULTS A total of 126 patients were finally enrolled and included 61 in the ODG group and 65 in the LDG group. Baseline clinical and pathological characteristics were generally balanced between the two groups. After a median follow-up of 8.31 years, the 5-year overall survival rate was estimated to be 82.8% (95% CI: 69.4-90.7%) for the ODG group and 86.7% (95% CI: 73.9-93.5%) for the LDG group and the recurrence patterns were similar between the two groups. CONCLUSIONS Our data showed that the surgical results of both approaches are satisfactory, and LDG offers a reasonable option to ODG in patients with early gastric cancer.
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Affiliation(s)
- Feng Wang
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
| | - Shengbo Zhang
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
| | - Wei Zhao
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
| | - Deyou Wang
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
| | - Sifeng Tang
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
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Chittawadagi B, Nayak SK, Ramakrishnan P, Kumar S, Cumar B, Natarajan R, Palanivelu PR, Chinnusamy P. Laparoscopic D2 gastrectomy in advanced gastric cancer: Postoperative outcomes and long-term survival analysis. Asian J Endosc Surg 2021; 14:707-716. [PMID: 33605064 DOI: 10.1111/ases.12926] [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: 06/16/2020] [Revised: 11/29/2020] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Data on laparoscopic treatment of operable gastric cancer from India is sparse. This study aims to document outcomes of laparoscopic D2 gastrectomy in an Indian population. MATERIALS AND METHODS Data of patients who underwent laparoscopic D2 gastrectomy for operable advanced gastric cancer between February 2012 and January 2017 were collected from electronic hospital records supplemented by telephonic interviews and analyzed. Survival was evaluated using Kaplan-Meier survival analysis curves. RESULTS In total 121 patients were included. Conversion to open gastrectomy was 5.7%. One hundred and fourteen patients (73 laparoscopic subtotal gastrectomy and 41 laparoscopic total gastrectomy) were included for analysis. D2 lymphadenectomy was done in all cases; mean number of dissected lymph nodes was 23.12 ± 9.14 (12-45). Major complications (Clavien-Dindo Grade III and IV) was seen in 6.1% of cases with reoperation rate of 3.5% (4/114). Stage 3 disease was seen in 60.6% cases and stage 2 disease in 32.5%. Follow-up data were available for 76.3% of patients with mean follow-up of 29.5 months. Overall survival across all stages was 38.7 months. Five-year disease-free survival and overall survival were 36.7% and 55.9% respectively, across all stages. CONCLUSION Laparoscopic D2 gastrectomy is safe, feasible with similar postoperative complications and comparable survival outcomes across all stages when compared to available literature on open gastrectomy cases.
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Affiliation(s)
- Bhushan Chittawadagi
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Sunil K Nayak
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | | | - Saravana Kumar
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Bharath Cumar
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Ramesh Natarajan
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Praveen R Palanivelu
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
| | - Palanivelu Chinnusamy
- Division of Esophago-Gastric Surgery, GEM Hospital and Research Center, Coimbatore, India
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Transpyloric optic navigation of tumor using a laparoscope during totally laparoscopic distal gastrectomy for gastric cancer. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:76-83. [PMID: 35600785 PMCID: PMC8965982 DOI: 10.7602/jmis.2021.24.2.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/08/2022]
Abstract
Purpose Methods Results Conclusion
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Zheng Z, Yin J, Liu XY, Yan XS, Xu R, Li MY, Cai J, Chen GY, Zhang J, Zhang ZT. Current indications for endoscopic submucosal dissection of early gastric cancer. World J Gastrointest Oncol 2021; 13:560-573. [PMID: 34163573 PMCID: PMC8204359 DOI: 10.4251/wjgo.v13.i6.560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/31/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
The development of endoscopic treatment technology has further promoted the minimally invasive treatment of early gastric cancer (EGC). Endoscopic treatment has achieved better therapeutic effects in terms of safety and prognosis and is the preferred treatment method for patients who meet the indications for endoscopic treatment. However, the consequent problem is that some patients receiving endoscopic treatment may undergo non-curative resection, and the principle of follow-up management for non-curative resection patients deserves further attention. In addition, there are still debates on how to improve the accuracy of clinical staging, select a reasonable treatment method for patients who meet the expanded indications for endoscopic treatment, manage patients with positive endoscopic surgical margins, conduct research on function-preserving surgery, and manage the treatment of EGC under the current situation in China. Consequently, we aim to review current indications for endoscopic submucosal dissection of EGC in order to better inform treatment options.
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Affiliation(s)
- Zhi Zheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jie Yin
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiao-Ye Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiao-Sheng Yan
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Rui Xu
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Meng-Yi Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jun Cai
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Guang-Yong Chen
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jun Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhong-Tao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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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-).
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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
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Garbarino GM, Costa G, Laracca GG, Castagnola G, Mercantini P, Di Paola M, Vita S, Masoni L. Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer in middle-low-volume centers in Western countries: a propensity score matching analysis. Langenbecks Arch Surg 2020; 405:797-807. [PMID: 32754848 PMCID: PMC7471172 DOI: 10.1007/s00423-020-01951-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022]
Abstract
Background Gastrectomy with D2 lymphadenectomy is the standard treatment for patients with resectable gastric cancer. Laparoscopic distal gastrectomy (LDG) is routinely performed for early gastric cancer, and its indications are increasing even for locally advanced gastric cancer. The aim of this study is to compare two middle–low-volume centers in Western countries experience on LDG versus open distal gastrectomy (ODG) for locally advanced gastric cancer in terms of surgical and oncological outcomes. Methods We reviewed the data of 123 consecutive patients that underwent LDG and ODG with D2 lymphadenectomy between 2009 and 2014. Among them, 91 were eligible for inclusion (46 LDG and 45 ODG). After propensity score matching analysis, using a 1:1 case-control match, 34 patients were stratified for each group. Results The mean operative time was significantly longer in the LDG group (257.2 vs. 197.2, p < 0.001). No differences were observed in terms of intraoperative blood loss, average number of lymph nodes removed, and lymph node metastases. The postoperative morbidity was comparable in the two groups. LDG group had a significant faster bowel canalization and soft oral intake (p < 0.001). The 5-year overall and disease-free survival were higher for patients treated by laparoscopy, but the post-hoc subgroups analysis revealed that the advantage of LDG was significant just in N0 and stage IB-II patients, whereas N+ and stage III patient’s survival curves were perfectly superimposable. Conclusions LDG for locally advanced gastric cancer seems to be feasible and safe with surgical and long-term oncological outcomes comparable with open surgery, even in medium–low-volume centers.
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Affiliation(s)
- Giovanni Maria Garbarino
- Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy. .,Genaral Surgery Department, San Pietro Fatebenefratelli Hospital, Via Cassia 600, 00189, Rome, Italy.
| | - Gianluca Costa
- Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Giovanni Guglielmo Laracca
- Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy.,Genaral Surgery Department, San Pietro Fatebenefratelli Hospital, Via Cassia 600, 00189, Rome, Italy
| | - Giorgio Castagnola
- Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Paolo Mercantini
- Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Massimiliano Di Paola
- Genaral Surgery Department, San Pietro Fatebenefratelli Hospital, Via Cassia 600, 00189, Rome, Italy
| | - Simone Vita
- Genaral Surgery Department, San Pietro Fatebenefratelli Hospital, Via Cassia 600, 00189, Rome, Italy
| | - Luigi Masoni
- Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy.,Genaral Surgery Department, San Pietro Fatebenefratelli Hospital, Via Cassia 600, 00189, Rome, Italy
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Strong VE, Russo AE, Nakauchi M, Schattner M, Selby LV, Herrera G, Tang L, Gonen M. Robotic Gastrectomy for Gastric Adenocarcinoma in the USA: Insights and Oncologic Outcomes in 220 Patients. Ann Surg Oncol 2020; 28:742-750. [PMID: 32656721 PMCID: PMC8323985 DOI: 10.1245/s10434-020-08834-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND While multiple Asian and a few Western retrospective series have demonstrated the feasibility and safety of robotic-assisted gastrectomy for gastric cancer, its reliability for thorough resection, especially for locoregional disease, has not yet been firmly established, and reported learning curves vary widely. To support wider implementation of robotic gastrectomy, we evaluated the learning curve for this approach, assessed its oncologic feasibility, and created a selection model predicting the likelihood of conversion to open surgery in a US patient population. PATIENTS AND METHODS We retrospectively reviewed data on all consecutive patients who underwent robotic gastrectomy at a high-volume institution between May 2012 and March 2019. RESULTS Of the 220 patients with gastric cancer selected to undergo curative-intent robotic gastrectomy, surgery was completed using robotics in 159 (72.3%). The median number of removed lymph nodes was 28, and ≥ 15 lymph nodes were removed in 94% of procedures. Surgical time decreased steadily over the first 60-80 cases. Complications were generally minor: 7% of patients experienced complications of grade 3 or higher, with an anastomotic leak rate of 2% and mortality rate 0.9%. Factors predicting conversion to open surgery included neoadjuvant chemotherapy, BMI ≥ 31 kg/m2, and tumor size ≥ 6 cm. CONCLUSIONS These findings support the safety and oncologic feasibility of robotic gastrectomy for selected patients with gastric cancer. Proficiency can be achieved by 20 cases and mastery by 60-80 cases. Ideal candidates for this approach are patients with few comorbidities, BMI < 31 kg/m2, and tumors < 6 cm.
