The issue of lymphadenectomy during laparoscopic gastrectomy for gastric carcinoma

Memon, Muhammed Ashraf; Butler, Nick; Memon, Breda

doi:10.4251/wjgo.v2.i2.65

Cited by 16 publications

(10 citation statements)

References 17 publications

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“…Our study is one of few that address LG in a cohort with exclusively advanced disease, showing comparable results for RFS and overall survival. The need for adequate lymphadenectomy in advanced gastric cancer has been established in the literature, although the extent remains a topic of debate [34][35][36]. Given the technically challenging nature of laparoscopic procedures and the associated learning curve, concern about achieving adequate lymph node retrieval in LG has been raised.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection

et al. 2012

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“…This is a very excellent article; the basic organization of this report is clear and convincing, and the associated conclusions and recommendations are based on a review by investigators with long-standing interest in gastric disorders. [2][3][4] Worldwide, gastric cancer is one of the top-3 leading causes of cancer mortality, but their incidence and presentation vary geographically. Currently, surgery is the only possible cure.…”

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confidence: 99%

Extended or Limited Lymph Node Dissection? A Gastric Cancer Surgical Dilemma

et al. 2012

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reporting the outcome of a meta-analysis of randomized controlled trial evaluating the efficacy and drawbacks of limited (D1) versus extended (D2) lymphadenectomy for proven gastric carcinoma. This is a very excellent article; the basic organization of this report is clear and convincing, and the associated conclusions and recommendations are based on a review by investigators with long-standing interest in gastric disorders. [2][3][4] Worldwide, gastric cancer is one of the top-3 leading causes of cancer mortality, but their incidence and presentation vary geographically. Currently, surgery is the only possible cure. Nodal status is an important prognostic indicator for gastric cancer, and despite results of randomized controlled trials, debate continues over the importance of aggressive lymphadenectomy. On the basis of the results of the meta-analysis, the authors conclude that D1 gastrectomy is associated with significant fewer anastomotic leaks, postoperative complication rate, and reoperation rate, decreased length of hospital stay, and 30-day mortality rate. Finally, the 5-year survival in patients who underwent D1 gastrectomy was similar to the D2 cohort. 1 Similar results have been founded in recent meta-analysis. 5 Overall, 14 randomized controlled trials (3432 patients) were included in the meta-analysis. Of the D1 and D2 surgery groups, the operative mortality and postoperative morbidity were higher in the D2 group than in the D1 group, but the 3-and 5-year survival rates were not statistically different. Also, the operative time was shorter in the D1 group than in the D2 group. In the D2 versus D3 surgical group, the operative mortality, percentage of postoperative complications, operative time, and hospital stay were not significantly different. The results suggest that D2 and D3 surgical Disclosure: The authors did not receive any financial support or commercial sponsorship. All authors were involved in drafting the manuscript and revising it critically for important intellectual content and have given final approval of the version to be published. Furthermore, all authors have participated sufficiently in the work to take public responsibility for its content.procedures may not offer specific advantages for gastric cancer and, instead, may lead to disadvantages for patient outcomes. 5 Comparisons of D1 and D2 surgical procedures in randomized trials show that the possible risks and benefits of D2 should be considered unproven. Although not demonstrated in the trial evidence, observational studies show that D2 dissection is an acceptable procedure in surgical centers that have low operative mortality rates. Planned subgroup analysis of the trial data shows that D2 could be considered the preferred treatment approach for fit patients with intermediate stage (II-III) gastric cancer. D1 dissection should be preferred in unfit patients, in patients with early (stage Ia) cancer, and at centers where gastrectomy is performed by surgeons without training in the D2 technique. Gastric resection for cancer sh...

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“…9 Some skepticism still remains regarding the oncological efficacy of the laparoscopic treatment of gastric cancer, in particular on the extent of lymphadenectomy. 3,10,11 It has been definitively established that surgical resection with D2 lymph node dissection is the standard of care and the only potentially curative treatment available for advanced gastric cancer. [12][13][14] Departments of 1 Medical and Surgical Critical Care and 2 Clinical Pathophysiology, University of Florence, Florence, Italy.…”

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Totally Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Matched Cohort Study

Cianchi

Qirici²,

Trallori³

et al. 2013

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: The role of laparoscopic surgery for the treatment of gastric cancer is still controversial, particularly in terms of oncologic efficacy. The aim of this study was to compare short-term outcomes of laparoscopic and open resection for gastric cancer at a single Western institution. Subjects and Methods: This study was designed as a matched cohort study from a prospective gastric cancer database. Forty-one patients undergoing laparoscopic gastrectomy for gastric cancer between June 2008 and January 2012 were matched with 41 patients undergoing open gastrectomy in the same time period. Patient pairing was done according to age, gender, type of gastrectomy (subtotal or total), and tumor stage via a randomized statistical method. The short-term outcomes and oncologic adequacy of the laparoscopic and open procedures were compared. A D2 lymph node dissection was performed in the majority of patients in both groups. Results: The two study groups were similar with respect to patient and tumor characteristics. Laparoscopic procedures were associated with a decreased blood loss (118.7 versus 312.4 mL, P < .005), incidence of surgeryunrelated complications (3 versus 9 patients, P < .05), and duration of hospital stay (8.1 versus 11.5 days, P < .05) but increased operative time for both subtotal (223.5 versus 158.2 minutes, P < .001) and total (298.1 versus 185.5 minutes, P < .001) gastrectomies. The mean number of retrieved lymph nodes after D2 dissection was similar: 30.0 for laparoscopic and 29.7 for open patients. Conclusions: Within the limitations of a nonrandomized analysis, this study shows that the laparoscopic approach is a safe and oncologically adequate option for the treatment of gastric cancer, which compares favorably with open gastrectomy in short-term outcomes.

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The issue of lymphadenectomy during laparoscopic gastrectomy for gastric carcinoma

Cited by 16 publications

References 17 publications

Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection

Laparoscopic gastrectomy for patients with advanced gastric cancer produces oncologic outcomes similar to those for open resection

Extended or Limited Lymph Node Dissection? A Gastric Cancer Surgical Dilemma

Totally Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Matched Cohort Study

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