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

Abstract

Objective: This retrospective comparative study aimed to evaluate the feasibility and outcomes of laparoscopic subtotal gastrectomy (LSG) with D2 lymphadenectomy compared to open subtotal gastrectomy (OSG) for distal gastric adenocarcinoma. Methods:A total of 42 patients with biopsy-proven distal gastric adenocarcinoma underwent either LSG or OSG with D2 lymphadenectomy at AIIMS Bhubaneswar, India, from March 2019 to July 2022. Baseline characteristics, operative parameters, postoperative outcomes, and one-year follow-up data were reviewed. Statistical analysis was performed using IBM SPSS Statistics 25.0. Results: LSG was performed in 26 patients, with 4 cases (15.38%) requiring conversion to OSG due to technical challenges or bleeding. Both LSG and OSG groups were comparable in age, sex, BMI, comorbidities, and clinical stage. Neoadjuvant chemotherapy was administered to 86.4% and 85.0% of patients in LSG and OSG groups, respectively. The mean number of harvested lymph nodes in the LSG group was 20.77, meeting the AJCC criteria for radical gastrectomy. The mean operative time and blood loss were similar between the groups. LSG patients had significantly lower pain scores at 3 and 12 hours post-operation, faster resolution of postoperative ileus, and earlier mobilization compared to OSG. The incidence of postoperative complications was comparable between the groups, with no significant difference in disease-free survival after one year. Conclusion: LSG with D2 lymphadenectomy is a feasible and safe option for resectable distal gastric adenocarcinoma, offering comparable outcomes to OSG. While the mean number of harvested lymph nodes in LSG was slightly lower than OSG, it still met the AJCC criteria. Careful patient selection and surgeon expertise are essential due to the potential need for conversion to open surgery. The impact of neoadjuvant chemotherapy on lymph node harvest rates in LSG cases warrants further investigation. The choice between LSG and OSG should be individualized based on patient factors and tumor characteristics.