Laparoscopic total gastrectomy as a valid procedure to treat gastric cancer option both in early and advanced stage: A systematic review and meta-analysis

Oh, Youjin; Kim, Min Seo; Lee, Yoon Teak; Lee, Chang Min; Kim, Jong Han

doi:10.1016/j.ejso.2019.08.018

Cited by 27 publications

(21 citation statements)

References 57 publications

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“…There are no significant differences in radicality of resection or lymph node yield as shown in our series [18]. As with MIO, overall survival is at least equivalent for minimally invasive gastrectomy [18].…”

Section: Discussionsupporting

confidence: 49%

“…A MIA in gastric cancer is safe, with a reduction in overall perioperative complications [18,27e32]. There are no significant differences in radicality of resection or lymph node yield as shown in our series [18]. As with MIO, overall survival is at least equivalent for minimally invasive gastrectomy [18].…”

Section: Discussionmentioning

confidence: 51%

“…Laparoscopic total and subtotal gastrectomy is safe, provides improved peri-operative outcomes and at least equivalent oncological outcomes when compared with open gastrectomy [17,18]. In oesophageal resection, MIAs include hybrid oesophagectomy (laparoscopic gastric mobilisation with open thoracotomy or thoracoscopic mobilisation with laparotomy ± cervical incision) and a totally MIA (laparoscopic and thoracoscopic).…”

Section: Introductionmentioning

confidence: 99%

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Surgery by a minimally invasive approach is associated with improved textbook outcomes in oesophageal and gastric cancer

Bolger¹,

Azzawi²,

Whooley³

et al. 2021

European Journal of Surgical Oncology

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Introduction: Textbook outcome (TBO) is a composite measure of a number of peri-operative and clinical outcomes in oesophagogastric malignancy. It has previously been shown that TBOs are associated with improved overall survival in both oesophageal and gastric cancer. The influence of a minimally invasive approach (MIA) on TBO is not well defined. The purpose of this study is to validate TBO in our population, examine the influence of a MIA on achieving a TBO, and the impact of TBO on long-term survival. Methods: 269 patients undergoing oesophagectomy and 258 patients undergoing subtotal or total gastrectomy were included in this study. Demographic, clinical and pathological differences between patients with and without a TBO were compared using univariable and multivariable analysis. Overall survival for those with and without a TBO was examined. The influence of MIA on overall survival and TBO was determined using Cox proportional hazard models. Results: Patients undergoing oesophagectomy and gastrectomy were significantly more likely to achieve a TBO when MIA was used (p ¼ 0.01 and 0.001 respectively). When MIA is included as an outcome measure patients achieving a TBO show improved overall survival in both oesophageal and gastric cancer. MIA, clear resection margins and no unplanned admission to critical care are the strongest predictors of overall survival from the putative bundle of TBO parameters. Conclusion: Minimally invasive surgery is associated with improved TBO. Completion of a minimally invasive approach should be considered for inclusion as a textbook parameter.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgery by a minimally invasive approach is associated with improved textbook outcomes in oesophageal and gastric cancer

Bolger¹,

Azzawi²,

Whooley³

et al. 2021

European Journal of Surgical Oncology

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“…Reporting of five-year oncological outcomes after LTG is even more limited. Nevertheless, a recent large-scale meta-analysis by Oh et al including 19 studies – with subgroup analysis of EGC and AGC – has shown comparable 5-year survival rates [ 6 ]. A number of RCTs comparing LTG with OTG are planned or ongoing and will hopefully provide evidence of higher grade [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another element of this process is the implementation of minimally invasive surgical techniques, such as laparoscopic and robotic-assisted gastrectomy, which aim to minimize the surgical trauma and accelerate the postoperative recovery. Several studies have demonstrated the advantages of laparoscopic surgery in early gastric cancer (EGC) and there are indications that this may also apply in advanced gastric cancer (AGC) [ 6 , 7 ]. Nevertheless, locally advanced tumors require a more extensive lymph node dissection, representing a technically more demanding procedure.…”

Section: Introductionmentioning

confidence: 99%

Implementation of minimally invasive gastrectomy for gastric cancer in a western tertiary referral center

et al. 2020

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Background: Minimally invasive techniques have gradually come to take a leading position in the surgical treatment of gastrointestinal malignancies. In order to define an effective process for the implementation of similar techniques in the treatment of gastric cancer, patient caseload represents a pivotal factor for education and training, but is a prerequisite not fulfilled in most Western countries. Additionally, as opposed to the East, a variety of additional factors such as the usually advanced stage of the disease and differences in patient characteristics are prevailing and raise further obstacles. Hereby we report a strategy for a safe and effective process for the implementation of laparoscopic gastric cancer surgery in a Western tertiary referral center. Methods: The present study describes the stepwise implementation of laparoscopic gastrectomy for the treatment of gastric cancer at a tertiary referral center, comprising the time period 2012-2019. This process was facilitated by a close collaboration with two high-volume centers in Japan, as well as exchanging fellowships and observerships between the Karolinska University Hospital and other European centers. From the initially strict selection of cases for laparoscopic surgery, laparoscopic gastrectomy has gradually become the preferred approach also in patients with locally advanced tumors. Results: From January 1st 2010 until December 31st 2019, 249 patients were operated for gastric cancer, of whom 141 (56.6%) had an open and 108 (43.4%) a laparoscopic procedure. In the latter group, total gastrectomy was performed in 33.3% of the patients. While blood loss, operation time and length of stay decreased during the first years after implementation, these variables increased slightly during the last years of the study period, probably due to the higher proportion of advanced gastric cancer cases, as well as the higher rate of laparoscopic total gastrectomy with more extended lymphadenectomy. Conclusions: Laparoscopic surgery is currently a valid therapeutic option for gastric cancer, which has expanded to also embrace total gastrectomy and locally advanced tumors. Collaboration between centers in the East and West, centralization to high-volume centers and application of enhanced recovery protocols are essential components in the implementation and further refinement of minimally invasive gastrectomy.

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Minimally invasive surgery in advanced gastric cancer

Lee

Kim

2022

Annals of Gastroent Surgery

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According to GLOBOCAN 2018, there were over 1 000 000 new cases of GC in 2018 and an estimated 783 000 deaths, making it the fifth most frequently diagnosed cancer and the third leading cause of cancer death worldwide. 1 The traditional treatment option for GC is surgical resection, which includes gastrectomy with D2 lymph node dissection after laparotomy. However, several less invasive procedures and minimally invasive surgeries (MISs) have been developed to reduce the invasiveness of surgery and improve patients' quality of life. In 1994, Dr. Seigo Kitano first introduced laparoscopyassisted distal gastrectomy (LADG) for early gastric cancer (EGC).Since then, based on many studies and clinical trials, the laparoscopic approach has become increasingly established in GC surgery. 2 In addition, even more popular than LADG, a totally laparoscopic gastrectomy technique has been developed to reduce surgical wound and surgical stress compared to laparoscopic-assisted methods. In 2009, Ikeda et al reported the advantages of totally laparoscopic distal gastrectomy (TLDG) over LADG as less invasive, secure ablation of the tumor with the stomach, and safe anastomosis. 3 Chen et al reported that TLDG had a longer surgery time but less bleeding and shorter hospitalization than open gastrectomy (OG) in a systematic review including one randomized controlled trial (RCT) and 13 observational studies. 4 In eastern Asian countries, several study groups have been established as a platform to organize and conduct prospective RCTs in each country; for example, the Japanese Clinical Oncology Study Group (JCOG) in Japan, the Korean Laparoscopic Gastrointestinal Surgical Study Group (KLASS) in South Korea, and the Chinese Laparoscopic Gastrointestinal Surgical Study Group (CLASS) in China to evaluate the safety and feasibility of MIS on GC. In Korea, the KLASS-01 trial has proven the efficacy of laparoscopic distal gastrectomy (LDG) vs open subtotal gastrectomy for clinical stage I GC with better short-term outcomes and equivalent long-term survival. 5,6 In Japan, similar results have been demonstrated for LDG vs open distal gastrectomy for clinical stage IA/IB GC in the JCOG 0912 trial. 7,8 In China, the safety of laparoscopic total gastrectomy

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Laparoscopic total gastrectomy as a valid procedure to treat gastric cancer option both in early and advanced stage: A systematic review and meta-analysis

Cited by 27 publications

References 57 publications

Surgery by a minimally invasive approach is associated with improved textbook outcomes in oesophageal and gastric cancer

Surgery by a minimally invasive approach is associated with improved textbook outcomes in oesophageal and gastric cancer

Implementation of minimally invasive gastrectomy for gastric cancer in a western tertiary referral center

Minimally invasive surgery in advanced gastric cancer

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