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Zentralbl Chir 2018; 143(02): 145-154
DOI: 10.1055/a-0586-9275
Original Article/Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Totally Laparoscopic versus Open Gastrectomy for Gastric Cancer: a Matched Pair Analysis

Article in several languages: English | deutsch
Kaja Ludwig
1   Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Deutschland
,
Sylke Schneider-Koriath
1   Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Deutschland
,
Uwe Scharlau
1   Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Deutschland
,
Holger Steffen
1   Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Deutschland
,
Daniela Möller
1   Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Deutschland
,
Jörn Bernhardt
2   Endoskopie/Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Deutschland
› Author Affiliations
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Publication History

Publication Date:
02 May 2018 (online)

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Abstract

Background Laparoscopic gastrectomy has been established for treatment of early gastric cancer (EGC) especially in Eastern Asian countries. Currently, it still needs evaluation for advanced gastric cancer (AGC, T ≥ 2). Difficulty is how far Asian study data are valid for western conditions.

Methods Out of 502 patients who underwent gastric cancer surgery between 2003 and 2016 at Klinikum Suedstadt Rostock 90 patients were selected for a retrospective study to compare totally laparoscopic D2-gastrectomy (LG, n = 45) with open D2-gastrectomy (OG, n = 45). The groups were matched by age, gender and tumour stage (TNM).

Results Average age was 62.9 years (33 – 83), 42.2% were female. There were no differences between both study groups concerning BMI, ECOG and comorbidities. Amounts of EGC and AGC were 35.5% and 64.4% in LG, 28.9% and 71.0% in OG (p = 0.931). In LG-group 53.3% of the patients and in OG-group 51.1% of the patients were nodal negative (p = 0.802). 31.1% of patients in LG and in 33.3% in OG (p = 0.821) undergone perioperative chemotherapy. Total gastrectomy was performed in 73.3% in LG and 82.2% in OG, subtotal resections were done in 26.7% in LG and 17.8% in OG (p = 0.310). Resection free margins (R0) were recognized in 97.8% of the patients in both groups, and for EGC in all cases (p = 0.928). Total numbers of retrieved lymph nodes were significant higher in LG (33.1, 17 – 72) than in OG (28.2, 14 – 57). A significant longer operation time was noticed for laparoscopic gastrectomy in contrast to open surgery (+ 43.0 ± 27.2 min, p = 0.0054). Overall morbidity in OG (44.4%) was twice as high as in LG (22.2%, p < 0.05) due to lower rate of minor complications (Clavien I – II) in LG (LG vs. OG: 13.3% vs. 37.8%, p = 0.0078). For major complications (Clavien ≥ III) no difference between both groups was detected (LG vs. OG: 8.8% vs. 6.6%, p = 0.69). LG showed a significant faster postoperative recovery with earlier oral fluid intake (LG vs. OG: 25.9 h vs. 46.2 h) and shorter time to first flatus (LG vs. OG: 81.6 vs. 102.6 h). Patients after LG were earlier out of bed (LG vs. OG: 69.7 h vs. 108.7 h) and also hospital stay was significantly shorter (11.9 days in LG vs. 16.3 days in OG, p = 0.037). 30- and 90-days mortality was equal for LG and OG (0 and 2.2% per group). After a median follow up of 51.9 month (1 – 117) there were similar results for 3- and 5-year overall survival (OS for LG: 75.6% and 64.6% vs. OG: 68.9% and 64.6%, p = 0.446). Also no differences for 3- and 5-year OS were detected concerning patients without lymph node metastases (LG: 91.7% and 83.4% vs. OG: 91.3% and 78.3%, p = 0.658) or lymph node positive patients (LG: 47.6% and 38.1% vs. OG: 40.9% and 31.8%, p = 0.665).

Conclusion Despite western conditions laparoscopic D2 gastrectomy is certainly a save and feasibly approach for surgical therapy of EGC and AGC with low morbidity and mortality, and faster postoperative recovery. The oncologic outcome seems to be equivalent to open surgery.

