Survival and Perioperative Morbidity of Totally Laparoscopic Versus Open Gastrectomy for Early Gastric Cancer: Analysis From a Single Latin American Centre

Abstract

Background:Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim:To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods:This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results:Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion:The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

Operative, peri-operative and long-term oncological benefits of performing open and laparoscopic gastrectomy for management of gastric cancer patients: A comparative study

“…So the advantages of the laparoscopic approach could be applied to gastric cancer patients. Our results are similar to many previous recent studies [4,[10][11][12][13][14]. We showed a lower incidence of abdominal wound infection and local complication, additionally we showed a lower incidence of respiratory complications in LG than in open gastrectomy due to early movement and shorter time of hospital stay.…”

“…We showed a lower incidence of abdominal wound infection and local complication, additionally we showed a lower incidence of respiratory complications in LG than in open gastrectomy due to early movement and shorter time of hospital stay. NORERO et al, [10] Kim et al, [15] and Marrelli et al [16], showed similar results. Many studies have showed the rate of postoperative complication in patients that underwent LG was less than those of patients that underwent open gastrectomy, that was near to our results [4,5,17].…”

“…The first LG was done more than twenty years ago, there is a controversy regarding the use of LG in management of gastric cancer due to insufficient studies about its long-term oncologic outcomes [10]. Most previous studies which have compared LG with open gastrectomy included only a small number of patients and just focused on the short-term and the perioperative outcomes, as intra-operative bleeding, operative time and postoperative complications [11].…”

Desarrollo de la técnica de disección submucosa endoscópica en cáncer gástrico incipiente. Primeros cincuenta casos de un cirujano.

“…Se estima una invasión linfática tumoral en aproximadamente 3% de los tumores mucosos y hasta 23% de los tumores submucosos 23 . En nuestra experiencia en gastrectomías con disección ganglionar sólo un 6% de los tumores T1a o T1b tenían compromiso linfático 24 con lo cual en el 94% de estos pacientes podría haberse evitado dicha intervención.…”

“…De los aspectos más relevantes a considerar son la menor morbilidad y prácticamente nula mortalidad asociada a la técnica lo que plantea claros beneficios respecto a la cirugía resectiva tradicional. En nuestro hospital, un centro de alto volumen en que se operan aproximadamente 70 gastrectomías al año, hemos reportado una mortalidad en gastrectomías por cáncer gástrico incipiente de 2,6% 24 . Lo anterior permite estimar que 1 a 2 pacientes de nuestra serie hubieran fallecido en el período postoperatorio sólo por el hecho de haber sido sometidos a una gastrectomía, cuando esta podría haberse evitado.…”