Yonsei Med J.  2012 Sep;53(5):952-959.

Comparative Study of Laparoscopy-Assisted versus Open Subtotal Gastrectomy for pT2 Gastric Cancer

• Chun HT
• Kim KH
• Kim MC
• Jung GJ

Abstract

PURPOSE
Laparoscopy-assisted distal gastrectomy (LADG) is a widely accepted surgery for early gastric cancer. However, its use in advanced gastric cancer has rarely been studied. The aim of this study is to investigate the feasibility and survival outcomes of LADG for pT2 gastric cancer.
MATERIALS AND METHODS
Between January 2004 and December 2009, we evaluated 67 and 52 patients who underwent open distal gastrectomy (ODG) and LADG, respectively, with diagnosis of pT2 gastric cancer. The clinicopathological characteristics, postoperative outcomes, and survival were retrospectively compared between the two groups.
RESULTS
There were statistically significant differences in the proximal margin of the clinicopathological parameters. The operation time was significantly longer in LADG than in ODG (207.7 vs. 159.9 minutes). There were 6 (9.0%) and 5 (9.6%) complications in ODG and LADG, respectively. During follow-up periods, tumor recurrence occurred in 7 (10.4%) patients of the ODG and in 4 (7.7%) patients of the LADG group. The 5-year survival rate of ODG and LADG was 88.6% and 91.3% (p=0.613), respectively. In view of lymph node involvement, 5-year survival rates were 96.0% in ODG versus 97.0% in LADG for patients with negative nodal metastasis (p=0.968) and 80.9% in ODG versus 78.7% in LADG for those with positive nodal metastasis (p=0.868).
CONCLUSION
Although prospective study is necessary to compare LADG with open gastrectomy for the treatment of advanced gastric cancer, laparoscopy-assisted distal gastrectomy might be considered as an alternative treatment for some pT2 gastric cancer.

Keyword

Laparoscopy; pT2 gastric cancer; subtotal gastrectomy

MeSH Terms

Diagnosis
Gastrectomy*
Humans
Laparoscopy
Lymph Nodes
Neoplasm Metastasis
Prospective Studies
Recurrence
Retrospective Studies
Stomach Neoplasms*
Survival Rate

Figure

• 

  Fig. 1 Comparison of 5-year survival rate for pT2 gastric cancer between ODG and LADG. There was no statistically difference between both groups (p=0.446). ODG, open distal gastrectomy; LADG, laparoscopy-assisted distal gastrectomy.

• 

  Fig. 2 Comparison of 5-year survival rate for pT2 gastric cancer between ODG and LADG according to lymph node metastasis. The 5 year survival rates of negative nodal metastasis (A) between both groups were 96.0% and 97.0% (p=0.968), and those of positive nodal metastasis (B) were 80.9% and 78.7% (p=0.868), respectively. ODG, open distal gastrectomy; LADG, laparoscopy-assisted distal gastrectomy.

Reference

1. Ohtsu A, Yoshida S, Saijo N. Disparities in gastric cancer chemotherapy between the East and West. J Clin Oncol. 2006. 24:2188–2196.

2. Adachi Y, Shiraishi N, Kitano S. Modern treatment of early gastric cancer: review of the Japanese experience. Dig Surg. 2002. 19:333–339.

3. Hyung WJ, Kim SS, Choi WH, Cheong JH, Choi SH, Kim CB, et al. Changes in treatment outcomes of gastric cancer surgery over 45 years at a single institution. Yonsei Med J. 2008. 49:409–415.

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

5. Kim MC, Kim KH, Kim HH, Jung GJ. Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol. 2005. 91:90–94.

6. Kim MC, Kim HH, Jung GJ. Surgical outcome of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer. Eur J Surg Oncol. 2005. 31:401–405.

7. Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y. Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years' experience. Surg Laparosc Endosc Percutan Tech. 2002. 12:204–207.

8. Kim KH, Kim MC, Jung GJ, Kim HH. The learning curve in laparoscopy assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer considering the operation time. J Korean Surg Soc. 2006. 70:102–107.

9. Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH. Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc. 2009. 23:1252–1258.

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. Shuang J, Qi S, Zheng J, Zhao Q, Li J, Kang Z, et al. A case-control study of laparoscopy-assisted and open distal gastrectomy for advanced gastric cancer. J Gastrointest Surg. 2011. 15:57–62.

12. Goh PM, Khan AZ, So JB, Lomanto D, Cheah WK, Muthiah R, et al. Early experience with laparoscopic radical gastrectomy for advanced gastric cancer. Surg Laparosc Endosc Percutan Tech. 2001. 11:83–87.

13. Nakamura K, Kamei T, Ohtomo N, Kinukawa N, Tanaka M. Gastric carcinoma confined to the muscularis propria: how can we detect, evaluate, and cure intermediate-stage carcinoma of the stomach? Am J Gastroenterol. 1999. 94:2251–2255.

14. Otsuji E, Kuriu Y, Ichikawa D, Okamoto K, Hagiwara A, Yamagishi H. Characteristics of gastric carcinoma invading the muscularis propria. J Surg Oncol. 2005. 92:104–108.

15. Lu Y, Liu C, Zhang R, Li H, Lu P, Jin F, et al. Prognostic significance of subclassification of pT2 gastric cancer: a retrospective study of 847 patients. Surg Oncol. 2008. 17:317–322.

16. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al. American Joint Committee on Cancer (AJCC) cancer staging manual. 2002. 6th ed. New York, NY: Springer.

17. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011. 14:113–123.

18. Kim KH, Kim MC, Jung GJ, Kim HH. Long-term outcomes and feasibility with laparoscopy-assisted gastrectomy for gastric cancer. J Gastric Cancer. 2012. 12:18–25.

19. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. 2010. 7th ed. New York: Springer.

20. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987. 11:418–425.

21. Sawai K, Takahashi T, Suzuki H. New trends in surgery for gastric cancer in Japan. J Surg Oncol. 1994. 56:221–226.

22. Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S, et al. Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg. 1999. 229:49–54.

23. 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.

24. Sarela AI, Turnbull AD, Coit DG, Klimstra D, Brennan MF, Karpeh MS. Accurate lymph node staging is of greater prognostic importance than subclassification of the T2 category for gastric adenocarcinoma. Ann Surg Oncol. 2003. 10:783–791.

25. Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, et al. Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc. 2007. 21:21–27.

26. Park do J, Kong SH, Lee HJ, Kim WH, Yang HK, Lee KU, et al. Subclassification of pT2 gastric adenocarcinoma according to depth of invasion (pT2a vs pT2b) and lymph node status (pN). Surgery. 2007. 141:757–763.

27. Isozaki H, Fujii K, Nomura E, Mabuchi H, Nishiguchi K, Hara H, et al. Prognostic factors of advanced gastric carcinoma without serosal invasion (pT2 gastric carcinoma). Hepatogastroenterology. 1999. 46:2669–2672.

28. Kim WS, Park SH, Kim JH. Lymphadenectomy for Stomach Cancer in T2 Stage. J Korean Surg Soc. 2002. 63:468–472.

29. Abe S, Yoshimura H, Nagaoka S, Monden N, Kinugasa S, Nagasue N, et al. Long-term results of operation for carcinoma of the stomach in T1/T2 stages: critical evaluation of the concept of early carcinoma of the stomach. J Am Coll Surg. 1995. 181:389–396.