Key words

laparoscopic gastrectomy - early gastric cancer - advanced gastric cancer
 

  • References/Literatur

  • 1 Kamanger F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions oft he world. J Clin Oncol 2006; 24: 2137-2150
    CrossrefPubMedGoogle Scholar
  • 2 Shen L, Shan YS, Hu HM. et al. Management of gastric cancer in Asia: resource-stratified guidelines. Lancet Oncol 2013; 14: e535-e547
    CrossrefPubMedGoogle Scholar
  • 3 Kitano S, Iso Y, Moriyama M. et al. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4: 146-148
    PubMedGoogle Scholar
  • 4 Hayashi H, Ochiai T, Shimada H. et al. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 2005; 19: 1172-1176
    CrossrefPubMedGoogle Scholar
  • 5 Kim YW, Baik YH, Yun YH. et al. Improved quality of live outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 2008; 248: 721-727
    CrossrefPubMedGoogle Scholar
  • 6 Chen XZ, Hu JK, Yang LW. et al. Short-term evaluation of laparoscopy-assisted distal gastrectomy for predictive early gastric cancer. A meta-analysis of randomized controlled trials. Surg Laparosc Endosc Percutan Tech 2009; 19: 277-284
    CrossrefPubMedGoogle Scholar
  • 7 Deng Y, Zhang Y, Guo TK. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: a meta-analysis based on seven randomized controlled trials. Surg Oncol 2015; 24: 71-77
    CrossrefPubMedGoogle Scholar
  • 8 Kim YW, Yoon AM, Yun YH. et al. Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc 2013; 27: 4267-4276
    CrossrefPubMedGoogle Scholar
  • 9 Lee JH, Lee CM, Son SY. et al. Laparoscopic versus open gastrectomy for gastric cancer: Long-term oncologic results. Surgery 2014; 155: 154-164
    CrossrefPubMedGoogle Scholar
  • 10 Takiguchi S, Fujiwara Y, Yamasaki M. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study. World J Surg 2013; 37: 2379-2386
    CrossrefPubMedGoogle Scholar
  • 11 Hur H, Lee HY, Kim MC. et al. Efficacy of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer: the protocol of the KLASS-02 multicenter randomized controlled clinical trial. BMC Cancer 2015; 15: 355-362
    CrossrefPubMedGoogle Scholar
  • 12 Inaki N, Etoh T, Ohyama T. et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 2015; 39: 2734-2741
    CrossrefPubMedGoogle Scholar
  • 13 Park YK, Yoon HM, Kim YW. et al. Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer. Results from a randomized phase II multicenter clinical trial (COACT 1001). Ann Surg 2017; DOI: 10.1097/SLA.0000000000002168.
    CrossrefPubMedGoogle Scholar
  • 14 Sakuramoto S, Yamashita K, Kikuchi S. et al. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc 2013; 27: 1695-1705
    CrossrefPubMedGoogle Scholar
  • 15 Hu Y, Ying M, Huang C. et al. Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective cohort study from China. Surg Endosc 2014; 28: 2048-2056
    CrossrefPubMedGoogle Scholar
  • 16 Brenkman HJF, Gisbertz SS, Slaman AE. et al. Postoperative outcomes of minimally invasive gastrectomy versus open gastrectomy during the early introduction of minimally invasive gastrectomy in the netherlands. A population-based cohort study. Ann Surg 2017; DOI: 10.1097/SLA.0000000000002391.
    CrossrefPubMedGoogle Scholar
  • 17 Strong VE, Song KY, Park CH. et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated Nomogram. Ann Surg 2010; 251: 640-646
    CrossrefPubMedGoogle Scholar
  • 18 Inokuchi M, Nakagawa M, Tanioka T. et al. Long- and short-term outcomes of laparoscopic gastrectomy versus open gastrectomy in patients with clinically and pathological locally advanced gastric cancer: a propensity-score matching analysis. Surg Endosc 2018; 32: 735-742 doi:10.1007/s00464-017-5730-7
    CrossrefPubMedGoogle Scholar
  • 19 Kim KH, Kim HC, Jung GJ. et al. Comparative analysis of five-year survival results of laparoscopy-assisted gastrectomy versus open gastrectomy for advanced gastric cancer: a case-control study using a propensity score method. Dig Surg 2012; 29: 165-171
    CrossrefPubMedGoogle Scholar
  • 20 An JY, Heo GU, Cheong JH. et al. Assessment of open versus laparoscopy-assisted gastrectomy in lymph-node-positive early gastric cancer: a retrospective cohort analysis. J Surg Oncol 2010; 102: 77-81
    CrossrefPubMedGoogle Scholar
  • 21 Hu Y, Huang C, Sun Y. et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 2016; 34: 1350-1357
    CrossrefPubMedGoogle Scholar
  • 22 Viñuela EF, Gonen M, Brennan MF. et al. Laparoscopic versus open distal gastrectomy for gastric cancer. A meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 2012; 255: 446-456
    CrossrefPubMedGoogle Scholar
  • 23 Zou ZH, Zhao LY, Mou TY. et al. Laparoscopic vs. open D2 gastrectomy for locally advanced gastric cancer: a meta-analysis. World J Gastroenterol 2014; 20: 16750-16764
    CrossrefPubMedGoogle Scholar
  • 24 Brenkman HJF, Haverkamp L, Ruurda JP. et al. Worldwide practice in gastric cancer surgery. World J Gastroenterol 2016; 22: 4041-4048
    CrossrefPubMedGoogle Scholar
  • 25 Haverkamp L, Weijs TJ, van der Sluis PC. et al. Laparoscopic total gastrectomy versus open total gastrectomy. A systematic review and meta-analysis. Surg Endosc 2013; 27: 1509-1520
    CrossrefPubMedGoogle Scholar
  • 26 Wang W, Zhang X, Shen C. et al. Laparoscopic versus open total gastrectomy for gastric cancer: an up-dated meta-analysis. PloS One 2016; 9: e88753
    PubMedGoogle Scholar
  • 27 Shinohara T, Satoh S, Kanaya S. et al. Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 2013; 27: 286-294
    CrossrefPubMedGoogle Scholar
  • 28 Lin XJ, Huang CH, Zheng CH. et al. Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China. World J Surg Oncol 2013; 11: 4 doi:10.1186/1477-7819-11-4
    CrossrefPubMedGoogle Scholar
  • 29 Best LMJ, Mughal M, Gurusamy KS. Laparoscopic versus open gastrectomy for gastric cancer. Cochrane Data Syst Rev 2016; (03) CD011389 DOI: 10.1002/14651858.CD011389.pub2.
    CrossrefPubMedGoogle Scholar
  • 30 Kitano S, Shiraishi N, Fujii K. et al. A randomized controlled trial comparing open vs. laparoscopy-assisted distal gastrectomy for treatment of early gastric cancer: an interim report. Surgery 2002; 131 (1 Suppl.): S306-S311
    CrossrefPubMedGoogle Scholar
  • 31 Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs. laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 2005; 19: 168-173
    CrossrefPubMedGoogle Scholar
  • 32 Hosono S, Arimoto Y, Ohtani H. et al. Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy. World J Gastroenterol 2006; 12: 7676-7683
    CrossrefPubMedGoogle Scholar
  • 33 Ludwig K, Scharlau U, Schneider-Koriath S. et al. Minimal-invasive Magenchirurgie. Chirurg 2012; 83: 16-22
    CrossrefPubMedGoogle Scholar
  • 34 Memon MA, Khan S, Yunus RM. et al. Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc 2008; 22: 1781-1789
    CrossrefPubMedGoogle Scholar
  • 35 Yakoub D, Athanasiou T, Tekkis P. et al. Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach?. Surg Oncol 2009; 18: 322-333
    CrossrefPubMedGoogle Scholar
  • 36 Zeng YK, Yang ZL, Peng JS. et al. Laparoscopy-assisted versus open gastrectomy for early gastric cancer. Evidence from randomized and nonrandomized clinical trials. Ann Surg 2012; 256: 39-52
    CrossrefPubMedGoogle Scholar
  • 37 Chen XZ, Wen L, Rui YY. et al. Long-term survival outcomes of laparoscopic versus open gastrectomy for gastric cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2015; 94: e454 doi:10.1097/MD.0000000000000454
    CrossrefPubMedGoogle Scholar
  • 38 Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 2009; 23: 1759-1763
    CrossrefPubMedGoogle Scholar
  • 39 Cai J, Wei D, Gao CF. et al. A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig Surg 2011; 28: 331-337
    CrossrefPubMedGoogle Scholar
  • 40 Haverkamp L, Brenkman HJ, Seesing MF. et al. Laparoscopic versus open gastrectomy for gastric cancer, a multicenter prospectively randomized controlled trial (LOGICA-trail). BMC Cancer 2015; 15: 556 doi:10.1186/s12885-015-1551-z
    CrossrefPubMedGoogle Scholar