title: Long-term outcome after laparoscopic gastrectomy: a multicenter retrospective study.
abstract: BACKGROUND
  Despite its spread and advances, laparoscopic gastrectomy (LG) for advanced gastric cancer (AGC) remains controversial. The aim of this study was to evaluate the oncologic outcomes and to identify the potential risk factors for recurrence and survival after LG in AGC patients.
  
  
  METHODS
  The medical records of patients who underwent radical LG for histopathologically diagnosed stage IB or more advanced gastric cancer from 2004 to 2012 were collected. The clinicopathologic factors and outcomes were evaluated retrospectively.
  
  
  RESULTS
  LG was performed for 300 patients, with a median operative time of 278 min and blood loss of 46 ml. Postoperative morbidity was defined as Clavien-Dindo grades III and IV and occurred in 13 patients (6.3%) in the laparoscopic distal gastrectomy group. The pathologic stage was IB in 109 patients (36.3%), IIA in 77 patients (25.7%), IIB in 48 patients (16.0%), IIIA in 31 patients (10.3%), IIIB in 19 patients (6.3%), and IIIC in 16 patients (5.3%). Median follow-up period was 55.2 months. The 3-year relapse-free survival (RFS) rate was 92.7% for stage IB, 87.0% for IIA, 68.8% for IIB, 64.5% for IIIA, 47.4% for IIIB, and 43.8% for IIIC. The 5-year actual overall survival rate was 91.1% for stage IB, 72.7% for II, and 62.5% for III. Multivariate analysis revealed postoperative complication as an independent risk factor for RFS.
  
  
  CONCLUSIONS
  LG for AGC was feasible and provided comparable oncologic outcomes with those previously reported. Postoperative complications correlated with poor prognosis. Randomized control trials should be conducted to confirm these results of LG for AGC in the general population.
authors.affiliation: Department of Surgery, Sapporo Kiyota Hospital, Shinei 1-1-1-1, Kiyota-ku, Sapporo, Hokkaido, Japan. hkawase@opal.plala.or.jp.|Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan. hkawase@opal.plala.or.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawase
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Yuma
authors.initials: Y
authors.lastname: Ebihara
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
authors.affiliation: Department of Surgery, Teine Keijinkai Hospital, Maeda 1-12-1-40, Teine-ku, Sapporo, Hokkaido, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Nakamura
authors.affiliation: Department of Surgery, Obihiro-Kosei General Hospital, West-6, South-8, Obihiro, Hokkaido, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Murakawa
authors.affiliation: Department of Surgery, Hokkaido Gastroenterology Hospital, Honcho 1-1, Higashi-ku, Sapporo, Hokkaido, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Surgery, Tonan Hospital, North-1, West-6, Chuou-ku, Sapporo, Hokkaido, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Okushiba
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Actual survival; Advanced gastric cancer; Laparoscopic gastrectomy; Postoperative complications; Prognosis