Current status of laparoscopic gastrectomy for cancer in Japan

Kitano, Seigo; Shiraishi, Norio

doi:10.1007/s00464-003-8820-7

Cited by 107 publications

(69 citation statements)

References 25 publications

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“…During the past decade, LAG was used in specific patients with EGC that did not require extensive lymph node dissection (D1 or D1 + a). Now, because of technical advances leading to improved outcomes, the indications for LAG have expanded to include more extensive lymph node dissection (D1 + b or D2) [6,13], cancers in the upper third of the stomach requiring laparoscopic total gastrectomy or proximal gastrectomy, and advanced gastric cancer (T2N0) in clinical research [8,10,16].…”

Section: Discussionmentioning

confidence: 99%

“…LAG provides many other advantages when compared with conventional open gastrectomy: less blood loss and inflammation, better post-operative pulmonary function, less postoperative pain, earlier first flatus and eating, shorter hospital stays, and better cosmesis [10]. With regard to operative curability, the surgical margins and the number of dissected lymph nodes in LAG are equivalent to those in conventional open gastrectomy [20].…”

Section: Introductionmentioning

confidence: 99%

“…According to a survey conducted by the Japan Society for Endoscopic Surgery, the incidences of intraoperative and postoperative complications after laparoscopy-assisted distal gastrectomy (LADG) are 1.4 and 9.7%, respectively; the major intraoperative and postoperative complications are bleeding, gastric stasis, anastomosis leakage, and wound infection [10].…”

Section: Introductionmentioning

confidence: 99%

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Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

et al. 2006

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Background: Laparoscopy-assisted gastrectomy (LAG) is a complex and time-consuming procedure, which is increasingly used for early gastric cancer (EGC). We provide a multidimensional analysis of the learning curve in LAG. Methods: Cumulative sum method was used to analyze outcomes of 109 patients undergoing LAG for EGC by one surgeon over a two year period; the influence of patient selection was evaluated. Target failure rate was set at 10%, with failure defined as open conversion, mortality, major morbidity, residual tumor, or inappropriate lymphadenectomy. Results: There were 19 failures-fourteen performance and five oncologic. The learning curve, which displayed a slight rising trend and three phases was achieved after 40 cases with selected patients; it was broken, however, by the introduction of advanced procedures and unselected patients. Conclusions: Advanced procedures and broad indications in LAG should be delayed until a learning curve is completed under the target failure rate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

et al. 2006

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“…Early gastric cancer (EGC), which is associated with a 5-year-survival rate of 90%, is diagnosed in more than 50% of patients with gastric cancer in Japan [1]. As the general population ages, larger numbers of elderly patients with EGC will be candidates for endoscopic resection.…”

Section: Introductionmentioning

confidence: 99%

Multicenter study of the long-term outcomes of endoscopic submucosal dissection for early gastric cancer in patients 80 years of age or older

et al. 2011

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Background Little information is available on the longterm outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in patients of advanced age (C80 years). Methods A multicenter study was conducted at 10 Japanese institutions concerning their results for ESD. Data on 440 patients of advanced age (C80 years) with EGC (470 lesions) were collected and reviewed. Early and long-term outcomes of ESD were assessed. We compared the overall survival rates between 3 patient groups, those with curative ESD, additional surgery after noncurative ESD, and nonsurgical follow-up after noncurative ESD.Results Bleeding and perforation rates were 3.2 and 2.8%, respectively. Curative ESD was achieved in 366 of the 470 lesions (77.9%). Of the 104 patients with noncurative ESD, 12 patients (11.5%) underwent additional surgery and 91 patients (87.5%) were followed without surgery. The 5-year survival rate in the patients with nonsurgical follow-up after noncurative ESD (66.7%) was significantly lower than that in the patients with curative ESD (80.3%, p = 0.0001). There was no significant -011-0067-8 difference in the 5-year survival rates between the patients with curative ESD and those with surgery after noncurative ESD (100%, p = 0.21), nor was there a difference in these rates between the patients with surgery after noncurative ESD and those with nonsurgical follow-up after noncurative ESD (p = 0.061). None of the patients developed cancer recurrence after curative ESD, and none developed cancer recurrence following the additional surgery after noncurative ESD. In the patients with curative ESD and in those with surgery after noncurative ESD, the cumulative observed survival was better than the expected survival for the general population of similar age and gender. Conclusions ESD is safe for the treatment of EGC in patients 80 years of age or older. Both curative ESD and additional surgery after noncurative ESD may contribute to the extension of life expectancy.123 Gastric Cancer (2012) 15:70-75 DOI 10.1007/s10120

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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].…”

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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Current status of laparoscopic gastrectomy for cancer in Japan

Cited by 107 publications

References 25 publications

Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

Multicenter study of the long-term outcomes of endoscopic submucosal dissection for early gastric cancer in patients 80 years of age or older

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

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