Annals of Surgical Treatment and Research

The Korean Surgical Society (대한외과학회)
권호 표지

Comparison of Laparoscopy-Assisted by Conventional Open Distal Gastrectomy and Extraperigastric Lymph Node Dissection in Early Gastric Cancer

조기 위암의 복강경 보조하 및 개복 위아전 절제술의 비교

Kim, Min-Chan;Lee, Sung-Gun;Jung, Il-Kwon;Jung, Ghap-Joong;Kim, Hyung-Ho
김민찬;이성근;정일권;정갑중;김형호

  • Published : 20050100
⟨ Previous Next ⟩

Abstract

Purpose: A laparoscopy-assisted gastrectomy with lymph node dissection for gastric cancer is considered technically more complicated than the open method. To evaluate the short-term surgical validity, the surgical outcome of the laparoscopy-assisted distal gastrectomy (LADG) with extraperigastric lymph node dissection was compared with that of the conventional open distal gastrectomy (CODG) in patients with early gastric cancer. Methods: One hundred and forty-seven patients with early gastric cancer received a radical distal gastrectomy during 2002 and 2003, where a LADG was performed on 71 patients. The clinicopathological characteristics, postoperative outcomes and courses, and the postoperative morbidities and mortalities were compared between the two groups. Data were retrieved from the stomach cancer database at Dong-A University Medical center. Results: Baseline characteristics, including gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, tumor size, T stage, and lymph node metastasis, were similar between the two groups. No significant differences were found between these groups in terms of the number of retrieved lymph nodes with respect to D1+(D1+no. 7) and D1+\beta (D1+no. 7, 8a, and 9) lymphadenectomies. In the LADG group, the wound size was smaller (P＜0.0001), but the operation time was longer (P=0.0001) than in the CODG group. The perioperative recovery was faster in the LADG than in the CODG group, as reflected by the shorter hospital stay (P=0.0176) and less additional analgesics (P=0.0370). The serum albumin level in the LADG was higher (P=0.0002) on day 7 than that in the CODG group, and the leukocyte count in the LADG lower (P=0.0445) on day 1 than that in the CODG gruop. There were no significant differences in the postoperative morbidities and mortalities between the two groups. Conclusions: Our data confirmed that a LADG with an extraperigastric (no. 7, 8, and 9) lymph node dissection was a feasible and acceptable surgical technique for early gastric cancer. From a surgical point of view, a LADG with an extraperigastric lymph node dissection is suggested to be a preferred surgical option for patients with early gastric cancer. Its oncological validity awaits larger and prospective multicenterd trials.