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Affiliation(s)
- Vivian E Strong
- Departments of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Ashley E Russo
- Departments of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Masaya Nakauchi
- Departments of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Mark Schattner
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luke V Selby
- Departments of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Gabriel Herrera
- Departments of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Laura Tang
- Departments of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Departments of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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11
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Zhu Z, Li L, Xu J, Ye W, Zeng J, Chen B, Huang Z. Laparoscopic versus open approach in gastrectomy for advanced gastric cancer: a systematic review. World J Surg Oncol 2020; 18:126. [PMID: 32534587 PMCID: PMC7293787 DOI: 10.1186/s12957-020-01888-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Additional studies comparing laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for advanced gastric cancer (AGC) have been published, and it is necessary to update the systematic review of this subject. OBJECTIVE We conducted the meta-analysis to find some proof for the use of LG in AGC and evaluate whether LG is an alternative treatment for AGC. METHOD Randomized controlled trials (RCT) and high-quality retrospective studies (NRCT) compared LG and OG for AGC, which were published in English between January 2010 and May 2019, were search in PubMed, Embase, and Web of Knowledge by three authors independently and thoroughly. Some primary endpoints were compared between the two groups, including intraoperative time, intraoperative blood loss, harvested lymph nodes, first flatus, first oral intake, first out of bed, post-operative hospital stay, postoperative morbidity and mortality, rate of disease recurrence, and 5-year over survival (5-y OS). Besides, considering for this 10-year dramatical surgical material development between 2010 and 2019, we furtherly make the same analysis based on recent studies published between 2016 and 2019. RESULT Thirty-six studies were enrolled in this systematic review and meta-analysis, including 5714 cases in LAG and 6094 cases in OG. LG showed longer intraoperative time, less intraoperative blood loss, and quicker recovery after operations. The number of harvested lymph nodes, hospital mortality, and tumor recurrence were similar. Postoperative morbidity and 5-y OS favored LG. Furthermore, the systemic analysis of recent studies published between 2016 and 2019 revealed similar result. CONCLUSION A positive trend was indicated towards LG. LG can be performed as an alternative to OG for AGC.
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Affiliation(s)
- Zhipeng Zhu
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China
| | - Lulu Li
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China
| | - Jiuhua Xu
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, Fujian, People's Republic of China
| | - Weipeng Ye
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, Fujian, People's Republic of China
| | - Junjie Zeng
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China
| | - Borong Chen
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China
| | - Zhengjie Huang
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Si Ming District, Xiamen, 361003, Fujian, People's Republic of China. .,Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, Fujian, People's Republic of China.
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12
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Ju MR, Wang SC, Zeh HJ, Porembka MR. Minimally invasive gastrectomy for cancer and anastomotic options. J Surg Oncol 2020; 122:49-60. [PMID: 32200555 DOI: 10.1002/jso.25904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
In this review article, we explore patient selection criteria for minimally invasive surgery (MIS) gastrectomy, present evidence on the risks and benefits of minimally invasive techniques, describe operative techniques focusing specifically on reconstruction options, and discuss the learning curve associated with these operations.
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Affiliation(s)
- Michelle R Ju
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sam C Wang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert J Zeh
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew R Porembka
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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13
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Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Hyung WJ. Effect of Laparoscopic Distal Gastrectomy vs Open Distal Gastrectomy on Long-term Survival Among Patients With Stage I Gastric Cancer: The KLASS-01 Randomized Clinical Trial. JAMA Oncol 2020; 5:506-513. [PMID: 30730546 DOI: 10.1001/jamaoncol.2018.6727] [Citation(s) in RCA: 323] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Laparoscopic distal gastrectomy is gaining popularity over open distal gastrectomy for gastric cancer because of better early postoperative outcomes. However, to our knowledge, no studies have proved whether laparoscopic distal gastrectomy is oncologically equivalent to open distal gastrectomy. Objective To examine whether the long-term survival among patients with stage I gastric cancer undergoing laparoscopic distal gastrectomy is noninferior to that among patients undergoing open distal gastrectomy. Design The Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) group, which includes 15 surgeons from 13 institutes, conducted a phase 3, multicenter, open-label, noninferiority, prospective randomized clinical trial (KLASS-01) of patients with histologically proven, preoperative clinical stage I gastric adenocarcinoma from January 5, 2006, to August 23, 2010. Survival and recurrence status of the patients was determined in December 2016. Interventions Patients were randomly assigned (1:1) to laparoscopic distal gastrectomy (n = 705) or open distal gastrectomy (n = 711). Of these patients, 85 received a surgical approach opposite the one to which they were randomized (63 randomized to the open surgery group and 22 to the laparoscopic group). Main Outcomes and Measures Difference in 5-year overall survival between the laparoscopic and open distal gastrectomy groups. The noninferiority margin was prespecified as -5% (corresponding hazard ratio of 1.54), with an assumed survival of 90% after 5 years in the open surgery group. Results Among the 1416 patients (mean [SD] age, 57.3 [11.1] years; 940 [66.4%] male) included in the study, the 5-year overall survival rates were 94.2% in the laparoscopic group and 93.3% in the open surgery group (log-rank P = .64). Intention-to-treat analysis confirmed the noninferiority of the laparoscopic approach compared with the open approach (difference, 0.9 percentage points; 1-sided 97.5% CI, -1.6 to infinity). The 5-year cancer-specific survival rates were similar between the 2 groups (97.1% in the laparoscopic group and 97.2% in the open surgery group, log-rank P = .91; difference, -0.03 percentage points; 1-sided 97.5% CI, -1.8 to infinity). Per-protocol analysis results were consistent with the intention-to-treat results for overall and cancer-specific survival rates. Conclusions and Relevance The KLASS-01 trial revealed similar overall and cancer-specific survival rates between patients receiving laparoscopic and open distal gastrectomy. Laparoscopic distal gastrectomy is an oncologically safe alternative to open surgery for stage I gastric cancer. Trial Registration ClinicalTrials.gov identifier: NCT00452751.
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Affiliation(s)
- Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Wook Kim
- Department of Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Chan Young Kim
- Department of Surgery, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Sang-Il Lee
- Department of Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seong Yeob Ryu
- Department of Surgery, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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14
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Shen J, Ma X, Yang J, Zhang JP. Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer. World J Gastrointest Oncol 2020; 12:21-36. [PMID: 31966911 PMCID: PMC6960078 DOI: 10.4251/wjgo.v12.i1.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 02/05/2023] Open
Abstract
In addition to the popularity of laparoscopic gastrectomy (LG), many reconstructive procedures after LG have been reported. Surgical resection and lymphatic dissection determine long-term survival; however, the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer (GC). Presently, no consensus exists regarding the optimal reconstructive procedure. In this review, the current state of digestive tract reconstruction after LG is reviewed. According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction, we divide these reconstruction procedures into three categories consistent with the resection procedures. We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes (length of surgery and blood loss) and postoperative complications (anastomotic leakage and stricture) to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.
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Affiliation(s)
- Jian Shen
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Xiang Ma
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jing Yang
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jian-Ping Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
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15
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Surgical and nutritional outcomes of laparoscopic proximal gastrectomy versus total gastrectomy: a meta-analysis. Surg Endosc 2020; 34:1061-1069. [DOI: 10.1007/s00464-019-07352-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022]
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16
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Choi CI, Lee CM, Park JH, Jee YS, Lee HH, Jeong O, Park S. Recent Status of Laparoscopic Distal Gastrectomy in Korea: A Multicenter Retrospective Cohort Study (Pre-study Survey of KLASS-07 Trial). Front Oncol 2019; 9:982. [PMID: 31632913 PMCID: PMC6786092 DOI: 10.3389/fonc.2019.00982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/16/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose: To analyze the surgical trend and brief postoperative results of laparoscopic distal gastrectomy (LDG) in Korea on the basis of a multicenter cohort. Materials and Methods: Data of 812 patients who underwent LDG between January and December 2016 were collected from 14 surgeons at 7 institutions. Patients were divided into laparoscopy-assisted distal gastrectomy (LADG) group and totally laparoscopic distal gastrectomy (TLDG) group. Perioperative and clinicopathologic outcomes were compared retrospectively. Results: Among the patients [n = 222 (27.3%) LADG; n = 590 (72.7%) TLDG], there are no significant differences in patient's demographics (sex, age, body mass index, and American Society of Anesthesiologists score). Billroth-I anastomosis (84.7%) was most performed in the LADG group, but Billroth-II anastomosis (59.0%) in the TLDG group (p < 0.001). The mean operative time was longer in the TLDG group (197.3 ± 44.4 min vs. 222.0 ± 60.2 min, p < 0.001), and there was no statistical difference in the hospital stay between the two groups (9.6 ± 4.8 days vs. 8.9 ± 7.1 days, p = 0.149). There were no significant differences in morbidity and mortality between the two groups. The length of proximal margin was longer in the TLDG group (4.3 ± 3.1 cm vs. 6.0 ± 3.4 cm, p < 0.001), but the distal margin was longer in the LADG group (6.5 ± 3.7 cm vs. 5.5 ± 3.1 cm, p < 0.001). The distribution of operations among each institution was shown very heterogeneously. Conclusion: There was no significant difference related to surgical outcome between LADG and TLDG in pre-study survey prior to KLASS-07 trial. Therefore, to obtain more reliable data, well designed prospective randomized controlled study is needed.
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Affiliation(s)
- Chang In Choi
- Department of Surgery, Biomedical Research Institute, Pusan National University College of Medicine, Busan, South Korea
| | - Chang Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Ji Ho Park
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Ye Seob Jee
- Department of Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Han Hong Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Oh Jeong
- Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea
| | - Sungsoo Park
- Department of Surgery, Korea University Medical Center Anam Hospital, Seoul, South Korea
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17
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Ryan S, Tameron A, Murphy A, Hussain L, Dunki-Jacobs E, Lee DY. Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis. Surg Innov 2019; 27:26-31. [PMID: 31441711 DOI: 10.1177/1553350619868113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background. We compared the outcomes of laparoscopic-assisted (LA) and robotic-assisted (RA) gastrectomies performed for gastric adenocarcinoma in the National Cancer Database. Methods. The National Cancer Database was queried for patients 18 years old with stages I to III gastric adenocarcinoma who underwent LA or RA gastrectomy. Propensity matching was performed between the 2 groups with regard to clinical staging, adjuvant treatment, demographics, and the extent of surgery. Results. A cohort of 1893 (1262 = LA, 631 = RA) patients was identified in a 2:1 propensity matching. The groups were well matched. The rate of negative margin as well as 30- and 90-day mortality were similar between the 2 cohorts. Long-term survival was similar between the 2 groups (median survival 49.2 months in LA vs 56.2 months for RA, P = .405). However, the average number of lymph nodes (LNs) sampled was significantly higher in the RA group compared with the LA group (19.6 vs 17.4, P < .001). Similarly, the percentage of surgeries in which ≥15 LNs were sampled was also greater in the RA group compared with the LA group (63.9% vs 57.6%, P = .010). On multivariable analysis, having 15 LNs or more examined was associated with better survival (hazard ratio = 0.72, 95% confidence interval = 0.60-0.87, P < .001). Advanced age, nodal positivity, and advanced clinical stages were significantly associated with worse survival. Conclusions. RA gastrectomy may allow a greater harvest of LNs, and thus more accurate staging, without increasing short-term adverse outcomes compared with LA gastrectomy. Short-term and long-term outcomes in this well-matched cohort appear comparable for both approaches.
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Affiliation(s)
- Sean Ryan
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA
| | - Ashley Tameron
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA
| | - Amy Murphy
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA
| | - Lala Hussain
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA
| | - Erik Dunki-Jacobs
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA.,TriHealth Cancer Institute, Cincinnati, OH, USA
| | - David Y Lee
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA.,TriHealth Cancer Institute, Cincinnati, OH, USA
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18
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Park YS, Shin DJ, Son SY, Kim KH, Park DJ, Ahn SH, Park DJ, Kim HH. Roux Stasis Syndrome and Gastric Food Stasis After Laparoscopic Distal Gastrectomy with Uncut Roux-en-Y Reconstruction in Gastric Cancer Patients: A Propensity Score Matching Analysis. World J Surg 2019; 42:4022-4032. [PMID: 29915987 DOI: 10.1007/s00268-018-4715-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Uncut Roux-en-Y gastrojejunostomy (uRYGJ) was developed to prevent slow peristalsis in the Roux limb after Roux-en-Y gastrojejunostomy (RYGJ). This study compared the incidence of Roux stasis syndrome (RSS) and severe gastric food stasis in gastric cancer patients who underwent RYGJ or uRYGJ after laparoscopic curative distal gastrectomy. METHODS Between January 2006 and June 2012, 319 patients underwent RYGJ or uRYGJ. After covariates were adjusted by propensity score matching, 39 patients in the RYGJ group and 65 patients in the uRYGJ group were included in the final analysis. RSS was defined as the presence of symptoms, such as nausea, vomiting, and abdominal fullness, requiring refasting without ileus or obstruction within 30 days post-surgery. Gastric food stasis was measured endoscopically at 1 and 3 years after gastrectomy. RESULTS Operative outcomes and morbidities were similar between the two groups, whereas the incidence of RSS was higher in the RYGJ group than in the uRYGJ group, although the difference was not significant (7.7 vs. 0%; odds ratio (OR) 0.157; 95% confidence interval (CI) 0-1.059, p = 0.111). Comparison of endoscopic findings revealed that severe gastric stasis 1 year after surgery was significantly less frequent in the uRYGJ group (46.2 vs. 13.8%; OR 0.247; 95% CI 0.102-0.599, p = 0.002). The same result was reproduced 3 years after surgery (39.4 vs. 15.5%; OR 0.279; 95% CI 0.088-0.882, p = 0.030). CONCLUSIONS Compared with RYGJ, uRYGJ after laparoscopic distal gastrectomy is a safe and effective procedure for preventing severe postoperative gastric food stasis.
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Affiliation(s)
- Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Dong Joon Shin
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sang-Yong Son
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Ki-Hyun Kim
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Dong Jin Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea. .,Department of Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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19
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Dias AR, Jacob CE, Ramos MFKP, Pereira MA, Szor DJ, Yagi OK, Barchi LC, Ribeiro U, Zilberstein B, Cecconello I. Laparoscopic D2 Gastrectomy for Gastric Cancer: Mid-Term Results and Current Evidence. J Laparoendosc Adv Surg Tech A 2019; 29:495-502. [PMID: 30526290 DOI: 10.1089/lap.2018.0474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Although the first laparoscopic gastrectomy was performed in 1991, there was a long delay until it was incorporated into the regular practice of western surgeons. In Brazil, there are only few case series reported and data on its safety and efficacy along with mid- and long-term results are desired. OBJECTIVE Present the mid-term results of laparoscopic gastrectomy with curative intent in the treatment of gastric adenocarcinoma and review the current evidence on the therapy of this neoplasia with the laparoscopic access. METHODS Patients who underwent D2 laparoscopic gastrectomy for gastric adenocarcinoma were retrospectively reviewed. RESULTS Sixty-nine patients met the inclusion criteria. The mean age was 59.2 years and the mean body mass index was 24.2 kg/m2. Subtotal gastrectomy was performed in 73.9%. The mean number of harvested lymph nodes was 36.7, increased lymph node count and shorter operative time were observed in the last 34 cases. Median hospital stay was 8 days. Postoperative complications occurred in 22 (31.9%) cases. Surgical mortality was 4.3%. CONCLUSION Laparoscopic gastrectomy can be performed safely with excellent short- and mid-term results. As experience increases, surgical duration is reduced and lymph node count rises.
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Affiliation(s)
- Andre Roncon Dias
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos Eduardo Jacob
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Marina Alessandra Pereira
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniel Jose Szor
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Osmar Kenji Yagi
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Leandro Cardoso Barchi
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ulysses Ribeiro
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Zilberstein
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ivan Cecconello
- Gastrointestinal Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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20
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Lee CM, Park JH, In Choi C, Lee HH, Min JS, Jee YS, Jeong O, Chae H, Choi SI, Huang H, Park S. A multi-center prospective randomized controlled trial (phase III) comparing the quality of life between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy for gastric Cancer (study protocol). BMC Cancer 2019; 19:206. [PMID: 30845995 PMCID: PMC6407283 DOI: 10.1186/s12885-019-5396-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/20/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND KLASS (the Korean Laparoendoscopic Gastrointestinal Surgery Study) is a time-honored study group that has established laparoscopic surgery for gastrointestinal disease in Korea and has performed some important studies for the rationale of laparoscopic gastrointestinal surgery. A multi-center RCT (randomized controlled trial) to compare the quality of life (QOL) of patients undergoing totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer, named as KLASS 07, has been currently prepared in Korea. METHODS Patients diagnosed as gastric cancer, with clinical stage IA (T1N0M0) or IB (T1N1M0 / T2N0M0) according to the 7th edition of the Americal Joint Committee on Cancer System, were randomized to receive either TLDG or LADG. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 gastrectomies and at least 30 gastrectomies annually (regardless of open or laparoscopic surgery for gastric cancer). The patients who are allocated to TLDG group undergo intracorporeal anastomosis and those who are assigned to LADG undergo extracorporeal anastomosis for gastrointestinal reconstruction. DISCUSSION Thirty-one surgeons from 26 institutions were engaged in this trial. The primary endpoint is 30-day morbidity, and secondary endpoint is QOL assessed by the questionnaire score. The KLASS 07 trial is the first multi-center RCT to investigate whether there are significant and quantifiable differences between the QOL of TLDG and LADG. The findings from this trial are expected to be the critical clues for designing the detailed procedures during laparoscopic surgery for gastric cancer. TRIAL REGISTRATION The protocol of KLASS 07 (CKLASS 01) was registered in http://register.clinicaltrials.gov as NCT03393182 (Date of registration: January 2nd, 2018.).
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Affiliation(s)
- Chang Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ji Ho Park
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang In Choi
- Department of Surgery, Medical Research Institute, Pusan National Universtiy Hospital, Busan, Korea
| | - Han Hong Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Science, Busan, Korea
| | - Ye Seob Jee
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Oh Jeong
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Hyundong Chae
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gang Dong, Seoul, Korea
| | - Hua Huang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. .,Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No.270 Dong an Road, Shanghai, 200032, China.
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea. .,Department of Surgery, Korea University Medical Center Anam Hospital, Inchon-ro 73, Seongbuk-gu, Seoul, 02841, Korea.
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Abstract
Regional variation in treatment paradigms for gastric adenocarcinoma has attracted a great deal of interest. Between Asia and the West, major differences have been identified in tumor biology, implementation of screening programs, extent of surgical lymphadenectomy, and routine use of neoadjuvant versus adjuvant treatment strategies. Minimally invasive techniques, including both laparoscopic and robotic platforms, have been studied in both regions, with attention to safety, feasibility, and long-term oncologic outcomes. The purpose of this review is to discuss advances in the understanding of the etiology and underlying biology of gastric cancer, as well as the current state of management, focusing on the differences between Asia and the West.
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Affiliation(s)
- Ashley E Russo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; ,
| | - Vivian E Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; ,
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He H, Li H, Su X, Li Z, Yu P, Huang H, Huang C, Ye J, Li Y, Suo J, Yu J, Li G, Xu Z, Zhao G, Cao H, Hu J, Du X, Liu F, Sun Y. Study on safety of laparoscopic total gastrectomy for clinical stage I gastric cancer: the protocol of the CLASS02-01 multicenter randomized controlled clinical trial. BMC Cancer 2018; 18:944. [PMID: 30285673 PMCID: PMC6171153 DOI: 10.1186/s12885-018-4846-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/21/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The safety of laparoscopic total gastrectomy (LTG) for the treatment of gastric cancer remains lack of clinical evidence. The Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group recently launched a multicenter randomized clinical trial (CLASS02-01) to compare the safety of LTG for clinical stage I gastric cancer with the conventional open total gastrectomy (OTG). METHODS This CLASS02-01 trial is a prospective, multicenter, randomized, controlled, open, and non-inferiority trial. Two hundred patients who met the inclusion criteria and did not accord with the exclusion criteria will be randomly divided into LTG group (n = 100) and OTG group (n = 100). The primary purpose of this study is to evaluate the early operative morbidity and mortality of LTG compared with OTG for clinical stage I gastric adenocarcinoma. The second purpose is to evaluate the recovery course and compare the postoperative hospital stay of the patients enrolled in this study. DISCUSSION This CLASS02-01 trial is the first prospective randomized two-arm controlled study to determine the safety of LTG compared with OTG. Through this trial, we hope to show that experienced surgeons can safely perform LTG with lymphadenectomy for gastric cancer. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03007550 . December 30, 2016.
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Affiliation(s)
- Hongyong He
- Department of General Surgery, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Haojie Li
- Department of General Surgery, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Xiangqian Su
- Department of General Surgery, Beijing Cancer Hospital, Peking University, Beijing, 100142, China
| | - Ziyu Li
- Department of General Surgery, Beijing Cancer Hospital, Peking University, Beijing, 100142, China
| | - Peiwu Yu
- Department of General Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Hua Huang
- Department of General Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Changming Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Jianxin Ye
- Department of General Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350009, China
| | - Yong Li
- Department of General Surgery, Guangdong General Hospital, Guangzhou, 510080, China
| | - Jian Suo
- Department of General Surgery, The First Bethune Hospital of Jilin University, Changchun, 130021, China
| | - Jiren Yu
- Department of General Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, China
| | - Guoxin Li
- Department of General Surgery, Nangfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Gang Zhao
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, 200240, China
| | - Hui Cao
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, 200240, China
| | - Jiankun Hu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaohui Du
- Department of General Surgery, Chinese PLA General Hospital, Beijing, 10853, China
| | - Fenglin Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China.
| | - Yihong Sun
- Department of General Surgery, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China.
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Park DJ, Park YS, Son SY, Lee JH, Lee HS, Park YS, Lee KH, Kim YH, Park KU, Lee WW, Ahn S, Ahn SH, Kim HH. Long-Term Oncologic Outcomes of Laparoscopic Sentinel Node Navigation Surgery in Early Gastric Cancer: A Single-Center, Single-Arm, Phase II Trial. Ann Surg Oncol 2018; 25:2357-2365. [DOI: 10.1245/s10434-018-6523-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Indexed: 08/30/2023]
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24
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Comparison of robotic- and laparoscopic-assisted gastrectomy in advanced gastric cancer: updated short- and long-term results. Surg Endosc 2018; 33:528-534. [DOI: 10.1007/s00464-018-6327-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/06/2018] [Indexed: 12/31/2022]
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25
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Lee B, Lee YT, Park YS, Ahn SH, Park DJ, Kim HH. Learning Curve of Pure Single-Port Laparoscopic Distal Gastrectomy for Gastric Cancer. J Gastric Cancer 2018; 18:182-188. [PMID: 29984068 PMCID: PMC6026715 DOI: 10.5230/jgc.2018.18.e20] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/14/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022] Open
Abstract
Purpose Despite the fact that there are several reports of single-port laparoscopic distal gastrectomy (SPDG), no analysis of its learning curve has been described in the literature. The aim of this study was to investigate the favorable factors for SPDG and to analyze the learning curve of SPDG. Materials and Methods A total of 125 cases of SPDG performed from November 2011 to December 2015 were enrolled. All operations were performed by 2 surgeons (surgeon A and surgeon B). The moving average method was used for defining the learning curve. All cases were divided into 10 cases in a sequence, and the mean operative time and estimated blood loss data were extracted from each group. Results Surgeon A performed 68 cases (female-to-male sex ratio, 91.1%:8.82%), and surgeon B performed 57 cases (female-to-male sex ratio, 61.4%:38.5%). The operative time of surgeon B significantly decreased after 30 cases (157.8±38.4 minutes vs. 118.1±34.5 minutes, P=0.003); that of surgeon A did not significantly decrease before and after around 30 cases (160.8±51.6 minutes vs. 173.3±35.2 minutes, P=0.6). The subgroup analysis showed that the operative time significantly decreased in the patients with body mass index (BMI) of <25 kg/m2 (<25 kg/m2:≥25 kg/m2, 159.3±41.7 minutes: 194.25±81.1 minutes; P=0.001). Conclusions Although there was no significant decrease in the operative time for surgeon A, surgeon B reached the learning curve upon conducting 30 cases of SPDG. BMI of <25 kg/m2 was found to be a favorable factor for SPDG.
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Affiliation(s)
- Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Taek Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Compliance to D2 lymphadenectomy in laparoscopic gastrectomy. Updates Surg 2018; 70:197-205. [PMID: 29926307 PMCID: PMC6060987 DOI: 10.1007/s13304-018-0553-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/06/2018] [Indexed: 12/23/2022]
Abstract
The objective of this study is to describe the compliance to D2 lymphadenectomy in laparoscopic gastrectomy. Radical partial or total gastrectomy with modified D2 lymphadenectomy is the standard of care for locally advanced gastric cancer. It is unclear whether compliance to D2 lymphadenectomy in laparoscopy is comparable to that in open surgery. A review of the literature was performed and results are described in a descriptive review. Available randomized trials are mostly performed for early gastric cancer, for which formal D2 lymphadenectomy is usually not required. Most trials report no differences in number of retrieved lymph nodes between open and laparoscopic gastrectomy. Only one trial used adherence to D2 lymphadenectomy as primary outcome parameter, and found no difference between laparoscopic and open gastrectomy. Results from randomized trials in advanced gastric cancer are awaited. In the meantime, the laparoscopic approach can be used in experienced centers.
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27
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Park DJ, Park YS, Ahn SH, Kim HH. [Laparoscopic Proximal Gastrectomy as a Surgical Treatment for Upper Third Early Gastric Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 70:134-140. [PMID: 28934829 DOI: 10.4166/kjg.2017.70.3.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recently, the incidence of upper third gastric cancer has increased, and with it the number of endoscopic submucosal dissection (ESD) procedures performed has been increasing. However, if ESD is not indicated or non-curable, surgical treatment may be necessary. In the case of lower third gastric cancer, it is possible to preserve the upper part of the stomach; however, in the case of upper third gastric cancer, total gastrectomy is still the standard treatment option, regardless of the stage. This is due to the complications associated with upper third gastric cancer, such as gastroesophageal reflux after proximal gastrectomy rather than oncologic problems. Recently, the introduction of the double tract reconstruction method after proximal gastrectomy has become one of the surgical treatment methods for upper third early gastric cancer. However, since there has not been a prospective comparative study evaluating its efficacy, the ongoing multicenter prospective randomized controlled trial (KLASS-05) comparing laparoscopic proximal gastrectomy with double tract reconstruction and laparoscopic total gastrectomy is expected to be important for determining the future of treatment of upper third early gastric cancer.
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Affiliation(s)
- Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Ho Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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28
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Seo HS, Song KY, Jung YJ, Kim JH, Park CH, Lee HH. Right-Side Approach-Duet Totally Laparoscopic Distal Gastrectomy (R-Duet TLDG) Using a Three-Port to Treat Gastric Cancer. J Gastrointest Surg 2018; 22:578-586. [PMID: 28900841 DOI: 10.1007/s11605-017-3575-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/30/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastric cancer is commonly treated via minimally invasive surgery. The present study explored the feasibility of right-side approach-duet (R-duet) totally laparoscopic distal gastrectomy using a three-port compared with a four- or five-port. METHODS A total of 251 patients who underwent curative totally laparoscopic distal gastrectomy for gastric cancer (72 R-duet, 74 four-port, and 105 five-port) at the Catholic Medical Center were enrolled. All operations were performed using conventional laparoscopic instruments. The clinicopathological characteristics, operative details, and postoperative short-term outcomes were analyzed retrospectively. RESULTS The clinicopathological characteristics did not differ significantly among the groups, except that the N stage was higher in the five-port group. The operating time was significantly longer in the four-port than the R-duet group (R-duet, four-port, and five-port 148.2 ± 30.7, 162.4 ± 30.6, and 159.9 ± 31.5 min, respectively; p = 0.024). The estimated blood loss did not differ significantly. Postoperatively, the times to flatus and to soft diet consumption and the hospital stay were significantly longer in the five-port group. The extent of postoperative complications did not differ among the groups. CONCLUSIONS R-duet totally laparoscopic distal gastrectomy is a reliable form of reduced-port surgery when used to treat gastric cancer; no special instruments are required.
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Affiliation(s)
- Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Yoon Ju Jung
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Ji Hyun Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Cho Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
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29
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Obama K, Kim YM, Kang DR, Son T, Kim HI, Noh SH, Hyung WJ. Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer 2018. [PMID: 28639136 DOI: 10.1007/s10120-017-0740-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Initial experiences with robotic gastrectomy (RG) for gastric cancer have demonstrated favorable short-term outcomes, suggesting that RG is an effective alternative to laparoscopic gastrectomy (LG). However, data on long-term survival and recurrence after RG for gastric cancer have yet to be reported. The objective of this study was to assess long-term outcomes after RG compared with LG. METHODS We retrospectively evaluated 313 and 524 patients who underwent RG or LG, respectively, for gastric cancer between July 2005 and December 2009. We compared long-term outcomes using the entire and a propensity-score matched cohort. RESULTS The entire cohort analysis revealed no statistically significant differences in 5-year overall survival(OS) or relapse-free survival(RFS) (p = 0.4112 and p = 0.8733, respectively): 93.3% [95% confidence interval (CI) 89.9-95.6] and 90.7% (95% CI, 86.9-93.5) after RG and 91.6% (95% CI 88.9-93.7) and 90.5% (95% CI 87.6-92.7) after LG, respectively; hazard ratios for death and recurrence in the robotic group were 0.828 (95% CI, 0.528-1.299; p = 0.4119) and 0.968 (95% CI, 0.649-1.445; p = 0.8741), respectively. The propensity-matched cohort analysis demonstrated no statistically significant differences for 5-year OS or RFS (p = 0.5207 and p = 0.2293, respectively): 93.2% and 90.7% after RG and 94.2% and 92.6% after LG, respectively; hazard ratios for death and recurrence in the robotic group were 1.194 (95% CI, 0.695-2.062; p = 0.5214) and 1.343 (95% CI, 0.830-2.192; p = 0.2321), respectively. CONCLUSION The potential technical superiority of robotic system over laparoscopy did not improve oncological outcomes after gastrectomy. Long-term oncological outcomes were not different between RG and LG. Nevertheless, robotic applications in minimally invasive gastric cancer surgery may be an oncologically safe alternative.
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Affiliation(s)
- Kazutaka Obama
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoo-Min Kim
- Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Dae Ryong Kang
- Office of Biostatistics, Ajou University School of Medicine, Suwon, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea. .,Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Korea. .,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea. .,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.
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Coburn N, Cosby R, Klein L, Knight G, Malthaner R, Mamazza J, Mercer CD, Ringash J. Staging and surgical approaches in gastric cancer: A systematic review. Cancer Treat Rev 2018; 63:104-115. [DOI: 10.1016/j.ctrv.2017.12.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 02/07/2023]
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Yoshida K, Honda M, Kumamaru H, Kodera Y, Kakeji Y, Hiki N, Etoh T, Miyata H, Yamashita Y, Seto Y, Kitano S, Konno H. Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: A retrospective cohort study based on a nationwide registry database in Japan. Ann Gastroenterol Surg 2018; 2:55-64. [PMID: 29863131 PMCID: PMC5881294 DOI: 10.1002/ags3.12054] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/17/2017] [Indexed: 12/12/2022] Open
Abstract
To clarify the safety profile of laparoscopic distal gastrectomy (LDG) for gastric cancer patients, the short‐term outcome of LDG was compared to that of open distal gastrectomy (ODG) by propensity score matching using data from the Japanese National Clinical Database (NCD). We conducted a retrospective cohort study of patients undergoing distal gastrectomy between January 2012 and December 2013. Using the data for 70 346 patients registered in the NCD, incidences of mortality and morbidities were compared between LDG patients and ODG patients in the propensity score matched stage I patients (ODG: n = 14 386, LDG: n = 14 386) and stage II‐IV patients (ODG: n = 3738, LDG: n = 3738), respectively. There was no significant difference in mortality rates between LDG and ODG at all stages. Operating time was significantly longer in LDG compared to ODG, whereas blood loss and incidences of superficial surgical site infection (SSI), deep SSI, and wound dehiscence were significantly higher in ODG at all stages. Interestingly, pancreatic fistula was found significantly more often in LDG (1%) compared to ODG (0.8%) (P = .01) in stage I patients; however, it was not different in stage II‐IV patients. The length of postoperative stay was significantly longer in patients undergoing ODG compared to LDG at all stages. LDG in general practice might be a feasible therapeutic option in patients with both advanced gastric cancer and those with early gastric cancer in Japan.
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Affiliation(s)
- Kazuhiro Yoshida
- Graduate School of Medicine Department of Surgical Oncology Gifu University Gifu Japan
| | - Michitaka Honda
- Department of Minimally Invasive Medical and Surgical Oncology Fukushima Medical University Fukushima Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment Graduate School of Medicine University of Tokyo Tokyo Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery Graduate School of Medicine Nagoya University Nagoya Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery Department of Surgery Graduate School of Medicine Kobe University Kobe Japan
| | - Naoki Hiki
- Department of Gastroenterological Surgery Gastroenterological Center Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan
| | - Tsuyoshi Etoh
- Faculty of Medicine Department of Gastroenterological and Pediatric Surgery Oita University Oita Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management School of Medicine Keio University Tokyo Japan
| | - Yuichi Yamashita
- Department of Gastroenterological Surgery Fukuoka University Faculty of Medicine Fukuoka Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
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Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study. Gastric Cancer 2018; 21:162-170. [PMID: 28887712 DOI: 10.1007/s10120-017-0764-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic distal gastrectomy (LDG) is becoming the standard procedure for gastric cancer. However, supporting evidence thus far has been derived primarily from randomized control trials conducted by centers of excellence. In the present study we used the National Clinical Database (NCD) in Japan to prospectively accumulate data from diverse types of hospitals and examine whether LDG is a safe and valid standard procedure. METHODS From the NCD, 169 institutions were selected to form a cohort that was considered to be representative of Japan. From August 2014 to July 2015, 5288 patients who underwent LDG were registered prospectively, and clinical data were acquired through the NCD. To compare surgical outcomes between open distal gastrectomy (ODG) and LDG, we adjusted for confounding factors using propensity score matching, ultimately retrieving data from 1067 patients in each group. RESULTS There were no significant differences in the number of in-hospital deaths in the ODG and LDG groups (3/1067 vs. 6/1067; P = 0.51) or in the number of reoperations (20/1067 vs. 29/1067; P = 0.19). However, the length of hospital stay was significantly shorter in the LDG. Although wound infection and dehiscence were more common in the ODG group, LDG was more often associated with grade B or higher pancreatic fistulas. CONCLUSION The safety and minimal invasiveness of LDG were confirmed in the present Japanese nationwide survey. However, care must be taken to prevent the formation of pancreatic fistulas with LDG, and further improvements in surgical quality are warranted in this regard.
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Lee H, Kwon W, Han Y, Kim JR, Kim SW, Jang JY. Optimal extent of surgery for early gallbladder cancer with regard to long-term survival: a meta-analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 25:131-141. [DOI: 10.1002/jhbp.521] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Hongeun Lee
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Jae Ri Kim
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
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Wang Y, Zhao X, Song Y, Cai A, Xi H, Chen L. A systematic review and meta-analysis of robot-assisted versus laparoscopically assisted gastrectomy for gastric cancer. Medicine (Baltimore) 2017; 96:e8797. [PMID: 29310358 PMCID: PMC5728759 DOI: 10.1097/md.0000000000008797] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Robotic-assisted gastrectomy (RAG) has been used for gastric cancer since 2002. This meta-analysis was carried out to evaluate whether RAG is safer and more effective than conventional laparoscopically assisted gastrectomy (LAG) for gastric cancer. METHODS We performed a manual search for these 2 types of operations (RAG and LAG) in the PubMed, Embase, and the Cochrane Library databases up to April 30, 2016. Twelve nonrandomized controlled trials that reported on RAG and LAG for gastric cancer were included. Outcomes evaluated included operation time, number of retrieved lymph nodes, blood loss, length of the resection margin, complications, and postoperative hospital stay. RESULTS A total of 3744 patients in 12 studies were included (1134 patients in the RAG group and 2610 patients in the LAG group). The operation time was significantly shorter in the LAG group [weighted mean difference (WMD) 42.0 (95% confidence interval, 95% CI 28.11-55.89) minutes; P < .00001], while the loss of blood volume was lower in the RAG group (P = .01). The number of retrieved lymph nodes, duration of postoperative stay, length of the proximal resection margin, length of the distal resection margin, and postoperative complications were similar between groups. CONCLUSION We conclude that RAG is a safe and appropriate treatment for gastric cancer patients in comparison to LAG. Nevertheless, RAG is not superior to LAG. Future research on RAG should focus on comparing the differences in retrieved lymph nodes in different tiers, evaluating the postoperative recovery and reducing the cost of the treatment.
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Marchesi F, De Sario G, Cecchini S, Tartamella F, Riccò M, Romboli A. Laparoscopic subtotal gastrectomy for the treatment of advanced gastric cancer: a comparison with open procedure at the beginning of the learning curve. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:302-309. [PMID: 29083335 PMCID: PMC6142852 DOI: 10.23750/abm.v88i3.6541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/14/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND In the last decades, after some initial concern, laparoscopic subtotal gastrectomy (LSG) is gaining popularity also for the treatment of advanced gastric cancer (AGC). The aim of this study is to compare a single surgeon initial experience on LSG and open subtotal gastrectomy in terms of surgical safety and radicality, postoperative recovery and midterm oncological outcomes. METHODS a case control study was conducted matching the first 13 LSG for AGC with 13 open procedures performed by the same surgeon. Operative and pathological data, postoperative parameters and midterm oncological outcomes were analyzed. RESULTS There was no significant difference in mortality (0%) and morbidity, while the laparoscopic approach allowed lower analgesic consumption and faster bowel movement recovery. Operation time was significantly higher in LSG patients (301.5 vs 232 min, p: 0.023), with an evident learning curve effect. Both groups had a high rate of adequate lymph node harvest, but the number was significantly higher in LSG group (p: 0.033). No significant difference in survival was registered. Multivariate analysis identified age at diagnosis, diffuse-type tumor, pN and LODDS as independent predictors of worse prognosis. CONCLUSIONS LSG can be safely performed for the treatment of AGC, allowing faster postoperative recovery.
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Affiliation(s)
- Federico Marchesi
- Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma, Via Gramsci n.14, 43100 Parma Italia..
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Huh YJ, Lee JH. The Advances of Laparoscopic Gastrectomy for Gastric Cancer. Gastroenterol Res Pract 2017; 2017:9278469. [PMID: 29018482 PMCID: PMC5605869 DOI: 10.1155/2017/9278469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022] Open
Abstract
Laparoscopic gastrectomy is evolving. With the increasing expertise and experience of oncologic surgeons in the minimally invasive surgery for gastric cancer, the indication for laparoscopic gastrectomy is expanding to advanced cases. Many studies have demonstrated the benefits of minimally invasive surgery, including reduced risk of surgery-related injury, reduced blood loss, less pain, and earlier recovery. In order to establish concrete evidence for the suitability of minimal invasive surgery for gastric cancer, many multicenter RCTs, comparing the short- and long-term outcomes of laparoscopic versus open surgery, are in progress. Advances in laparoscopic gastrectomy are moving toward increasingly minimally invasive approaches that enable the improvement of the quality of life of patients, without compromising on oncologic safety.
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Affiliation(s)
- Yeon-Ju Huh
- Department of Surgery, Ewha Womans University Mokdong Hospital, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Yangcheon-gu, Seoul 07985, Republic of Korea
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Abstract
Background: Clinical trials comparing laparoscopic gastrectomy (LG) versus traditional open gastrectomy (OG) have been planned, their surgical outcomes reported but their oncologic outcomes are still pending. Consequently, we have conducted this large-scale historical cohort study to provide relevant information rapidly to guide our current practice. Methods: Through a consensus meeting involving surgeons, biostatisticians, and epidemiologists, 30 variables of preoperative information possibly influencing surgeons’ choice between LG versus OG and potentially associating with outcomes were identified to enable rigorous estimation of propensity scores. A total of 4235 consecutive patients who underwent gastrectomy for gastric adenocarcinoma were identified and their relevant data were gathered from the participating hospitals. After propensity score matching, 1848 patients (924 each for LG and OG) were selected for comparison of long-term outcomes. Results: In the propensity-matched population, the 5-year overall survival was 96.3% [95% confidence interval (CI) 95.0–97.6] in the OG as compared with 97.1% (95% CI, 95.9–98.3) in LG. The number of all-cause death was 33/924 in the OG and 24/924 in the LG through the entire period, and the hazard ratio (LG/OG) for overall death was 0.75 (95% CI, 0.44–1.27; P = 0.290). The 3-year recurrence-free survival was 97.4% (95% CI, 96.4–98.5) in the OG and 97.7% (95% CI, 96.5–98.8) in the LG. The number of recurrence was 22/924 in the OG and 21/924 in the LG through the entire period, and the hazard ratio was 1.01 (95% CI, 0.55–1.84; P = 0.981). Conclusions: This observational study adjusted for all-known confounding factors seems to provide strong enough evidence to suggest that LG is oncologically comparable to OG for gastric cancer.
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Pan H, Li T, Huang Z, Yu H, Kong D, Ding Y, Pan C, Jiang Y. Laparoscopic versus opengastric surgery for the treatment of pathological T 1N 0M 0 gastric cancer in elderly patients: a matched study. Sci Rep 2017; 7:1919. [PMID: 28507294 PMCID: PMC5432525 DOI: 10.1038/s41598-017-02182-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/07/2017] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to compare the outcomes of laparoscopic surgery (LAP) and open gastric surgery (OP) in early gastric cancer patients aged ≥70 years.We conducted a retrospectively analysis among patientswith pathological T1N0M0 gastric cancer,who underwent LAP or OP between January 1, 2001 and December 31, 2008. We identified a well-balanced cohort of 2,360 patients (1180 patients in each group). LAP has been shown to offer a superior perioperative results to OP, including lower blood loss, shorter time to oral intake, walk and bowel function recovery, shorter time of hospital stay, and less blood transfusion required. However, the intraoperative and postoperative complications, local recurrence, and metastasis didn't show statistically significant differences between groups. The 5-year overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were 60.1% vs.63.2%, 80.8% vs. 83.3%, and 87.6% vs. 89.5% in the LAP group and OP group, respectively. The hazard ratios (HR) for OS, DFS, and CSS were 1.09(95% confidence interval [CI]: 0.95-1.25; P = 0.215), 1.03(95% CI: 0.91-1.18; P = 0.636), and 1.07 (95% CI: 0.88-1.30; P = 0.484), respectively, compared LAP group with OP group. In conclusion, LAP is an acceptable alternative to OP in elderly patients with early gastric cancer.
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Affiliation(s)
- Haiyan Pan
- School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, PR China
| | - Tao Li
- Department of Chemotherapy, The People's Hospital of Gaozhou, Gaozhou, 525200, Guangdong, PR China
| | - Zhigang Huang
- School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, PR China
| | - Haibing Yu
- School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, PR China
| | - Danli Kong
- School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, PR China
| | - Yuanlin Ding
- School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, PR China
| | - Congcong Pan
- Research Institute of The Aged Care Industry, Guangdong Medical University, Dongguan, 523808, Guangdong, PR China.
| | - Yugang Jiang
- Department of Gastrointestinal surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jing 5 Road, Jinan, 250021, Shandong, PR China.
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Kim SM, An JY. Editorial concerning "Long-term outcomes of laparoscopic versus open surgery for clinical stage I gastric cancer: the LOC-1 study". Transl Gastroenterol Hepatol 2017; 2:12. [PMID: 28275744 DOI: 10.21037/tgh.2017.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Su Mi Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Minimally invasive surgery for gastric cancer: the American experience. Gastric Cancer 2017; 20:368-378. [PMID: 26961133 DOI: 10.1007/s10120-016-0605-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive surgical techniques are increasingly being implemented in oncologic care. This study assesses the impact of minimally invasive surgery on oncologic and perioperative outcomes in the management of gastric cancer in the USA. METHODS From the American College of Surgeons and American Cancer Society National Cancer Data Base, we identified 6427 patients who underwent gastrectomy for cancer from 2010 to 2012. Treatment groups were categorized with an intention-to-treat paradigm as robotic, laparoscopic, and open surgery. Univariate and multivariate analyses were performed to estimate the impact of the surgical approach on oncologic and perioperative outcomes. RESULTS Of patients undergoing definitive surgical intervention, 3.5 % (n = 223) underwent robotic gastrectomy, 23.1 % (n = 1487) underwent laparoscopic gastrectomy, and 73.4 % (n = 4717) underwent open surgery. Minimally invasive gastrectomy was more frequently performed on white (P = 0.018), privately insured patients (P = 0.049) treated at academic centers (P < 0.0001) in the eastern USA (P < 0.0001). After demographics, comorbidities, and tumor-related factors had been controlled for, patients who underwent laparoscopic gastrectomy had the postoperative length of stay decreased by 1.08 days (P < 0.0001) and greater odds of having at least 15 lymph nodes resected (odds ratio 1.16, P = 0.023). Use of robotic surgery did not have a statistically significant effect on the postoperative length of stay relative to open surgery (P = 0.222) but the patients so treated had greater odds of having at least 15 lymph nodes resected (odds ratio 1.51, P = 0.005). There were no differences in R0 resection rates or perioperative mortality on the basis of the surgical approach alone. CONCLUSIONS These findings suggest that use of minimally invasive surgery for gastric cancer in the USA is impacting the adequacy of oncologic resection but is not yet having a clinically significant impact on perioperative outcomes relative to a conventional open approach.
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Russo A, Li P, Strong VE. Differences in the multimodal treatment of gastric cancer: East versus west. J Surg Oncol 2017; 115:603-614. [PMID: 28181265 DOI: 10.1002/jso.24517] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 11/27/2016] [Accepted: 11/27/2016] [Indexed: 02/06/2023]
Abstract
There has been a great deal of interest about varying treatment paradigms of gastric cancer in Eastern and Western countries. Differences in tumor biology, screening initiatives, surgical approach, extent of lymphadenectomy, and neoadjuvant versus adjuvant chemotherapy regimens have been studied and documented in the literature. The purpose of this review is to give an updated report on the current status and management differences in the treatment of gastric cancer between Eastern and Western countries.
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Affiliation(s)
- Ashley Russo
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ping Li
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Marchesi F, de Sario G, Cecchini S, Tartamella F, Riccò M, Romboli A. Laparoscopic subtotal gastrectomy for the treatment of advanced gastric cancer: a comparison with open procedure at the beginning of the learning curve. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88. [PMID: 29083335 PMCID: PMC6142852 DOI: 10.23750/abm.v%vi%i.6541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the last decades, after some initial concern, laparoscopic subtotal gastrectomy (LSG) is gaining popularity also for the treatment of advanced gastric cancer (AGC). The aim of this study is to compare a single surgeon initial experience on LSG and open subtotal gastrectomy in terms of surgical safety and radicality, postoperative recovery and midterm oncological outcomes. METHODS a case control study was conducted matching the first 13 LSG for AGC with 13 open procedures performed by the same surgeon. Operative and pathological data, postoperative parameters and midterm oncological outcomes were analyzed. RESULTS There was no significant difference in mortality (0%) and morbidity, while the laparoscopic approach allowed lower analgesic consumption and faster bowel movement recovery. Operation time was significantly higher in LSG patients (301.5 vs 232 min, p: 0.023), with an evident learning curve effect. Both groups had a high rate of adequate lymph node harvest, but the number was significantly higher in LSG group (p: 0.033). No significant difference in survival was registered. Multivariate analysis identified age at diagnosis, diffuse-type tumor, pN and LODDS as independent predictors of worse prognosis. CONCLUSIONS LSG can be safely performed for the treatment of AGC, allowing faster postoperative recovery.
