title: Totally laparoscopic gastric resection with extended lymphadenectomy for gastric adenocarcinoma.
abstract: BACKGROUND
  Laparoscopic gastric resection with extended lymphadenectomy is being evaluated in North America for the surgical treatment of gastric cancer. The aim of this study is to compare short-term postoperative and oncologic outcomes of laparoscopic and open resection for gastric cancer at a single cancer center.
  
  
  METHODS
  The study population consisted of patients with gastric adenocarcinoma who underwent a completely abdominal intervention with curative intent. Laparoscopic and open gastric resections were compared. A totally laparoscopic technique was employed with a robotic extended lymphadenectomy in a subset of patients.
  
  
  RESULTS
  A total of 78 consecutive patients were evaluated, including 30 laparoscopic and 48 open procedures. An extended lymphadenectomy was performed in 58 patients and was executed robotically in 16 of these. There was no difference in the mean number of lymph nodes retrieved by laparoscopic or open approach (24 +/- 8 vs. 26 +/- 15, P = .66). Laparoscopic procedures were associated with decreased blood loss (200 vs. 383 mL, P = .0009) and length of stay (7 vs. 10 days, P = .0009), but increased operative time (399 vs. 298 minutes, P < .0001).
  
  
  CONCLUSIONS
  Completely laparoscopic gastric resection yields similar lymph node numbers compared with open surgery for gastric cancer. It was found to be advantageous in terms of operative blood loss and length of stay. Minimally invasive techniques represent an oncologically adequate alternative for the surgical treatment of gastric adenocarcinoma.
authors.affiliation: Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Guzman
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.forename: Byrne
authors.initials: B
authors.lastname: Lee
authors.forename: Perry A
authors.initials: PA
authors.lastname: Soriano
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Nelson
authors.forename: I
authors.initials: I
authors.lastname: Benjamin Paz
authors.forename: Vijay
authors.initials: V
authors.lastname: Trisal
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.forename: Joshua D I
authors.initials: JD
authors.lastname: Ellenhorn
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome