Comparison of laparoscopic and open gastrectomy for malignant disease

Weber, Kaare J.; Reyes, Christine; Gagner, M; Divino, Celia M.

doi:10.1007/s00464-002-8738-5

Cited by 86 publications

(56 citation statements)

References 14 publications

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“…Other benefits of the laparoscopic ap proach, including decreased time to ambulation and resumed diet, decreased consumption of analgesia and a shorter length of stay, have been reported in these studies. 16,17,33 However, we found no difference in length of stay. We performed a laparoscopic assisted technique that included a limited median incision for digestive reconstruction.…”

Section: Discussioncontrasting

confidence: 68%

“…Comparative studies consisted of retrospective designs, 14,15,26-32 2 case-matched cohorts 17,33 and a single prospective randomized controlled trial (RCT) by Huscher and colleagues. 16 Sample sizes were limited owing to the Western gastric cancer reality.…”

Section: Discussionmentioning

confidence: 99%

“…Others reported no difference between the laparoscopic and open approaches. 15,16,[26][27][28][29][30][31]33 In a meta-analysis of RCTs comparing laparoscopic and open approaches for early gastric cancer, Ohtani and colleagues 9 concluded that there was a lesser number of LNs with laparoscopy. Debate is still ongoing about the extent of the lymphadenectomy and the number of LNs needed in the specimen.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre

Christou

2013

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Background:The Eastern experience has reported the safety of laparoscopic assisted gastrectomy (LAG) for gastric cancer. Its use in Western countries is still debated owing to concerns about its oncologic equivalence to open gastrectomy (OG). We sought to review and compare their operative outcomes and oncologic specimen quality (number of harvested lymph nodes and surgical margins) for gastric adenocarcinoma (GA). Methods:We reviewed the charts of all patients undergoing LAG (2007( ) and OG (2000 for GA in a single institution. Several surgeons performed the OGs, whereas 1 fellowship-trained laparoscopic surgeon performed LAGs. The primary outcome was quality of the surgical specimen, assessed by the number of harvested lymph nodes (LNs) and margin status. Secondary outcomes were perioperative events. Data were analyzed as intention to treat. Results:We retrieved 60 cases (47 OGs, 13 LAGs). The conversion rate was 23%. Conclusion:Laparoscopic assisted gastrectomy is a challenging but safe and feasible procedure in experienced hands. It offers the same radical resection as OG regarding negative margins and LN retrieval. Long-term follow-up is warranted.Contexte : La gastrectomie assistée par laparoscopie (GAL) a été démontrée dans des études orientales comme sécuritaire dans le traitement de l'adénocarcinome gastrique (AG). En occident, l'équivalence oncologique de la GAL avec la gastrectomie ouverte (GO) demeure cependant controversée. Cette étude vise à comparer le devenir postopératoire et la qualité des spécimens oncologiques de ces interventions, dans le traitement de l'AG. (2007)(2008)(2009)(2010) ou GO (2000GO ( -2010 pour AG dans un seul centre hospitalier ont été revus. Différents chirurgiens ont réalisé les GO. Toutes les GAL ont été réalisées par un seul chirurgien sur-spécialisé en chirurgie laparoscopique. Le critère d'évaluation principal était la qualité du spécimen chirurgical évaluée par le nombre de ganglions lymphatiques (GL) prélevés et le statut des marges de résection. Le critère d'évaluation secondaire était la morbidité postopératoire. Les données ont été analysées en fonction de l'intention de traiter. Méthodes : Tous les dossiers de patients opérés par GALRésultats : Soixante cas ont été inclus (47 GO, 13 GAL). Le taux de conversion s'est établi à 23 %. Le temps opératoire moyen était plus long de 115 minutes, et les pertes sanguines moyennes moindres de 425 mL (p < 0,001 dans les 2 cas) pour la GAL que pour la GO. Une moyenne de 14,4 (écart-type [ET] 9,8) et 11,2 (ET 8,2) GL ont été prélevés respectivement pour la GO et la GAL (p = 0.29). On a obtenu des marges négatives pour tous les patients. La durée moyenne du séjour ne différait pas (GAL 19 j c. GO 18,9 j; p = 0,91). Les complications majeures (12,7 % c. 23,1 %; p = 0,39) et la mortalité post-opératoires (2,1 % c. 7,7 %; p = 0,32) étaient similaires. Conclusion :La gastrectomie assistée par laparoscopie est une intervention complexe, mais peut être réalisée de manière sécuritaire en des mains expertes. Elle offre un spécimen onc...

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre

Christou

2013

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“…After reading the full texts of the remaining papers, 24 studies were removed as they only reported the outcomes of LG for AGC whereas no controlled or matched cases treated by OG were available. Among the remaining articles, 19 studies [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] were excluded because EGC cases were mixed with AGCs in the cohort studies and data on AGCs were not extractable. Eight studies were further deleted for the following reasons: 2 studies were ongoing randomized controlled trials (RCTs) that only described study design and patient enrollment criteria without results reported [56,57]; 2 studies had overlapped enrollments with former research [58,59]; 1 study reported incomplete data that were not suitable for analysis [60]; and 3 studies discussed other issues irrelevant to the topic of this meta-analysis [61][62][63].…”

Section: Resultsmentioning

confidence: 99%

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Quan

Huang

et al. 2015

Gastric Cancer

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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 metaanalysis. 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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“…The major complications are bleeding, gastric stasis, anastomosis leakage, and wound infection [4]. In the published literature, the incidence of postoperative complications with LAG ranges from 5.4% to 23.3% [5][6][7][8][9][10][11]. However, fewer than 50 patients participated in these studies.…”

mentioning

confidence: 99%

Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases

et al. 2008

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Background Complications associated with laparoscopically assisted gastrectomy (LAG) are not significantly different from those associated with open gastrectomy. However, additional risks related to abdominal access, pneumoperitoneum, and special electrosurgical instruments result in an increased incidence of complications with LAG. This study analyzed the causes and risk factors linked to postoperative morbidity. Methods A retrospective review analyzed the data of 300 patients who underwent consecutive LAG for gastric cancer in our department from May 2003 to October 2006. Among the 300 patients, total gastrectomy was performed for 42 patients, distal gastrectomy for 258 patients, and proximal gastrectomy for 3 patients. The clinical and operative data obtained included body mass index, medical comorbidities, history of previous abdominal surgery, operative time, type of surgery, extent of lymph node dissection according to the Japanese Guideline, number of retrieved lymph nodes and lymph node metastases, additional operative procedure, depth of tumor invasion, and disease stage. The outcome data consisted of mortality, major morbidities, and postoperative hospital stay. The 300 cases were divided into two periods: 50 cases in the first period and 250 cases in the second period. Results Postoperative complications developed in 61 cases (20.3%), wound infection in 21 cases (7%), intraabdominal abscess in 3 cases (1%), bleeding in 12 cases (4%), stenosis in 13 cases (4.3%), leakage in 3 cases (1%), acute pancreatitis in 2 cases (0.7%), pulmonary complication in 4 cases (1.3%), renal complication in 4 cases (1.3%), and cardiac complication in 2 cases (0.7%). The 30-day mortality rate was 0.7% (n = 2). Univariate analysis proved that gender, operative period, comorbidity, and operative times were important risk factors. Multivariate analysis proved that cormobidity and operative period were important risk factors. Conclusion The data suggest that LAG can be performed with acceptable perioperative complication rates. The surgeon's experience and careful patient selection determined optimal patient outcomes.

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Comparison of laparoscopic and open gastrectomy for malignant disease

Abstract: Laparoscopic gastrectomy for malignancy is a viable alternative to open surgery. Laparoscopic techniques can obtain adequate margins and follow oncologic principles. Short-term follow-up evaluation shows no difference in survival rates between the two approaches.

Cited by 86 publications

References 14 publications

Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre

Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases

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