Laparoscopy-Assisted Versus Open Distal Gastrectomy for Early Gastric Cancer

Zeng, Yi-Ke; Yang, Zhaohui; Peng, Junsheng; Lin, Hui; Cai, Ling

doi:10.1097/sla.0b013e3182583e2e

Cited by 199 publications

(156 citation statements)

References 41 publications

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“…Proponents of robotic technology, in particular, cite greater technical precision, more degrees of freedom in instrument articulation, and better visualization of anatomy relative to other surgical approaches [10]. With most of the experience and literature regarding surgery for gastric cancer coming from the East, previously published studies show a greater quantity of lymph nodes harvested during minimally invasive surgery, yet there is a general lack of consensus regarding improved R0 resection rates on the basis of the approach alone [11,[19][20][21][22][23]. For example, Vinuela et al [24] performed a meta-analysis of all English-language studies since 1992, including several from Eastern centers, and found that when they compared open versus laparoscopic distal gastrectomy outcomes, the former were associated with better lymph node harvest quantitatively, but no difference was seen in the odds of having less than the recommended minimum of lymph nodes on the basis of the approach alone.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for gastric cancer: the American experience

et al. 2016

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Background Minimally invasive surgical techniques are increasingly being implemented in oncologic care. This study assesses the impact of minimally invasive surgery on oncologic and perioperative outcomes in the management of gastric cancer in the USA. Methods From the American College of Surgeons and American Cancer Society National Cancer Data Base, we identified 6427 patients who underwent gastrectomy for cancer from 2010 to 2012. Treatment groups were categorized with an intention-to-treat paradigm as robotic, laparoscopic, and open surgery. Univariate and multivariate analyses were performed to estimate the impact of the surgical approach on oncologic and perioperative outcomes. Results Of patients undergoing definitive surgical intervention, 3.5 % (n = 223) underwent robotic gastrectomy, 23.1 % (n = 1487) underwent laparoscopic gastrectomy, and 73.4 % (n = 4717) underwent open surgery. Minimally invasive gastrectomy was more frequently performed on white (P = 0.018), privately insured patients (P = 0.049) treated at academic centers (P \ 0.0001) in the eastern USA (P \ 0.0001). After demographics, comorbidities, and tumor-related factors had been controlled for, patients who underwent laparoscopic gastrectomy had the postoperative length of stay decreased by 1.08 days (P \ 0.0001) and greater odds of having at least 15 lymph nodes resected (odds ratio 1.16, P = 0.023). Use of robotic surgery did not have a statistically significant effect on the postoperative length of stay relative to open surgery (P = 0.222) but the patients so treated had greater odds of having at least 15 lymph nodes resected (odds ratio 1.51, P = 0.005). There were no differences in R0 resection rates or perioperative mortality on the basis of the surgical approach alone. Conclusions These findings suggest that use of minimally invasive surgery for gastric cancer in the USA is impacting the adequacy of oncologic resection but is not yet having a clinically significant impact on perioperative outcomes relative to a conventional open approach.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for gastric cancer: the American experience

et al. 2016

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“…The feasibility of laparoscopy-assisted distal gastrectomy (LADG) has been assessed in many studies [1][2][3]. A multicenter phase II study has demonstrated that LADG can be performed safely by surgeons with sufficient experience [4].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer

et al. 2013

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Background Laparoscopy-assisted total gastrectomy (LATG) for gastric cancer is not yet widespread because of the technical difficulty of reconstruction. We have performed LATG on 100 patients with clinical stage I gastric cancer. This study investigated the short-term outcomes of LATG. Methods Between September 2001 and September 2012, 100 patients with clinical stage I gastric cancer underwent LATG with D1 plus beta or D2 lymphadenectomy. Roux-en-Y esophagojejunostomy was performed intracorporeally using end-to-side anastomosis with a circular stapler (the purse-string suture method). The primary endpoint was the proportion of postoperative complications during hospitalization. Results Mean operation time was 249 min; mean blood loss was 182 ml. There were no conversions to open surgery. According to the Clavien-Dindo classification, there were 8 grade II (8 %) and 10 grade IIIa/b (10 %) complications. There were no treatment-related deaths or grade IV complications. The most frequent complication was anastomotic or stump leakage (6 %), followed by pancreatic fistula (5 %). Reoperations were required in two patients with leakage. Conclusions The short-term outcomes of LATG in our study involving 100 patients were outlined. LATG for gastric cancer patients should be attempted preferably in a clinical trial setting by surgeons with sufficient experience in laparoscopic gastrectomy.

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“…В 2012 г. опубликован метаанализ и систематический обзор 22 исследований, посвященных сравнению результатов открытой и лапароскопической дистальной субтотальной резекции желуд-ка при РРЖ, куда вошло почти 3500 наблюдений [51]. Анализ по-казал, что лапароскопические операции сопровождаются лучши-ми непосредственными результатами и не ухудшают прогноз.…”

Section: выбор объема операции при рржunclassified

Current approaches to the diagnosis and treatment of early gastric cancer

Ryabov¹,

Соколов²,

Khomyakov³

et al. 2015

Onkol. Z. im. P.A. Gercena

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Рассмотрено современное состояние проблемы диагностики и лечения раннего рака желудка. Описаны различные ме-тоды эндоскопического исследования желудка, в том числе основанные на различных физических методах улучшения визуализации. Дана оценка предикторам лимфогенного метастазирования. На основании данных крупных клинических исследований сформулированы показания и противопоказания к различным видам хирургического лечения раннего рака желудка (эндоскопическим, малоинвазивным, открытым операциям). Ключевые слова: ранний рак желудка, эндоскопическая диагностика и лечение, предикторы лимфогенного метастазиро-вания, хирургическое лечение.The paper considers the state-of-the-art of the diagnosis and treatment of early gastric cancer. It describes various gastric endoscopic techniques, including those based on different physical methods for imaging improvement. The predictors of lymphatic cancer spread are assessed. Based on the data of large clinical trials, the authors formulated indications for and contraindications to different surgical treatment options (endoscopic, minimally invasive, open-access operations) for early gastric cancer.Key words: early gastric cancer, endoscopic diagnosis and treatment, predictors of lymphatic cancer spread, surgical treatment.

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Laparoscopy-Assisted Versus Open Distal Gastrectomy for Early Gastric Cancer

Cited by 199 publications

References 41 publications

Minimally invasive surgery for gastric cancer: the American experience

Minimally invasive surgery for gastric cancer: the American experience

Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer

Current approaches to the diagnosis and treatment of early gastric cancer

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