Abstract
Background
Laparoscopic assisted distal gastrectomy for adenocarcinoma has been widely reported from Japan and Korea but there are sparse data for Western patients. This study aimed to describe and compare the perioperative outcomes and pathological staging for consecutive patients who underwent laparoscopic or open gastrectomy by a single surgeon in the UK.
Methods
During the period from April 2005 to May, 2007, patients with gastric adenocarcinoma were selected for open or laparoscopic resection at the discretion of the surgeon. Gastric resections for gastrointestinal stromal tumour (GIST) or benign disease were excluded. Laparoscopic gastrectomy was performed entirely laparoscopically with intracorporeal anastomosis, followed by specimen retrieval via a suprapubic incision.
Results
There were 21 men and 8 women, median age 75 years (range 45–88 years), with American Anaesthesiology Association scores of 3 or 4 in 19 patients. Gastrectomy was performed laparoscopically in 18 patients (62%; total gastrectomy, 6 patients) or open in 11 patients (total gastrectomy, 7). Five laparoscopic gastrectomies were converted to open procedures, three patients had re-laparoscopy and one patient had subsequent laparotomy. As compared with open gastrectomy, laparoscopic resection had longer operation time and similar length of hospital stay. There was one postoperative mortality in each group. There was similar lymph node retrieval for laparoscopic or open resection [23 (range 10–44) versus 26 (8–95), respectively; p = 0.40], with inadequate lymphadenectomy (<15 nodes) in two laparoscopic cases and one open case. R1 resection was limited to patients with pT3 disease (laparoscopic, 4; open, 2).
Conclusions
Perioperative outcomes were similar for laparoscopic or open gastrectomy. Lymphadenectomy was adequate in 89% of laparoscopic gastrectomies. pT3 tumours were at risk of noncurative resection, as described in large Western series of open gastrectomy.
Similar content being viewed by others
References
Maruyama K, Kaminishi M, Hayashi K, Isobe Y, Honda I, Katai H, Arai K, Kodera Y, Nashimoto A (2006) Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer 9:51–66
Shiraishi N, Yasuda K, Kitano S (2006) Laparoscopic gastrectomy with lymph node dissection for gastric cancer. Gastric Cancer 9:167–176
Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72
Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237
Weber KJ, Reyes CD, Gagner M, Divino CM (2003) Comparison of laparoscopic and open gastrectomy for malignant disease. Surg Endosc 17:968–971
Carboni F, Lepiane P, Santoro R, Mancini P, Lorusso R, Santoro E (2005) Laparoscopic surgery for gastric cancer: preliminary experience. Gastric Cancer 8:75–77
Dulucq JL, Wintringer P, Stabilini C, Solinas L, Perissat J, Mahajna A (2005) Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study. Surg Endosc 19:933–938
Varela JE, Hiyashi M, Nguyen T, Sabio A, Wilson SE, Nguyen NT (2006) Comparison of laparoscopic and open gastrectomy for gastric cancer. Am J Surg 192:837–842
Topal B, Leys E, Ectors N, Aerts R, Penninckx F (2007) Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc
Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, Costanzi A, Pauna J, de Martini P (2007) Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21:21–27
Singh KK, Rohatgi A, Rybinkina I, McCulloch P, Mudan S (2007) Laparoscopic gastrectomy for gastric cancer: early experience among the elderly. Surg Endosc
Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 194:839–844
National Institute of Health and Clinical Excellence (2008) Laparoscopic gastrectomy for cancer (interventional procedures overview) http://www.nice.org
Sarela AI, Yelluri S (2007) Gastric adenocarcinoma with distant metastasis: is gastrectomy necessary? Arch Surg 142:143–149
Sarela AI, Tolan DJ, Harris K, Dexter SP, Sue-Ling HM (2008) Anastomotic leakage after esophagectomy for cancer: a mortality-free experience. J Am Coll Surg 206:516–523
Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA (2006) Volume and process of care in high-risk cancer surgery. Cancer 106:2476–2481
Kim KH, Kim MC, Jung GJ, Kim HH (2006) The impact of obesity on LADG for early gastric cancer. Gastric Cancer 9:303–307
Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Ann Surg 238:680–685
Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, Seto Y, Muto T (2007) Laparoscopic esophagogastric circular stapled anastomosis: a modified technique to protect the esophagus. Gastric Cancer 10:181–186
Okabe H, Satoh S, Inoue H, Kondo M, Kawamura J, Nomura A, Nagayama S, Hasegawa S, Itami A, Watanabe G, Sakai Y (2007) Esophagojejunostomy through minilaparotomy after laparoscopic total gastrectomy. Gastric Cancer 10:176–180
Jin SH, Kim DY, Kim H, Jeong IH, Kim MW, Cho YK, Han SU (2007) Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc 21:28–33
Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 194:839–844
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726
King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93:300–308
Consten EC, Gagner M (2004) Staple-line reinforcement techniques with different buttressing materials used for laparoscopic gastrointestinal surgery: a new strategy to diminish perioperative complications. Surg Technol Int 13:59–63
Dexter SP, Miller GV, Davides D, Martin IG, Sue Ling HM, Sagar PM, Larvin M, McMahon MJ (2000) Relaparoscopy for the detection and treatment of complications of laparoscopic cholecystectomy. Am J Surg 179:316–319
Sarela AI, Lefkowitz R, Brennan MF, Karpeh MS (2006) Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg 191:134–138
Sarela AI, Miner TJ, Karpeh MS, Coit DG, Jaques DP, Brennan MF (2006) Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma. Ann Surg 243:189–195
Karpeh MS, Leon L, Klimstra D, Brennan MF (2000) Lymph node staging in gastric cancer: is location more important than Number? An analysis of 1, 038 patients. Ann Surg 232:362–371
Sarela AI, Turnbull AD, Coit DG, Klimstra D, Brennan MF, Karpeh MS (2003) Accurate lymph node staging is of greater prognostic importance than subclassification of the T2 category for gastric adenocarcinoma. Ann Surg Oncol 10:783–791
Roder JD, Bottcher K, Siewert JR, Busch R, Hermanek P, Meyer HJ (1993) Prognostic factors in gastric carcinoma. Results of the German Gastric Carcinoma Study. Cancer 72:2089–2097
Kim SH, Karpeh MS, Klimstra DS, Leung D, Brennan MF (1999) Effect of microscopic resection line disease on gastric cancer survival. J Gastrointest Surg 3:24–33
Acknowledgements
The author is grateful for support and encouragement to surgical colleagues Simon PL Dexter, Michael J McMahon, and Henry Sue-Ling; anaesthesiologist, Peter Kimpson; specialist cancer nurses, Sharon Huntley and Kate Smith; and all members of the Leeds Upper GI Cancer multidisciplinary team.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sarela, A.I. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc 23, 153–160 (2009). https://doi.org/10.1007/s00464-008-0072-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-0072-0