Which method is more suitable for advanced gastric cancer with enlarged lymph nodes, laparoscopic radical gastrectomy or open gastrectomy?
- 369 Downloads
The oncologic outcome of laparoscopic radical gastrectomy (LG) with open radical gastrectomy (OG) for gastric cancer with preoperative enlarged lymph nodes (LNs) remains ambiguous.
The long-term outcomes of LG (n = 855) versus OG (n = 154) in gastric adenocarcinoma patients were analyzed retrospectively. Patients were stratified according to enlarged (> 10 mm) and small (≤ 10 mm) LNs (ELN and SLN) based on the long-axis diameter of the LNs.
The violin plot indicates that the distribution of ELN size was similar between two groups. Survival curves demonstrated that the overall survival (OS) in LG is enhanced compared with OG (p = 0.034). A stratified analysis revealed that the OS was better in the LG group compared with the OG group for patients with ELNs (p = 0.038). In a forest map analysis, the actual 3-year OS rate for LG was significantly increased compared with OG in enlarged suprapancreatic LN (ESLNs) patients. Stratified analysis based on different diameters of ESLNs revealed that the actual 3-year OS and cancer-specific survival (CSS)rate for LG was significant increased compared to OG with a diameter from 1.0 to 1.9 cm for pII or pIII stage patients. However, the actual 3-year OS and CSS rate for LG was significantly reduced compared with OG when the size exceeded 2.5 cm.
For advanced gastric cancer with an ESLN diameter from 1.0 to 1.9 cm, LG could be chosen preferentially; nevertheless, LG is not safe if ESLN are > 2.5 cm.
KeywordsGastric carcinoma Enlarged LN Lymphadenectomy Long-term outcome Suprapancreatic area
Sponsored by National Key Clinical Specialty Discipline Construction program of China (No. 649), Scientific and technological innovation joint capital Projects of Fujian Province (2016Y9031), General Project of Miaopu scientific research fund of Fujian Medical University (2015MP021), Youth Project of Fujian Provincial Health and Family Planning Commission (2016-1-41), Nature Fund Health Joint Fund Project of Fujian Province (2015J01464).
Compliance with ethical standards
Conflict of interest
None of the authors had any potential conflicts of interest, including relevant financial interests, activities, relationships, and affiliations.
Human rights statement and informed consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients for being included in the study.
- 4.Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc Percutaneous Tech. 1994;4(2):146–8.Google Scholar
- 5.Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer. 2010;13(4):238–44.CrossRefPubMedGoogle Scholar
- 7.Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report–a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010;251(3):417–20.CrossRefPubMedGoogle Scholar
- 9.Seung-Young O, Sebastianus K, Kyung-Goo L, Yun-Suhk S, Hwi-Nyeong C, Seong-Ho K, Hyuk-Joon L, Woo Ho K, Han-Kwang Y. Outcomes of minimally invasive surgery for early gastric cancer are comparable with those for open surgery: analysis of 1013 minimally invasive surgeries at a single institution. Surg Endosc. 2013;28(3):789–95.Google Scholar
- 11.Ju-Hee L, Min LC, Sang-Yong S, Hoon AS, Do Joong P, Hyung-Ho K. Laparoscopic versus open gastrectomy for gastric cancer: long-term oncologic results. Surgery. 2013;155(1):154–64.Google Scholar
- 14.Adachi T, Eguchi S, Beppu T, Ueno S, Shiraishi M, Okuda K, Yamashita YI, Kondo K, Nanashima A, Ohta M. Prognostic impact of preoperative lymph node enlargement in intrahepatic cholangiocarcinoma: a multi-institutional study by the Kyushu Study Group of Liver Surgery. Ann Surg Oncol. 2015;22(7):1–10.CrossRefGoogle Scholar
- 18.Huang CM, Chen QY, Lin JX, Zheng CH, Ping L, Xie JW, Wang JB, Lu J, Yang XT. Laparoscopic suprapancreatic lymph node dissection for advanced gastric cancer using a left-sided approach. Ann Surg Oncol. 2015;22(7):1.Google Scholar
- 21.Huang CM, Chen QY, Lin JX, Zheng CH, Li P, Xie JW. Huang’s three-step maneuver for laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer. Chinese. J Cancer Res. 2014;26(2):208–10.Google Scholar
- 23.Sato H, Shimada M, Kurita N, Iwata T, Nishioka M, Morimoto S, Yoshikawa K, Miyatani T, Goto M, Kashihara H, Takasu C. Comparison of long-term prognosis of laparoscopy-assisted gastrectomy and conventional open gastrectomy with special reference to D2 lymph node dissection. Surg Endosc. 2012;26(8):2240–6.CrossRefPubMedGoogle Scholar
- 26.Wang JB, Huang CM, Zheng CH, Li P, Xie JW, Lin JX. Efficien-cy of laparoscopic D2 radical gastrectomy in gastric cancer: experiences of 218 patients (in Chinese). Chin J Gastrointest Surg. 2010;48(7):502–5.Google Scholar
- 27.Huang CM, Lin JX, Zheng CH, Li P, Xie JW, Lin JX, Wang JB. Clinical efficacy analysis of laparoscopy-assisted radical gastrectomy for 1380 patients with gastric cancer (in Chinese). Chin J Gastrointest Surg. 2012;15(12):1265–8.Google Scholar
- 28.PhD CYM, PhD Z-GZM, Min YM, Zhang Huan, Zi-Lai Pan MD, PhD JCM, PhD MXM, Ming-Min Chen MD, PhD B-YLM, Hao-Ran Yin MD. Value of multidetector-row computed tomography in the preoperative T and N staging of gastric carcinoma: a large-scale Chinese study. J Surg Oncol. 2009;100(100):205–14.Google Scholar