title: Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery.
abstract: BACKGROUND
  Laparoscopy-assisted approaches have become popular for dissecting early-stage gastric cancer in Japan, but the outcomes after 5 years of followup have not been reported.
  
  
  METHODS
  Between January 1998 and March 2002, 94 patients with histologically proved early-stage gastric carcinoma participated in clinical studies and underwent gastrectomy with regional lymphadenectomy to evaluate feasibility and safety of the laparoscopy-assisted approach. Outcomes and pattern of disease failure during followup up to 5 years were evaluated in all patients. Multivariable analysis was performed to identify relevant prognostic factors.
  
  
  RESULTS
  Conversion to open procedures occurred in three patients. Median blood loss was 90 mL (interquartile range, 160 mL), and duration of operation was 230 minutes (interquartile range, 60 minutes). Operative morbidity and mortality were 22.3% and 0%, respectively. Nine patients died during the course of followup, for an overall 5-year survival rate of 90%. Two patients died of recurrent disease, and 2 other patients have been diagnosed with recurrences, for a 5-year recurrence-free survival of 95.6%. Three patients with recurrent cancer, including 1 with port-site recurrence, had stage IA disease (pT1pN0) at operation. Diabetes mellitus as a comorbidity was prominent as a prognostic factor.
  
  
  CONCLUSIONS
  Outcomes of patients with a preoperative diagnosis of early-stage cancer were excellent when treated with a laparoscopy-assisted approach, although rare patterns of disease failure were observed.
authors.affiliation: Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Michitaka
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.forename: Kazunari
authors.initials: K
authors.lastname: Misawa
authors.forename: Mizunobu
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Takashi
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Shinichi
authors.initials: S
authors.lastname: Miura
authors.forename: Norifumi
authors.initials: N
authors.lastname: Ohashi
authors.forename: Goro
authors.initials: G
authors.lastname: Nakayama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koike
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome