Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection

MacLellan, Steven; Mackay, Helen; Ringash, Jolie; Jacks, Lindsay M.; Kassam, Zahra; Conrad, Tatiana; Khalili, Ida; Okrainec, Allan

doi:10.1007/s00464-011-2118-y

Cited by 17 publications

(19 citation statements)

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“…[57] stated that the hematogenous pattern was most common after LG, followed by the locoregional pattern. This is consistent with the results of some of the included studies and other research [30]. The concern about dissemination of gastric cancer due to insufflated gas from pneumoperitoneum and port site or wound metastasis, although quite rare, has been emphasized.…”

Section: Discussionsupporting

confidence: 90%

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Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer

Chen

Mou

et al. 2013

World J Surg Onc

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BackgroundThe use of laparoscopic gastrectomy (LG) in advanced gastric cancer (AGC) remains a controversial topic, mainly because of doubts about its oncologic validity. This study is a systematic review and meta-analysis of the available evidence.MethodsA comprehensive search was performed until June 2013 to identify comparative studies evaluating survival rates, recurrence rates, surgical outcomes and complications. Pooled risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using the random effects model. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.ResultsFifteen trials were involved in this analysis. Compared to open gastrectomy (OG), LG involved a longer operating time (WMD = 48.67 min, 95% CI 34.09 to 63.26, P < 0.001); less blood loss (WMD = −139.01 ml, 95% CI −174.57 to −103.44, P < 0.001); earlier time to flatus (WMD = −0.79 days, 95% CI −1.14 to −0.44, P < 0.001); shorter hospital stay (WMD = −3.11 days, 95% CI −4.13 to −2.09, P < 0.001); and a decrease in complications (RR = 0.74, 95% CI 0.61 to 0.90, P = 0.003). There was no significant difference in the number of harvested lymph nodes, margin distance, mortality, cancer recurrence rate and long-term survival rate between the AGC patients treated with LG or OG (P > 0.05).ConclusionsDespite a longer operation, LG is a safe technical alternative to OG for AGC with a lower complication rate and enhanced postoperative recovery. Moreover, there were similar outcomes between both approaches in terms of cancer recurrence and the long-term survival rate. Because of the limitation of this study, methodologically high-quality studies are needed for further evaluation.

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Section: Discussionsupporting

confidence: 90%

“…After the titles and abstracts had been reviewed, papers without comparison of LG and OG for AGC were excluded, which left 21 comparative studies, 6 [25-30] of which did not meet the inclusion criteria and were excluded. This left a total of two RCTs and 13 observational studies [31-45], all of which were accessible in full-text format.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer

Chen

Mou

et al. 2013

World J Surg Onc

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“…Two-sided P values of less than 0.05 were used to assess statistical significance. MacLellan et al [12,13] have reported on recurrence outcomes. Of the 197 patients treated, 71 recurrences (36 %) were identified, of which 57 (80 %) were classified as having distant metastases as either the only site of failure Retrospective assessment of patterns of recurrence relative to radiotherapy volumes for… 889 or as a component of failure.…”

Section: Discussionmentioning

confidence: 99%

Retrospective assessment of patterns of recurrence relative to radiotherapy volumes for adjuvant conformal chemoradiotherapy in gastric cancer

et al. 2015

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Background Since the Intergroup 0116 study was published in 2000, adjuvant postoperative chemoradiotherapy using CT-planned and 3D conformal/intensity-modulated radiotherapy has been offered routinely to fit patients with resected gastric cancer at Princess Margaret Hospital .The objective of this study was to analyze patterns of disease recurrence with respect to the radiotherapy volumes. Methods For the date and site (local, locoregional, or distant) of the first recurrence, medical records were reviewed for all patients treated at Princess Margaret Hospital with adjuvant chemoradiotherapy for resected gastric adenocarcinoma (January 1, 2000 to November 30, 2009). Patients whose recurrences were limited to local and/or regional sites were selected for further analysis. Available diagnostic imaging of the recurrence site was registered to the original planning radiotherapy dataset for contouring. If necessary to respect changes in anatomy, the contour was translocated on the basis of anatomic descriptors. The center of mass for each recurrence was identified as a point and its location was categorized according to the isodose encompassing it; in field (90 % or more), marginal (50-89 %), or out of field (less than 50 %). Results Of all 197 patients, 14 (7 %) had isolated locoregional failure, constituting 20 % of all 71 patients with a recurrence. Successful fusions were feasible in five cases. Of these recurrences, four were in field and one was marginal. In a further four cases, visual inspection was used, showing one in-field recurrence, one marginal recurrence, and two out-of-field recurrences. In five patients, either a useable original dataset or diagnostic imaging of the recurrence was not available. Conclusions The rates of isolated local/locoregional tumor recurrence in this study were low. Of the small number of recurrences available for analysis, most (five of nine) were in field. Further studies involving a larger cohort of patients might allow a more meaningful analysis of trends in the recurrence site with evolving radiotherapy techniques.

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“…Meta‐analyses , a review , small‐scale randomized controlled trials (RCT) , a non‐randomized study , and retrospective studies have shown that laparoscopic gastrectomy has superior short‐term and comparable long‐term outcomes to open gastrectomy . Many of the studies that compared laparoscopic surgery with open surgery have confined the indications for laparoscopic surgery to cT1 and cN0‐1 cancer and have included only a limited number of patients with cStage ≥ II diseases.…”

Section: Clinical Question 1: Is Laparoscopic Gastrectomy (K655‐2) Rementioning

confidence: 99%

“…Many of the studies that compared laparoscopic surgery with open surgery have confined the indications for laparoscopic surgery to cT1 and cN0‐1 cancer and have included only a limited number of patients with cStage ≥ II diseases. Studies that involved a relatively large number of patients with advanced cancer have also shown that laparoscopic surgery is comparable to open surgery in terms of short‐ and long‐term postoperative outcomes . However, a single small‐scale RCT is the only study with a high level of evidence .…”

Section: Clinical Question 1: Is Laparoscopic Gastrectomy (K655‐2) Rementioning

confidence: 99%

Gastroenterological Surgery: Stomach

Uyama

Okabe²,

Kojima³

et al. 2015

Asian J Endoscop Surgery

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Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection

Abstract: The study findings suggest that laparoscopic gastrectomy is an oncologically safe procedure for advanced gastric cancer with outcomes similar to those for open resection.

Cited by 17 publications

References 50 publications

Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer

Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer

Retrospective assessment of patterns of recurrence relative to radiotherapy volumes for adjuvant conformal chemoradiotherapy in gastric cancer

Gastroenterological Surgery: Stomach

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