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Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects

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Laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection for advanced gastric cancer is still controversial. To evaluate the technical and oncologic feasibility and advantage of LADG with D2 lymph node dissection, the authors compared the surgical outcomes of LADG with D2 dissection and those of conventional open distal gastrectomy (ODG) for patients with early gastric cancer (EGC).


Between September 2004 and August 2005, the study enrolled 75 patients with a preoperative diagnosis of EGC. Of these 75 patients, 44 underwent LADG, and remaining 31 underwent ODG. All the patients received D2 lymph node dissection. Their clinicopathologic characteristics, postoperative outcomes, and retrieved lymph nodes were compared at each station.


Although the operative time was significantly longer for the LADG group than for the ODG group, the perioperative recovery was shorter and, consequently, the postoperative hospital stay was significantly shorter for the LADG group (7.7 vs 9.4 days, respectively; p = 0.003). No significant differences were found in the total number of retrieved lymph nodes (37.2 vs 42.4; p > 0.05) or node stations (p > 0.05) between the two groups.


LADG with D2 lymph node dissection is a safe and feasible procedure, and it is oncologically compatible with open gastrectomy. A large-scaled prospective randomized trial with advanced gastric cancer patients should be conducted to confirm the benefit of LADG.

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  1. 1.

    Bonenkamp JJ, Songun J, Hermans J, Sasako M, Welvaart K, Plukkeo JT, van Elk P, Obertop H, Gouma DJ, Taat CW, van Lanschot J, Meyer S, de Graaf PW, von Meyenfeldt MF, Tilanus H, van de Velde CJH (1995) Randomized comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748

  2. 2.

    Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P (1996) Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial. The Surgical Cooperative Group. Lancet 347:995–999

  3. 3.

    Etoh T, Shiraishi N, Kitano S (2002) Laparoscopic gastrectomy for gastric cancer. Dig Dis 23:113–118

  4. 4.

    Fujiwara M, Kodera Y, Kasai Y, Kanyama Y, Hibi K, Ito K, Akiyama S, Nakao A (2003) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: a review of 43 cases. J Am Coll Surg 196:75–81

  5. 5.

    Han HS, Kim YW, Yi NJ, Gary F (2003) Laparoscopy-assisted D2 subtotal gastrectomy in early gastric cancer. Surg Laparosc Endosc Percutan Tech 13:361–365

  6. 6.

    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer 1:10–24

  7. 7.

    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

  8. 8.

    Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:306–311

  9. 9.

    Korean Laparoscopic Gastrointestinal Surgery Study Group (2005) Nationwide Survey of Laparoscopic Gastric Surgery in Korea, 2004. J Korean Gastric Cancer Assoc 5:295–303

  10. 10.

    Miura S, Kodera Y, Fujiwara M, Ito S, Mochizuki Y, Yamamura Y, Hibi K, Ito K, Akiyama S, Nakao A (2004) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. J Am Coll Surg 198:933–938

  11. 11.

    Nakajima T (2002) Gastric cancer treatment guideline in Japan. Gastric Cancer 5:1–5

  12. 12.

    Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M (2005) Laparoscopically assisted gastrectomy with standard radical lymph node dissection for gastric cancer Surg Endosc 19:1692–1596

  13. 13.

    Roukos DH, Loren M, Encke A (1998) Evidence of survival benefit of extended (D2) lymphadenectomy in Western patients with gastric cancer based on a new concept: a prospective long-term follow-up study. Surgery 1253:573–578

  14. 14.

    Sasako M (1997) Risk factors for surgical treatment in the Dutch gastric cancer trial. Br J Surg 84:1567–1571

  15. 15.

    Sasako M, McCulloch P, Kinoshita T, Maruyama K (1995) New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 82:346–351

  16. 16.

    Tanimura S, Higashino M, Fukunaga Y, Osugi H (2003) Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 17:758–762

  17. 17.

    Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hasumi A (2000) Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach. Gastric Cancer 3:50–55

  18. 18.

    Uyama I, Sugiola A, Fujita J, Komori Y, Matsui H, Soga R, Wakayama A, Okamoto K, Ohyama A, Hasumi A (1999) Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer 2:186–190

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This work was partly supported by the Catholic Cancer Center.

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Correspondence to C. H. Park.

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Part of this article was presented and awarded the Best Video Award at the 14th International Congress of EAES, Berlin, Germany, 13–16 September 2006

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Song, K.Y., Kim, S.N. & Park, C.H. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 22, 655–659 (2008).

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  • D2 dissection
  • Gastric cancer
  • Laparoscopically assisted distal gastrectomy
  • Technical and oncologic aspects