Comparison of long-term prognosis of laparoscopy-assisted gastrectomy and conventional open gastrectomy with special reference to D2 lymph node dissection

For many decades, D2 procedure has been accepted in the far-east as the standard treatment for both early (EGC) and advanced gastric cancer (AGC). In case of AGC, the debate on the extent of nodal dissection has been open for many years in order to highlight the safety and efficacy of treatment, hence this study. A comprehensive literature research was performed in PubMed to identify studies that compared laparoscopic- assisted gastrectomy (LAG) and open gastrectomy (OG) with D2 lymph node dissection (D2-LND) for treatment of AGC for the last five years. Data of interest were checked and subjected to meta-analysis with RevMan 5.3 software. The pooled risk ratios (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI) were calculated. Overall, 19 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD -2.31; 95% CI -4.09 to -0.53; P = 0.01), less blood loss (WMD -120.49; 95% CI -174.27 to -66.71; P < 0.01), faster bowel recovery (WMD -0.55; 95% CI -0.86 to -0.24; P ˂ 0.01) and earlier ambulation (WMD -0.75; 95% CI -1.38 to -0.11; P = 0.02). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.94, 95% CI, -2.95 to 1.06; P=0.36), a lower complication rate [odds ratio (OR)=0.80; 95%CI, 0.68-0.97; P=0.02], and overall survival (OS) and disease-free survival (DFS) comparable to OG. In conclusion, for AGCs both techniques (LAG and OG) appeared comparable in short- and long-term results. More time was needed to perform LAG; nonetheless, it had some advantages in achieving faster postoperative recovery over OG. In order to clarify this controversial issue ongoing trials and future studies are needed.

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Laparoscopic Versus Open Gastrectomy With D2 Lymph Node Dissection for Gastric Cancer

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0b013e31822d02dc ◽

2011 ◽

Vol 21 (6) ◽

pp. 383-390 ◽

Cited By ~ 33

Author(s):

Hong-Bo Wei ◽

Bo Wei ◽

Cui-Ling Qi ◽

Tu-Feng Chen ◽

Yong Huang ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Open Gastrectomy ◽

Node Dissection ◽

D2 Lymph Node Dissection

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Extended Lymph Node Dissection for Gastric Cancer: Who May Benefit? Final Results of the Randomized Dutch Gastric Cancer Group Trial

Journal of Clinical Oncology ◽

10.1200/jco.2004.08.026 ◽

2004 ◽

Vol 22 (11) ◽

pp. 2069-2077 ◽

Cited By ~ 603

Author(s):

H.H. Hartgrink ◽

C.J.H. van de Velde ◽

H. Putter ◽

J.J. Bonenkamp ◽

E. Klein Kranenbarg ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Morbidity And Mortality ◽

Node Dissection ◽

Term Survival ◽

D2 Lymph Node Dissection ◽

Extended Lymph Node Dissection ◽

N2 Disease

Purpose The extent of lymph node dissection appropriate for gastric cancer is still under debate. We have conducted a randomized trial to compare the results of a limited (D1) and extended (D2) lymph node dissection in terms of morbidity, mortality, long-term survival and cumulative risk of relapse. We have reviewed the results of our trial after follow-up of more than 10 years. Patients and Methods Between August 1989 and June 1993, 1,078 patients with gastric adenocarcinoma were randomly assigned to undergo a D1 or D2 lymph node dissection. Data were collected prospectively, and patients were followed for more than 10 years. Results A total of 711 patients (380 in the D1 group and 331 in the D2 group) were treated with curative intent. Morbidity (25% v 43%; P < .001) and mortality (4% v 10%; P = .004) were significantly higher in the D2 dissection group. After 11 years there is no overall difference in survival (30% v 35%; P = .53). Of all subgroups analyzed, only patients with N2 disease may benefit of a D2 dissection. The relative risk ratio for morbidity and mortality is significantly higher than one for D2 dissections, splenectomy, pancreatectomy, and age older than 70 years. Conclusion Overall, extended lymph node dissection as defined in this study generated no long-term survival benefit. The associated higher postoperative mortality offsets its long-term effect in survival. For patients with N2 disease an extended lymph node dissection may offer cure, but it remains difficult to identify patients who have N2 disease. Morbidity and mortality are greatly influenced by the extent of lymph node dissection, pancreatectomy, splenectomy and age. Extended lymph node dissections may be of benefit if morbidity and mortality can be avoided.

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Effect of obesity on intraoperative bleeding volume in open gastrectomy with D2 lymph-node dissection for gastric cancer

Patient Safety in Surgery ◽

10.1186/1754-9493-2-7 ◽

2008 ◽

Vol 2 (1) ◽

Cited By ~ 10

Author(s):

Hirochika Makino ◽

Chikara Kunisaki ◽

Hirotoshi Akiyama ◽

Hidetaka A Ono ◽

Takashi Kosaka ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Open Gastrectomy ◽

Node Dissection ◽

Intraoperative Bleeding ◽

D2 Lymph Node Dissection ◽

Bleeding Volume

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Long-Term Outcomes of Laparoscopic Versus Open Gastrectomy With D2 Lymph Node Dissection for Advanced Gastric Cancer

Journal of Global Oncology ◽

10.1200/jgo.18.91200 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 225s-225s

Author(s):

Z. Li

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Propensity Score ◽

Advanced Gastric Cancer ◽

Propensity Score Matching ◽

Lymph Node Dissection ◽

Node Dissection ◽

Long Term Outcomes ◽

D2 Lymph Node Dissection

Background: Technical safety and short-term surgical outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC) have been investigated in many clinical trials. However, studies with large sample size and sufficient follow-up comparing LAG and open gastrectomy (OG) for AGC have seldom been reported. Aim: The purpose of this study was to compare the long-term outcomes of LAG vs open OG for AGC using a propensity score matching analysis. Methods: We retrospectively evaluated 459 and 856 patients who underwent LG or OG with D2 lymph node dissection, respectively, for AGC between June 2007 and June 2012. One-to-one propensity score matching was performed to compensate for heterogeneity between groups. We compared long-term outcomes between the 2 groups after propensity score matching. Results: In the propensity score-matched cohort, no significant differences were observed in 5-year overall survival (OS) (52.0% vs 53.4%; P = 0.805) and disease-free survival (DFS) (46.8% vs 47.3%; P = 0.963) between the LAG group and OG group. Stratified analysis showed that the 5-year OS and DFS rates were comparable between the 2 groups in each tumor stage ( P > 0.05). Multivariate analysis revealed that the operation method was not an independent prognostic factor for OS or DFS. Further analysis showed that the recurrence pattern was similar between the LAG group the OG group ( P > 0.05). Conclusion: LAG is a feasible surgical procedure for AGC in comparison with OG in terms of long-term prognosis, although the results should be confirmed by the ongoing randomized controlled trials.

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