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Affiliation(s)
- Federico Marchesi
- Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma, Parma, Italia,Correspondence: Federico Marchesi Università degli Studi di Parma, Dipartimento di Scienze Chirurgiche Sezione di Clinica Chirurgica, Generale e Terapia Chirurgica Via Gramsci n.14, 43100 Parma Tel. +39 0521 702156 Fax +39 0521 940125 E-mail:
| | - Giuseppina de Sario
- Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma, Parma, Italia
| | - Stefano Cecchini
- Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma, Parma, Italia
| | - Francesco Tartamella
- Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma, Parma, Italia
| | - Matteo Riccò
- Azienda provinciale per i servizi sanitari della p.a di Trento, UOPSAL, Trento, Italia
| | - Andrea Romboli
- Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma, Parma, Italia
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Kim DJ, Seo SH, Kim KH, Park YH, An MS, Bae KB, Choi CS, Oh SH. Comparisons of clinicopathologic factors and survival rates between laparoscopic and open gastrectomy in gastric cancer. Int J Surg 2016; 34:161-168. [DOI: 10.1016/j.ijsu.2016.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023]
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Quan Y, Huang A, Ye M, Xu M, Zhuang B, Zhang P, Yu B, Min Z. Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer 2016. [PMID: 26216579 DOI: 10.1007/s10120-015-0516-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. METHODS Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. RESULTS Overall, 26 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD, -3.63, 95 % CI, -4.66 to -2.60; P < 0.01), less blood loss (WMD, -161.37, 95 % CI, -192.55 to -130.18; P < 0.01), faster bowel recovery (WMD, -0.78, 95 % CI, -1.05 to -0.50; P < 0.01), and earlier ambulation (WMD, -0.95, 95 % CI, -1.47 to -0.44; P < 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.49, 95 % CI, -1.78 to 0.81; P = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P < 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. CONCLUSIONS For AGCs, LG appeared comparable with OG in short- and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.
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Affiliation(s)
- Yingjun Quan
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ao Huang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Min Ye
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ming Xu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Biao Zhuang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Bo Yu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Zhijun Min
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
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Aurello P, Sagnotta A, Terrenato I, Berardi G, Nigri G, D'Angelo F, Ramacciato G. Oncologic value of laparoscopy-assisted distal gastrectomy for advanced gastric cancer: A systematic review and meta-analysis. J Minim Access Surg 2016; 12:199-208. [PMID: 27279389 PMCID: PMC4916744 DOI: 10.4103/0972-9941.181283] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND: The oncologic validity of laparoscopic-assisted distal gastrectomy (LADG) in the treatment of advanced gastric cancer (AGC) remains controversial. This study is a systematic review and meta-analysis of the available evidence. MATERIALS AND METHODS: A comprehensive search was performed between 2008 and 2014 to identify comparative studies evaluating morbidity/mortality, oncologic surgery-related outcomes, recurrence and survival rates. Data synthesis and statistical analysis were carried out using RevMan 5.2 software. RESULTS: Eight studies with a total of 1456 patients were included in this analysis. The complication rate was lower in LADG [odds ratio (OR) 0.59; 95% confidence interval (CI) = 0.42-0.83; P < 0.002]. The in-hospital mortality rate was comparable (OR 1.22; 95% CI = 0.28-5-29, P = 0.79). There was no significant difference in the number of harvested lymph nodes, resection margins, cancer recurrence rate, cancer-related mortality or overall and disease-free survival (OS and DFS, respectively) rates between the laparoscopic and the open groups (P > 0.05). CONCLUSION: The current study supports the view that LADG for AGC is a feasible, safe and effective procedure in selected patients. Adequate lymphadenectomy, resection margins, recurrence, cancer-related mortality and long-term outcomes appear equivalent to open distal gastrectomy (ODG).
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Affiliation(s)
- Paolo Aurello
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Sagnotta
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Irene Terrenato
- Biostatistic Unit, Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Giammauro Berardi
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Nigri
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Francesco D'Angelo
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Ramacciato
- Department of General Surgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Suda K, Nakauchi M, Inaba K, Ishida Y, Uyama I. Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature. World J Gastroenterol 2016; 22:4626-37. [PMID: 27217695 PMCID: PMC4870070 DOI: 10.3748/wjg.v22.i19.4626] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/03/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO2 insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes. Since 1995, we have been actively using MIS for operable patients with resectable upper GI cancer and have developed stable and robust methodology in conducting totally laparoscopic gastrectomy for advanced gastric cancer and prone thoracoscopic esophagectomy for esophageal cancer using novel technology including da Vinci Surgical System (DVSS). We have recently demonstrated that use of DVSS might reduce postoperative local complications including pancreatic fistula after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. In this article, we present the current status and future perspectives on MIS for gastric and esophageal cancer based on our experience and a review of the literature.
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47
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Inaki N, Tsuji T, Doden K, Sakimura Y, Tawara H, Matsui R, Yamamoto D, Kitamura H, Bando H, Yamada T. Reduced port laparoscopic gastrectomy for gastric cancer. Transl Gastroenterol Hepatol 2016; 1:38. [PMID: 28138605 DOI: 10.21037/tgh.2016.04.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/11/2016] [Indexed: 12/20/2022] Open
Abstract
The use of reduced port laparoscopic surgery (RPS) has become increasingly popular. The concept of RPS includes all procedures derived from various efforts minimizing the invasiveness of surgery, with single-incision laparoscopic surgery (SILS) being the ultimate reduced port technique. Reduced-port laparoscopic gastrectomy (RPLG) for gastric cancer has not yet been fully established and still has issues such as feasibility, oncological validity, training, and education. The short-term results of reported studies are acceptable. However, long-term results that verify positive results or radical cure even in cases of cancer have not yet been published. Patients for whom RPLG is indicated should be selected carefully. Prospective multicenter studies should be conducted to establish RPS as a truly evidence-based practice that addresses not only cosmesis but also the appropriate balance between minimal invasiveness and radical cure.
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Affiliation(s)
- Noriyuki Inaki
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Toshikatsu Tsuji
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenta Doden
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Yusuke Sakimura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroki Tawara
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Ryota Matsui
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Daisuke Yamamoto
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Tetsuji Yamada
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Mihmanli M, Ilhan E, Idiz UO, Alemdar A, Demir U. Recent developments and innovations in gastric cancer. World J Gastroenterol 2016; 22:4307-20. [PMID: 27158199 PMCID: PMC4853688 DOI: 10.3748/wjg.v22.i17.4307] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 03/30/2016] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer has an important place in the worldwide incidence of cancer and cancer-related deaths. It can metastasize to the lymph nodes in the early stages, and lymph node metastasis is an important prognostic factor. Surgery is a very important part of gastric cancer treatment. A D2 lymphadenectomy is the standard surgical treatment for cT1N+ and T2-T4 cancers, which are potentially curable. Recently, the TNM classification system was reorganized, and the margins for gastrectomy and lymphadenectomy were revised. Endoscopic, laparoscopic and robotic treatments of gastric cancer have progressed rapidly with development of surgical instruments and techniques, especially in Eastern countries. Different endoscopic resection techniques have been identified, and these can be divided into two main categories: endoscopic mucosal resection and endoscopic submucosal dissection. Minimally invasive surgery has been reported to be safe and effective for early gastric cancer, and it can be successfully applied to advanced gastric cancer with increasing experience. Cytoreductive surgery and hyperthermıc intraperıtoneal chemotherapy were developed as a combined treatment modality from the results of experimental and clinical studies. Also, hyperthermia increases the antitumor activity and penetration of chemotherapeutics. Trastuzumab which is a monoclonal antibody interacts with human epidermal growth factor (HER) 2 and is related to gastric carcinoma. The anti-tumor mechanism of trastuzumab is not clearly known, but mechanisms such as interruption of the HER2-mediated cell signaling pathways and cell cycle progression have been reported previously. H. pylori is involved in 90% of all gastric malignancies and Japanese guidelines strongly recommend that all H. pylori infections should be eradicated regardless of the associated disease. In this review, we present innovations discussed in recent studies.
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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: 450] [Impact Index Per Article: 56.3] [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.
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Barchi LC, Jacob CE, Bresciani CJC, Yagi OK, Mucerino DR, Lopasso FP, Mester M, Ribeiro-Júnior U, Dias AR, Ramos MFKP, Cecconello I, Zilberstein B. MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29:117-20. [PMID: 27438040 PMCID: PMC4944749 DOI: 10.1590/0102-6720201600020013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 01/26/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. OBJECTIVE To evaluate and summarize the current status of minimally invasive resection of gastric cancer. METHODS A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. RESULTS 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. CONCLUSION Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale.
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Affiliation(s)
| | | | | | - Osmar Kenji Yagi
- Cancer Institute of the State of São Paulo, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Ulysses Ribeiro-Júnior
- Cancer Institute of the State of São Paulo, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - André Roncon Dias
- Cancer Institute of the State of São Paulo, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Ivan Cecconello
- Cancer Institute of the State of São Paulo, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Bruno Zilberstein
- Cancer Institute of the State of São Paulo, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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