Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer.
OBJECTIVE
Laparoscopy-assisted surgery has proved useful in the treatment of early gastric cancer, but its use in advanced cancer has rarely been studied. To investigate the efficacy and advantages of laparoscopy-assisted distal gastrectomy (LADG) with D2 dissection of lymph nodes versus conventional open D2 distal gastrectomy (ODG) in advanced gastric cancer.


METHODS
From January 2007 to June 2008, the clinical data of 66 cases of LADG for advanced gastric cancer were compared with that of 69 patients who, during the same period, underwent a conventional open radical distal gastrectomy.


RESULTS
No patient in the LADG group converted to conventional operation with laparotomy. Operative time was significantly longer for the LADG group than for the ODG group (266.05 +/- 55.05 vs. 223.78 +/- 26.79 min). No significant differences were found in the total number of retrieved lymph nodes (25.81 +/- 12.53 vs. 27.47 +/- 10.28) between the two groups. Patients in the LADG group had less blood loss, shorter time of analgesic use, earlier recovery of bowel activity, and shorter postoperative hospitalization time. Complication rates were comparable between the two groups.


CONCLUSIONS
LADG with D2 lymph node dissection is a safe and feasible procedure with adequate lymphadenectomy for the treatment of advanced gastric cancer. A large-scale prospective randomized trial with a longer follow-up period is needed to definitively assess whether LADG is a better alternative than ODG with D2 lymph node dissection.
Huang
Jiang Long
JL
Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Wei
Hong Bo
HB
Zheng
Zong Heng
ZH
Wei
Bo
B
Chen
Tu Feng
TF
Huang
Yong
Y
Guo
Wei Ping
WP
Hu
Baoguang
B
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D005773:Gastroscopy / Q000379:methods / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007813:Laparotomy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome