Laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a monoinstitutional Western center experience.
BACKGROUND
Laparoscopic gastrectomy (LAG) is safe for benign lesions; however, such surgery for cancer remains controversial. The aim of this study was to compare technical feasibility and oncologic efficacy of laparoscopic versus open gastrectomy for gastric carcinoma.


METHODS
Between January 2002 and November 2008, 109 gastric cancer patients underwent LAG (92 distal gastrectomy and 17 total gastrectomy) at our hospital. These patients were compared with 269 gastric cancer patients who underwent conventional open gastrectomy (OG; 171 distal gastrectomy and 98 total gastrectomy) during the same period.


RESULTS
Operation time was significantly longer in the LAG group than in the OG group. Estimated blood loss in the LAG group was significantly less than in the OG group. The morbidity rate was higher than in the OG group (p < 0.0001). The distance of the proximal resection margin was significantly lower in the OG group (2.8 ± 1.9 vs. 3.8 ± 2.5; p = 0.014). The mean number of nodes resected with LAG was 31 ± 14 and that with OG was 27 ± 13 (p = 0.002). The mean survival time was 53 months in both groups. There were no differences regarding overall patient survival at a mean time of follow-up of 33 months.


CONCLUSIONS
LAG with extended lymphadenectomy for gastric cancer is a feasible and safe procedure and has several advantages despite a higher rate of morbidity. Moreover, this method can achieve a radical oncologic equivalent resection and it does not have a deleterious effect on cancer-related outcome.
Department of Surgery, University Vita-Salute San Raffaele, Milan, Italy. orsenigo.elena@hsr.it
Elena
E
Orsenigo
Saverio
S
Di Palo
Andrea
A
Tamburini
Carlo
C
Staudacher
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome