Laparoscopic Gastrectomy for Gastric Cancer with Simultaneous Organ Resection

Abstract

Objectives: Simultaneous organ resection is performed in 10% of laparoscopic gastrectomies for gastric cancer. The purpose of this study is to investigate the feasibility and safety of simultaneous organ resection with laparoscopic gastrectomy for gastric cancer. Subjects and Methods: We retrospectively reviewed the medical records from a prospectively collected database of patients who underwent laparoscopic gastrectomy from May 2003 to April 2012 in a single center. The patients were classified into three groups: a gastrectomy-only (no simultaneous resection [NS]) group as a control, a combined resection (CB) group characterized by additional resection due to tumor invasion and extensive lymphadenectomy, and a concomitant resection (CC) group, including patients with other pathologic conditions. The clinical outcomes, in particular morbidity and mortality, were compared among the three groups. Results: The NS, CB, and CC groups included 1883 (90.1%), 66 (3.2%), and 140 (6.7%) patients, respectively. Mean operation time was longer in CB and CC patients than in NS patients (233.0 -59.3, 227.4 -100.9, and 180.1 -54.0 minutes, respectively; P < .001), and mean hospital stay was longer in the CB and CC groups than in the NS group (9.6 -5.2, 8.3 -4.7, and 6.9 -4.4 days, respectively; P < .001). However, there were no statistically significant differences among the groups in the incidence of complications (P = .185), complications more severe than grade II (P = .077), and mortality (P = 1.000). Conclusions: Laparoscopic simultaneous organ resection during laparoscopic gastrectomy for gastric cancer prolonged the operation time and hospital stay but did not increase morbidity and mortality.

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

“…Although many surgeons are concerned about whether all the procedures could not be realized with the laparoscopic approach, the recent advances in laparoscopic instruments (i.e., energy devices, surgical staplers, and high-resolution laparoscopes) have facilitated us to overcome the technical difficulty of laparoscopic procedures. Nevertheless, only few surgeons have tried to perform laparoscopic combined resection for T4b gastric cancer (10). This tendency involves the following reasons.…”

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

“…One of the important limitations of our study is the bias in patient selection. 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).…”

Eleven-year experience with 3000 cases of laparoscopic gastric cancer surgery in a single institution: analysis of postoperative morbidities and long-term oncologic outcomes

“…Other organ resections performed simultaneously were classified into two groups: concomitant resections for other pathological conditions (such as cholecystectomy for gallstone, colectomy for synchronous colon cancer, or hepatectomy for hemangioma), and combined resection for cancer invasion or for extended lymphadenectomy (such as distal pancreatectomy for the removal of a directly invaded tumor or splenectomy for resection of lymph node #10) [15]. Most concomitant resections except cholecystectomies were performed by surgeons from other divisions; attributing the postoperative complications to gastrectomy in such cases may be In addition, 148 operations performed by two surgeons were also excluded because these surgeons performed a small number of surgeries during a short period of time.…”