Keywords

References

  1. Lau H. Laparoscopic repair of perforated peptic ulcer: a metaanalysis. Surg Endosc 2004;18:1013-21
  2. Rothlin M, Schob O. Laparoscopic wedge resection for benign gastric tumors. Surg Endosc 2001;15:893-5 https://doi.org/10.1007/s004640000273
  3. Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Soga R, et al. Completely laparoscopic extragastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer 1999;2:186-90 https://doi.org/10.1007/s101200050044
  4. Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A. Laparoscopic total gastrectomy with distal pancreaticosplectomy and D2 lymphadectomy for early gastric cancer. Gastric Cancer 1999;2:230-4 https://doi.org/10.1007/s101200050069
  5. Huscher CG, Anastasi A, Crafa F, Recher A, Lirici MM. Laparoscopic gastric resections. Semin Laparosc Surg 2000;7: 26-54
  6. Horiuchi T, Shimomatsuya T, Chiba Y. Laparoscopically assisted pylorus-preserving gastrectomy. Surg Endosc 2001;15: 325-8 https://doi.org/10.1007/s004640000341
  7. Mochiki E, Kamimura H, Haga N, Asao T, Kuwano H. The technique of laparoscopically assisted total gastrectomy with jejunal interposition for early gastric cancer. Surg Endosc 2002;16:540-4 https://doi.org/10.1007/s00464-001-8219-2
  8. Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hatakawa Y, et al. Laparoscopic side to side esophagogastrostomy using a linear stapler after proximal gastrectomy. Gastric cancer 2001;4:98-102 https://doi.org/10.1007/PL00011731
  9. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy- assisted distal gastrecomy for the treatment of early gastric cancer: an interim report. Surgery 2002;131:306-11 https://doi.org/10.1067/msy.2002.120115
  10. Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-assisted billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 2000; 135:806-10 https://doi.org/10.1001/archsurg.135.7.806
  11. Tanimura H, Higashino M, Fukunaga Y, Osugi H. Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 2003;17:758-62 https://doi.org/10.1007/s00464-002-8625-0
  12. Weber KJ, Reyes CD, Gagner M, Divino CM. Comparison of laparoscopic and open gastrectomy for malignant disease. Surg Endosc 2003;17:968-71 https://doi.org/10.1007/s00464-002-8738-5
  13. Migoh S, Hasuda K, Nakashima K, Anai H. The benefit of laparoscopy-assisted distal gastrectomy compared with conventional open distal gastrectomy: a case matched control study. Hepatogastroenterology 2003;50:2251-4
  14. Tanimura S, Higashino M, Fukunaga Y, Osugi H. Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Gastric Cancer 2003;6:64-8 https://doi.org/10.1007/s101200300009
  15. Shiraishi N, Adachi Y, Kitano S, Bandoh T, Katsuta T, Morimoto A. Indication for and outcome of laparoscopy-assisted billroth I gastrectomy. Br J Surg 1999;86:541-4 https://doi.org/10.1046/j.1365-2168.1999.01083.x
  16. Asao T, Hosouchi Y, Nakabayashi T, Haga N, Mochiki E, Kuwano H. Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer. Br J Surg 2001;88:128-32 https://doi.org/10.1046/j.1365-2168.2001.01618.x
  17. Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M. Laparoscopy-assisted distal gastrectomy for early gastric cancer: Is it beneficial for patients of heavier weight? Ann Surg 2003;238:680-5 https://doi.org/10.1097/01.sla.0000094302.51616.2a
  18. Fujiwara M, Kodera Y, Fujiwara M, Ito S, Mochizuki Y, Yamamura Y, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: a review of 43 cases. J Am Coll Surg 2003;196:75-81 https://doi.org/10.1016/S1072-7515(02)01539-9
  19. Yi NJ, Kim YW, Han HS. Laparoscopy-assisted Billroth I gastrectomy compared with Hand-assisted laparoscopic surgery for early gastric cancer A Prospective study - J Korean Surg Soc 2002;62:57-63
  20. Gutt CN, Gessmann T, Schemmer P, Mehrabi A, Schmandra T, Kim ZG. The impact of carbon dioxide and helium insufflation on experimental liver metastases, macrophages, and cell adhesion molecules. Surg Endosc 2003;17:1628-31 https://doi.org/10.1007/s00464-002-9228-5
  21. Gutt CN, Riemer V, Brier C, Berguer R, Paolucci V. Standardized technique of laparoscopic surgery in the rat. Dig Surg 1998;15:371-5
  22. Jacobi CA, Sabat R, Bohm B, Zieren HU, Volk HD, Muller JM. Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells. Surgery 1997;121:72-8 https://doi.org/10.1016/S0039-6060(97)90185-9
  23. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, 2nd English ed. Gastric Cancer 1998;1: 10-24 https://doi.org/10.1007/PL00011681
  24. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer 2002;5:1-5
  25. Carli F, Trudel JL, Belliveau P. The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: a prospective, randomized trial. Dis Colon Rectum 2001;44:1083-9 https://doi.org/10.1007/BF02234626
  26. Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asao T, Kuwano H. Gastrointestinal recovery and outcome after laparoscopy-associated versus conventional open distal gastectomy for early gastric cancer. World J Surg 2002;26:1145-9 https://doi.org/10.1007/s00268-002-6286-8
  27. Goh PMY, Alponat A, Mak K, Kum CK. Early international results of laparoscopic gastrectomies. Surg Endosc 1997;11: 650-2 https://doi.org/10.1007/s004649900413
  28. Kim HH, Cho SH, Kim SS. Laparoscopic Billroth-II gastrectomy for benign gastric diseases. J Korean Surg Soc 1999; 56:664-70