title: A propensity score-matched case-control comparative study of laparoscopic and open extended (D2) lymph node dissection for distal gastric carcinoma.
abstract: BACKGROUND
  Technical proficiency at laparoscopic D2 lymph node dissection (LND) is essential for extending the use of laparoscopic surgery beyond the treatment of early gastric cancer (EGC). The aim of this study was to evaluate the technical and oncological feasibility of laparoscopic distal gastrectomy (LDG) with D2 LND for distal gastric cancer.
  
  
  METHODS
  Of 922 patients who underwent open or LDG with D2 LND for gastric carcinoma, 133 treated by LDG and 133 treated by open distal gastrectomy (ODG) were selected using the propensity score matching method. The short-term surgical outcomes and long-term survivals of these matched groups were compared.
  
  
  RESULTS
  The two study groups were well matched with respect to age, sex, body mass index, comorbidity, ASA score, abdominal operation history, and tumor stage. The LDG group had a significantly longer mean operating time (227 vs. 161 min, p < 0.001) but showed significantly less intraoperative blood loss (149 vs. 189 ml, p = 0.007). Total numbers of collected lymph nodes were similar in the two groups. Postoperatively, no significant intergroup differences were found for hospital stay, morbidity, or mortality. Furthermore, overall survivals were similar in the two groups (p = 0.621). Multivariate analysis showed that male gender, age ≥70 years, and intraoperative blood loss of ≥200 ml were independent risk factors of postoperative morbidity.
  
  
  CONCLUSIONS
  Laparoscopic D2 LND for distal gastric cancer is technically safe and feasible compared with ODG. A prospective randomized trial is warranted to evaluate long-term oncological outcomes in advanced gastric carcinoma.
authors: Division of Gastroenterologic Surgery, Department of Surgery, College of Medicine, Chonnam National University, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do 519-809, South Korea.
authors: Xue-Feng
authors: XF
authors: Zhao
authors: Oh
authors: O
authors: Jeong
authors: Mi Ran
authors: MR
authors: Jung
authors: Seong Yeop
authors: SY
authors: Ryu
authors: Young Kyu
authors: YK
authors: Park
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057216:Propensity Score; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
references: Surg Endosc. 2005 Feb;19(2):168-73
references: 15580441
references: Gastric Cancer. 2011 Jun;14(2):113-23
references: 21573742
references: Cancer Res Treat. 2012 Mar;44(1):11-24
references: 22500156
references: J Am Coll Surg. 2004 Jun;198(6):933-8
references: 15194075
references: Surg Endosc. 2009 Aug;23(8):1759-63
references: 19057958
references: Surg Endosc. 2003 Sep;17(9):1440-4
references: 12820059
references: Surg Endosc. 2012 Jun;26(6):1548-53
references: 22170319
references: Ann Surg. 2008 Nov;248(5):721-7
references: 18948798
references: Surg Endosc. 2010 Nov;24(11):2739-42
references: 20364352
references: J Gastrointest Surg. 2012 Oct;16(10):1854-9
references: 22847575
references: Stat Med. 1998 Oct 15;17(19):2265-81
references: 9802183
references: Dig Surg. 2010;27(4):291-6
references: 20689290
references: Gastric Cancer. 2012 Jul;15(3):299-304
references: 22083419
references: Surg Endosc. 2005 Sep;19(9):1172-6
references: 16132323
references: Surg Endosc. 2008 Mar;22(3):655-9
references: 17593447
references: World J Gastroenterol. 2006 Dec 21;12(47):7676-83
references: 17171799
references: Surg Endosc. 2005 Dec;19(12):1592-6
references: 16247578
references: Gastric Cancer. 2000 Aug 4;3(1):50-55
references: 11984710
references: Surg Laparosc Endosc. 1994 Apr;4(2):146-8
references: 8180768
references: Surg Endosc. 2012 Aug;26(8):2240-6
references: 22311300
references: World J Surg. 2008 Nov;32(11):2366-70
references: 18668280
references: Ann Surg. 2007 Jan;245(1):68-72
references: 17197967
references: World J Surg. 2012 Oct;36(10):2400-11
references: 22752074
references: Gastric Cancer. 1998 Dec;1(1):10-24
references: 11957040
references: J Laparoendosc Adv Surg Tech A. 2007 Aug;17(4):455-7
references: 17705725
references: J Gastric Cancer. 2011 Jun;11(2):69-77
references: 22076206