Feasibility and safety comparison of laparoscopy-assisted versus open gastrectomy for advanced gastric carcinoma with D2 lymphadenectomy

Abstract

Objective: Laparoscopy-assisted gastrectomy for advanced gastric cancer still remains controversial. The aim of this study is to compare oncologic feasibility and technical safety of laparoscopic versus open gastrectomy for advanced gastric cancer with D2 lymphadenectomy by comparing patients' short-term postoperative outcomes. Methods: One hundred and one patients with laparoscopy-assisted gastrectomy and 101 patients with open gastrectomy were one-to-one matched and then compared in terms of operative outcomes and hospital courses. Results: The laparoscopic group showed significantly longer operating time (297.4 vs. 198.1 min, P < 0.001), earlier first flatus time (2.8 vs. 3.6 days, P < 0.001), earlier diet start time (3.8 vs. 4.6 days, P < 0.001), shorter hospital stay (10.5 vs. 11.9 days, P < 0.001) and less morbidity (21.8 vs. 37.6%, P = 0.019). However, retrieval lymph nodes, intraoperative blood loss, transfused patients, postoperative fever and mortality were similar in the two groups. As for complications, incision infection (1.0 vs. 8.9%, P = 0.021) was significantly more common in the open group than in the laparoscopic group. In the subgroup comparisons of outcomes of laparoscopy-assisted gastrectomy, the tumor, node, metastasis III group showed significantly increased retrieval lymph nodes (37.2 vs. 31.0, P < 0.001), increased intraoperative blood loss (147.2 vs. 120.5 ml, P = 0.010), increased length of hospital stay (11.1 vs. 9.9 days, P < 0.001) and increased morbidity (32.6 vs. 13.8%, P = 0.024) when compared with the tumor, node, metastasis II group. Conclusions: Laparoscopy-assisted gastrectomy is feasible and safe for the treatment of advanced gastric cancer with D2 lymphadenectomy compared with open gastrectomy. Higher-level tumor stage (tumor, node, metastasis III) may increase the operative risk and should be performed with caution by surgeons with considerable experience of laparoscopic gastrectomy.

Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015

“…In the present survey, although the background of surgical procedures as well as the classification of benign or malignant disease differed between endoscopic and open surgery, PI were less frequent after endoscopic surgery, especially for esophageal surgery, gastrointestinal surgery, colorectal surgery, and cholecystectomy. Previous studies reported similar results regarding endoscopic surgery versus open surgery in esophageal surgery (23.5% vs 46.7%), gastrointestinal surgery (1.0% vs 1.8%‐8.9%), colorectal surgery (7.0%‐11.3% vs 15.7%‐25.0%), and cholecystectomy (0.6%‐5.9% vs 4.9%‐19.9%) . In the present survey, there was no incidence of PI after endoscopic esophageal surgery, although the procedures included only esophageal surgery for benign disease, such as esophageal achalasia, hiatus hernia, and selective vagotomy.…”

Staging and Surgical Approaches in Gastric Cancer: A Clinical Practice Guideline

“…Short-term outcomes (for example, blood loss, time to first flatus, length of hospital stay, and postoperative complications) favour laparoscopic compared with open gastrectomy [27][28][29][30][31][32][33][34] . Those observations are based on one systematic review and several more recent primary studies.…”

Laparoscopic Versus Open D2 Gastrectomy for the Treatment of Gastric Cancer: a Singapore Institution’s Experience over 7 Years

“…There was no significant difference in survival and time to recurrence between the 2 surgical techniques for upper and diffuse tumours, however there was significantly better survival and time to recurrence when laparoscopic surgery was performed for mid and lower tumours ( Fig. 4 (6) showed more rapid postoperative recovery in the laparoscopic gastrectomy group compared to the open gastrectomy group, with significantly earlier first flatus time, diet start time, and significantly shorter hospital stay. The 30-day morbidity and mortality rates in this study are consistent with the rates reported in other centres.…”