Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a case–control study

Abstract

In a non-specialized setting, laparoscopic distal gastrectomy (LDG) for locally advanced diseases remains controversial, particularly given to the technical demands of the learning curve required to perform an adequate resection with D2 lymph node dissection. Inclusion criteria for this statistically generated matching controlled study were all patients who underwent subtotal laparoscopic gastrectomies from January 2006 until September 2009 for locally advanced gastric adenocarcinoma (stage II-IIIb), compared with matched patients who underwent the same procedure in an open fashion during the same period. Sixty case-matched patients were evaluated (30 laparoscopic vs. 30 open). Operative time was significantly longer (p < 0.05) for LDG. Benefits for LDG (p < 0.05) were observed among surgical short-term outcome (postoperative hospital stay, ambulation, first bowel movement, first flatus, first stool, first eating and use of analgesic drugs) and postoperative non-surgical site complications (cardiopulmonary, urinary, etc.). The 42 months' overall survival was similar (p = 0.646). Laparoscopic gastrectomy is a safe technique in a non-academic hospital setting for locally advanced gastric cancer; it seems to be adequate in terms of margin status and adequate lymph node retrieval and is associated with additional benefits as a decreased length of hospital stay, a decreased narcotic use and fewer complications.

Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre

“…Francescutti and colleagues 27 have reported the only previous Canadian experience, but they included patients with benign lesions as well as those with malignant ones. All comparative studies have reported decreased or similar early postoperative morbidity with LAG ranging from 0% to 26%, [15][16][17][26][27][28][29]31 which compares with our results. Other benefits of the laparoscopic ap proach, including decreased time to ambulation and resumed diet, decreased consumption of analgesia and a shorter length of stay, have been reported in these studies.…”

“…Others reported no difference between the laparoscopic and open approaches. 15,16,[26][27][28][29][30][31]33 In a meta-analysis of RCTs comparing laparoscopic and open approaches for early gastric cancer, Ohtani and colleagues 9 concluded that there was a lesser number of LNs with laparoscopy. Debate is still ongoing about the extent of the lymphadenectomy and the number of LNs needed in the specimen.…”

“…No margins were positive for patients treated with a curative intent, so no difference was observed between groups, which is consistent with the current Western literature. 15,16,[26][27][28][29][30][31]33 However, obtaining a safe distal margin laparoscopically can be challenging for lesions seating close to the pylorus. This was the reason for 1 of the conversions in the LAG group in our study.…”

Comparative Analysis of Five-Year Survival Results of Laparoscopy-Assisted Gastrectomy versus Open Gastrectomy for Advanced Gastric Cancer: A Case-Control Study Using a Propensity Score Method

“…Despite the ongoing controversy about whether laparoscopic gastrectomy with D2 lymph node dissection for gastric cancer is safe and effective, the most recent studies showed that laparoscopic D2 lymph node dissection was a safe procedure for AGC if the surgery was performed by experienced surgeons [18][19][20][21][22]. Recently, there were several published reports of a case-control study that compared LAG to OG for AGC [20][21][22]. However, these reports did not have sufficient numbers of patients or a follow-up period long enough to compare the two groups.…”

Totally laparoscopic D2 radical distal gastrectomy using Billroth II anastomosis: A case report

“…Compared with the reported studies of totally laparoscopic subtotal gastrectomy (16)(17)(18)(19), these data suggest that our method of intracorporeal anastomosis using only stapling devices is safe and feasible, and offers a better or equally good early surgical outcome. Totally laparoscopic distal gastrectomy has been spotlighted since all of the procedures may be performed intracorporeally.…”