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Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma

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Abstract

Background

The role of laparoscopic total gastrectomy (LTG) in the treatment of gastric cancer is controversial. The present study analyzed the morbidity and adequacy of resection in LTG versus open total gastrectomy (OTG) for gastric adenocarcinoma.

Methods

Between 2003 and 2006, clinical data of 38 consecutive patients who underwent LTG for gastric adenocarcinoma were collected prospectively. The same data-entry form was used for retrospective data collection from 22 consecutive patients who underwent OTG within the same time period. Logistic regression models were used in univariate and multivariate analyses to identify the optimally combined factors related to the occurrence of postoperative complications and to the number of harvested lymph nodes.

Results

Postoperative complications occurred in 24 patients with subsequent mortality in two. Median (range) length of hospital stay was 11 (6–73) days and comparable after LTG versus OTG (p = 0.847). The occurrence of postoperative complications was related (p = 0.004) to the first year of surgery and patients’ medical condition before surgery [American Society of Anaesthesiologists (ASA) physical status III]. Microscopic tumor-free margins were obtained in all but two patients. The number of harvested lymph nodes was 17 (0–90), and determined by tumor wall penetration (p = 0.001).

Conclusions

The occurrence of complications after total gastrectomy is determined by the patients’ medical condition before surgery and the surgical expertise, but not by the approach. LTG and OTG can result in adequate tumor-free resection margins and lymph node yield, which is related to the tumor wall penetration. The role of LTG in gastric cancer needs further evaluation in randomized controlled trials with large patient series.

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References

  1. 1.

    Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S, Akazawa K (1999) Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 229:49–54

  2. 2.

    Bittner R, Butters M, Ulrich M, Uppenbrink S, Beger HG (1996) Total gastrectomy. Updated operative mortality and long-term survival with particular reference to patients older than 70 years of age. Ann Surg 224:37–42

  3. 3.

    Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, Meyer S, Plukker JT, Van Elk P, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H; Dutch Gastric Cancer Group (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340:908–914

  4. 4.

    Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, Smith DB, Langley RE, Verma M, Weeden S, Chua YJ, MAGIC Trial Participants (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20

  5. 5.

    Degiuli M, Sasako M, Ponti A, Soldati T, Danese F, Calvo F (1998) Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study. J Clin Oncol 16:1490–1493

  6. 6.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:214–215

  7. 7.

    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

  8. 8.

    Huscher CG, Mignoli 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

  9. 9.

    Ihse I (2003) The volume-outcome relationship in cancer surgery. Ann Surg 6:777–781

  10. 10.

    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

  11. 11.

    Kim MC, Kim HH, Jung GJ (2005) Surgical outcome of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer. Eur J Surg Oncol 31:401–405

  12. 12.

    Kitano S, Shiraishi N, UyamaI, Sugihara K, Tanigawa N, the Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncological outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72

  13. 13.

    Luft HS, Bunker JP, Enthoven AC (1979) Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 301:1364–1369

  14. 14.

    Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725–730

  15. 15.

    McCulloch P (2006) The role of surgery in patients with advanced gastric cancer. Best Pract Res Clin Gastroenterol 20:767–787

  16. 16.

    McCulloch P, Niita ME, Kazi H, Gama-Rodrigues J (2005) Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer. Br J Surg 92:5–13

  17. 17.

    Mejer HJ (2005) The influence of case load and the extent of resection on the quality of treatment outcome in gastric cancer. Eur J Surg Oncol 31:595–604

  18. 18.

    Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asao T, Kuwano H (2002) Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg 26:1145–1149

  19. 19.

    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

  20. 20.

    Usui S, Yoshida T, Ito K, Hiranuma S, Kudo SE, Iwai T (2005) Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy. Surg Laparosc Endosc Percutan Tech 15:309–314

  21. 21.

    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

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Correspondence to B. Topal.

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Topal, B., Leys, E., Ectors, N. et al. Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 22, 980–984 (2008). https://doi.org/10.1007/s00464-007-9549-5

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Keywords

  • Cancer
  • Surgery
  • Stomach
  • Laparoscopy
  • Outcome