title: Evaluation of the recurrence pattern of gastric cancer after laparoscopic gastrectomy with D2 lymphadenectomy.
abstract: BACKGROUND
  The aim of this study was to analyze the oncological aspects of gastric cancer following laparoscopic gastrectomy with D2 lymphadenectomy (LG-D2).
  
  
  METHODS
  We retrospectively evaluated the long-term outcomes of 354 patients who underwent LG-D2 for primary gastric cancer. Recurrence patterns and predictors of peritoneal metastasis were analyzed.
  
  
  RESULTS
  Median follow-up time was 43.8 months. Five-year overall survival rates for yp/pStages I, II, and III gastric cancer were 93.7, 78.5, and 42.2 %, respectively. Recurrence was observed in 86 patients. Peritoneal metastasis was the most frequent recurrence pattern (n = 51), followed by hepatic metastasis (n = 17). Lymphatic recurrence at distant sites was observed in 10 patients. No locoregional lymph node metastasis or local recurrence was seen. Nine of 51 cases of peritoneal recurrence were detected by probe laparoscopy. Peritoneal recurrence rates were significantly higher in yp/pT4 and yp/pN3 diseases compared with yp/pT ≤ 3 and yp/pN ≤ 2 diseases. Multivariate analyses demonstrated that yp/pT4, yp/pN3, tumor size ≥70 mm, vascular invasion, and undifferentiated tumors were predictors of peritoneal recurrence following LG-D2.
  
  
  CONCLUSIONS
  Long-term outcomes of gastric cancer following LG-D2, including recurrence patterns and predictors of peritoneal metastasis, were comparable to those following open D2 gastrectomy. LG-D2 showed good local control. Probe laparoscopy after LG may be effective in detecting peritoneal recurrence, which is not determined with less invasive examinations, including a CT scan. Future large-scale prospective studies are desirable to evaluate not only surgical but also oncological benefits and safety of LG-D2 for advanced gastric cancer.
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan ; Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-Kita, Kitakyusyu, Fukuoka 802-8555 Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kawamura
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan ; Department of Surgery, National Hospital Organization Himeji Medical Center, 68, Honmachi, Himeji, Hyogo 670-8520 Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Satoh
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Umeki
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Suda
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192 Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Uyama
keywords: D2 lymph node dissection; Gastric cancer; Laparoscopic gastrectomy; Recurrence pattern