How Does Combined Resection Affect the Clinical Outcomes After Laparoscopic Surgery for Serosa-Positive Gastric Cancer?: A Retrospective Cohort Study to Investigate the Short-Term Outcomes of Laparoscopic Combined Resection in Patients With T4b Gastric Cancer

Abstract

Background: Only few surgeons have tried to perform laparoscopic combined resection for T4b gastric cancer. The purpose of this study was to investigate the feasibility of laparoscopic combined resection through a comparison of the clinical outcomes between cT4a and cT4b cases. Methods:We reviewed the medical charts of patients who underwent laparoscopic gastrectomy for clinically T4 gastric cancer from May 2014 and July 2018. During this period, 62 patients with serosa-positive gastric cancer underwent laparoscopic curative surgery. The patients were divided into the following groups: patients who underwent gastrectomy and combined resection for the invaded organs (combined resection group) and those who did not undergo combined organ surgery (gastrectomy only group). Clinical outcomes were compared between the gastrectomy only and combined resection groups.Results: Of 62 patients included in this study, 43 and 19 patients were included in the gastrectomy only and combined resection groups, respectively. The operation time was significantly longer in the combined resection group (364.6 ± 102.5 vs. 247.7 ± 66.1 min; p < 0.001). The incidence of grade ≥ III complications was comparable between the groups (26.3% vs. 11.6%; p = 0.147). The time from the first operation to the initiation of adjuvant chemotherapy showed no statistically significant difference between the groups (48.1 ± 45.4 days vs. 31.6 ± 9.2; p = 0.134). Lee et al. Laparoscopic Combined Resection for AGCConclusions: Focusing on the high quality of image and new devices of laparoscopic surgery, it is necessary to re-evaluate the oncologic outcomes of combined resection for T4b gastric cancer.

Short-term safety and Long-term efficacy of multivisceral resection in pT4b gastric cancer patients without distant metastasis: a 20-year experience in China National Cancer Center

“…It was worth noting that in our study, we found that the pN stage was not the independent prognostic factor in GC patients who received MVR surgery. This is in contrast with previous findings 2 , 4 , 6 , 10 , 11 , 15 , 21 . A possible reason for such contrary results may be that the current pN stage has insufficient homogeneity and discriminatory ability in predicting the survival of GC patients comparing with the positive lymph nodes ratio 22 .…”

Case report: dual primary malignancies treated by laparoscopic multiorgan resection with natural orifice specimen extraction surgery

“…A series of asynchronous laparoscopic resections not only lengthen the treatment cycle but also cause the patient to suffer unnecessary pain, so it is not worth the risk. In contrast, although simultaneous laparoscopic multiorgan resection is more difficult and has a higher risk of conversion to laparotomy, this is still the best choice if appropriate techniques and equipment are used (11,12).…”

Comparison of open and laparoscopic gastrectomy for gastric cancer: a low volume center experience

“…There are few studies in the literature regarding laparoscopic gastrectomy in adjacent organ invasive tumors (T4b) (29). This is because; disruption of normal anatomy due to invasion and abnormal neovascularization may make the laparoscopic approach difficult (30). We prefer open surgery in these patients because of the fact that we are on the learning curve and laparoscopic approach is more complex in these tumors.…”