J Gastric Cancer.  2018 Jun;18(2):152-160. 10.5230/jgc.2018.18.e17.

Feasibility and Safety of Totally Laparoscopic Radical Gastrectomy for Advanced Gastric Cancer: Comparison with Early Gastric Cancer

• Lee S
• Lee H
• Lee J

• KMID: 2414535
• DOI: http://doi.org/10.5230/jgc.2018.18.e17

Abstract

PURPOSE
Totally laparoscopic gastrectomy (TLG) for advanced gastric cancer (AGC) is a technically and oncologically challenging procedure for surgeons. This study aimed to compare the oncologic feasibility and technical safety of TLG for AGC versus early gastric cancer (EGC).
MATERIALS AND METHODS
Between 2011 and 2016, 535 patients (EGC, 375; AGC, 160) underwent curative TLG for gastric cancer. Clinicopathologic characteristics and surgical outcomes of both patient groups were analyzed and compared.
RESULTS
Patients with AGC required a longer operation time and experienced more intraoperative blood loss than those with EGC did. However, patients from both the AGC and EGC groups demonstrated similar short-term surgical outcomes such as postoperative morbidity (14.4% vs. 13.3%, P=0.626), mortality (0% vs. 0.5%, P=0.879), time-to-first oral intake (2.7 days for both groups, P=0.830), and postoperative hospital stay (10.2 days vs. 10.1 days, P=0.886). D2 lymph node dissection could be achieved in the AGC group (95%), with an adequate number of lymph nodes being dissected (36.0±14.9). In the AGC group, the 3-year overall and disease-free survival rates were 80.5% and 73.7%, respectively.
CONCLUSIONS
TLG is as safe and effective for AGC as it is for EGC.

Keyword

Stomach neoplasms; Gastrectomy; Laparoscopy; Lymph node excision

MeSH Terms

Disease-Free Survival
Gastrectomy*
Humans
Laparoscopy
Length of Stay
Lymph Node Excision
Lymph Nodes
Mortality
Stomach Neoplasms*
Surgeons

Figure

• 

  Fig. 1 Kaplan-Meier survival curves of patients with AGC according to different tumor stages. (A) Cumulative OS; (B) Cumulative DFS. AGC = advanced gastric cancer; OS = overall survival; DFS = disease-free survival.

Reference

1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65:87–108.

2. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994; 4:146–148.

3. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017; 20:1–19.

4. Korean Academy of Medical Sciences. Korean Clinical Practice Guideline for Gastric Cancer. Seoul: Korean Academy of Medical Sciences;2012.

5. Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, et al. Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc. 2009; 23:2374–2379.

6. Lee YJ, Ha WS, Park ST, Choi SK, Hong SC. Port-site recurrence after laparoscopy-assisted gastrectomy: report of the first case. J Laparoendosc Adv Surg Tech A. 2007; 17:455–457.

7. Jung IK, Kim MC, Kim KH, Kwak JY, Jung GJ, Kim HH. Cellular and peritoneal immune response after radical laparoscopy-assisted and open gastrectomy for gastric cancer. J Surg Oncol. 2008; 98:54–59.

8. Miura S, Kodera Y, Fujiwara M, Ito S, Mochizuki Y, Yamamura Y, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. J Am Coll Surg. 2004; 198:933–938.

9. Memon MA, Khan S, Yunus RM, Barr R, Memon B. Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc. 2008; 22:1781–1789.

10. Lee J, Kim W. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol. 2009; 100:693–698.

11. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg. 2015; 39:2734–2741.

12. Park DJ, Han SU, Hyung WJ, Kim MC, Kim W, Ryu SY, et al. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc. 2012; 26:1548–1553.

13. Nakauchi M, Suda K, Nakamura K, Shibasaki S, Kikuchi K, Nakamura T, et al. Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional and oncological outcomes. Surg Endosc. 2017; 31:4631–4640.

14. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol. 2016; 34:1350–1357.

15. Hur H, Lee HY, Lee HJ, Kim MC, Hyung WJ, Park YK, et al. Efficacy of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer: the protocol of the KLASS-02 multicenter randomized controlled clinical trial. BMC Cancer. 2015; 15:355.

16. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250:187–196.

17. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008; 248:721–727.

18. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Inomata M, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007; 245:68–72.

19. Kim YW, Yoon HM, Yun YH, Nam BH, Eom BW, Baik YH, et al. Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc. 2013; 27:4267–4276.

20. Eom BW, Joo J, Kim YW, Bae JM, Park KB, Lee JH, et al. Role of bursectomy for advanced gastric cancer: result of a case-control study from a large volume hospital. Eur J Surg Oncol. 2013; 39:1407–1414.

21. Lee IS, Park YS, Ryu MH, Song MJ, Yook JH, Oh ST, et al. Impact of extranodal extension on prognosis in lymph node-positive gastric cancer. Br J Surg. 2014; 101:1576–1584.

22. Park YK, Yoon HM, Kim YW, Park JY, Ryu KW, Lee YJ, et al. Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer: results from a randomized phase II multicenter clinical trial (COACT 1001). Ann Surg. 2018; 267:638–645.

23. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007; 357:1810–1820.

24. Usui S, Tashiro M, Haruki S, Arita K, Ito K, Matsumoto A, et al. Spleen preservation versus splenectomy in laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer: A comparison of short-term outcomes. Asian J Endosc Surg. 2016; 9:5–13.

25. Son SY, Shin DJ, Park YS, Oo AM, Jung DH, Lee CM, et al. Spleen-preserving lymphadenectomy versus splenectomy in laparoscopic total gastrectomy for advanced gastric cancer. Surg Oncol. 2017; 26:207–211.

26. Hosogi H, Okabe H, Shinohara H, Tsunoda S, Hisamori S, Sakai Y. Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer. Transl Gastroenterol Hepatol. 2016; 1:30.

27. Inokuchi M, Otsuki S, Fujimori Y, Sato Y, Nakagawa M, Kojima K. Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy. World J Gastroenterol. 2015; 21:9656–9665.