Laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer: initial Egyptian experience at the National Cancer Institute

Abstract

Background: Laparoscopic gastrectomy has been used as a superior alternative to open gastrectomy for the treatment of early gastric cancer. However, the application of laparoscopic D2 lymphadenectomy remains controversial. This study aimed to evaluate the feasibility and outcomes of laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer. Results: Between May 2016 and May 2018, twenty-five consecutive patients with gastric cancer underwent laparoscopic D2 gastrectomy: eighteen patients (72%) underwent distal gastrectomy, four patients (16%) underwent total gastrectomy, and three patients (12%) underwent proximal gastrectomy. The median number of lymph nodes retrieved was 18 (5-35). A positive proximal margin was detected in 2 patients (8%). The median operative time and amount of blood loss were 240 min (200-330) and 250 ml (200-450), respectively. Conversion to an open procedure was performed in seven patients (28%). The median hospital stay period was 8 days (6-30), and the median time to start oral fluids was 4 days (3-30). Postoperative complications were detected in 4 patients (16%). There were two cases of mortality (8%) in the postoperative period, and two patients required reoperation (8%). Conclusions: Laparoscopic gastrectomy with D2 lymphadenectomy can be carried out safely and in accordance with oncologic principles.

Navigating the Gastric Cancer Maze: Embracing Laparoscopic D2 Lymphadenectomy for Safer and Faster Treatment: A retrospective cohort study

“…In this study, the mean operating time was 295.5 minutes in the LSG arm and 272.5 minutes in the OSG group. These ndings are consistent with other studies, which have reported durations ranging from 196 to 370 minutes for LSG and 168 to 296 minutes for OSG [13], [21], [22]. Despite this difference, it is crucial to consider the non-signi cance of the operative time disparity and weigh it against the numerous bene ts offered by minimally invasive surgery.…”

“…Despite this difference, it is crucial to consider the non-signi cance of the operative time disparity and weigh it against the numerous bene ts offered by minimally invasive surgery. The mean blood loss of 207.5 ml in the LSG group was comparable to 202.5 ml in the OSG group and aligns with existing literature [13], [15], [17].…”

“…In the LSG group, the number of lymph nodes retrieved met the AJCC criteria, which requires at least 16 nodes. The average number of harvested lymph nodes varies among medical literature [13]. Some studies report a harvest of 18 nodes, while most Asian studies recommend a clearance rate of over 30 nodes [13]- [17].…”

“…The average number of harvested lymph nodes varies among medical literature [13]. Some studies report a harvest of 18 nodes, while most Asian studies recommend a clearance rate of over 30 nodes [13]- [17]. These differences could be attributed to strict quality control measures and higher case volume in Asian studies.…”

Comparison of short-term outcomes of robotic-assisted and laparoscopic-assisted D2 gastrectomy for gastric cancer: a meta-analysis.

“…Meanwhile, the technology is limited when completion of lymph node dissection occurred. Although laparoscopic gastrectomy has been widely accepted as a treatment for early gastric cancer, the application of laparoscopic D2 lymphadenectomy remains controversial [ 6 ]. Recently, robotic systems have been developed [ 7 , 8 ].…”