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Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study.

Abstract

BACKGROUND
The oncologic safety and feasibility of laparoscopic D2 gastrectomy for advanced gastric cancer are still uncertain. The aim of this study is to compare our results for laparoscopic D2 gastrectomy with those for open D2 gastrectomy.
METHODS
Between 1998 and 2008, a total of 336 patients with clinical T2, T3, or T4 tumors underwent laparoscopic (n = 186) or open (n = 150) gastrectomy involving D2 lymph node dissection with curative intent. To produce this study population, 123 patients in the open group who matched those of the laparoscopic group with regard to age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, tumor location, and clinical tumor stage were retrospectively selected. The short- and long-term outcomes of these patients were examined.
RESULTS
Laparoscopic D2 gastrectomy was associated with significantly less operative blood loss and shorter hospital stay, but longer operative time, compared with open D2 gastrectomy. The mortality and morbidity rates of the laparoscopic group were comparable to those of the open group (1.1 % vs. 0, P = 0.519, and 24.2 % vs. 28.5 %, P = 0.402). The 5-year disease-free and overall survival rates were 65.8 and 68.1 % in the laparoscopic group and 62.0 and 63.7 % in the open group (P = 0.737 and P = 0.968). There were no differences in the patterns of recurrence between the two groups.
CONCLUSIONS
This study suggests that laparoscopic D2 gastrectomy provides reasonable oncologic outcomes with acceptable morbidity and low mortality rates. Although operation time is currently long, this approach is associated with several advantages of laparoscopic surgery, including quick recovery of bowel function and short hospital stay. Laparoscopic D2 gastrectomy may offer a favorable alternative to open D2 gastrectomy for patients with advanced gastric cancer.

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  • Publisher Full Text
  • Authors

    Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I

    Institution

    Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. shinohara@jikei.ac.jp

    Source

    Surgical endoscopy 27:1 2013 Jan pg 286-94

    MeSH

    Blood Loss, Surgical
    Epidemiologic Methods
    Female
    Gastrectomy
    Humans
    Laparoscopy
    Length of Stay
    Male
    Middle Aged
    Operative Time
    Postoperative Complications
    Stomach Neoplasms
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Evaluation Studies
    Journal Article

    Language

    eng

    PubMed ID

    22733201