Comparison of Open and Laparoscopic Gastrectomy With Lymph Node Dissection for Gastric Cancer

Bac Nguyen Hoang, Prof PhD, Long Vo Duy, Ms, Long Tran Cong Duy, Ms, Thuan Nguyen Duc, MD. University Medical Center, Hochiminh city, Vietnam


Background: Laparoscopic gastrectomy with lymph node dissection for gastric cancer has been performed in Vietnam as a technique that may offer benefits for patients. However, many controversies exist due to no evidence and no long-term results. There was no prospective multi-center large-scale randomized controlled trial in the world on the long-term outcome of laparoscopic gastric cancer surgery. The aim of this study was to compare technical feasibility, morbidity, mortality and 3-year survival of open and laparoscopic gastrectomy with lymph node dissection for gastric cancer.
Method: This study was designed as a prospective, non-randomized clinical trial with a total of 212 patients affected gastric adenocarcinoma between March 2007 and August 2011, at University Medical Center, Hochiminh city, Vietnam. Of these, 130 (61.3%) patients were underwent open gastrectomy (OG), while 82 (38.7%) patients were to the laparoscopic gastrectomy (LG) group. Demographics, ASA status, pTNM stage, histologic type of the tumor, number of resected lymph nodes, operative time, intraoperative blood loss, postoperative complications, and 3-year overall survival rates were studied to assess outcome differences between the groups.
Results: In all patients, the procedures were completed with D2 resection. For total gastrectomy, a Roux-en-Y reconstruction was performed, and a Billroth II reconstruction was used in subtotal gastrectomy. There was no conversion to laparotomy in the laparoscopic group. The demographics, preoperative data, and characteristics of the tumor were similar in the two groups. There was no significant differences in the mean operative time (176 vs. 182 min.), and the estimated intraoperative blood loss (120±20 vs. 102±16 ml), (OG vs. LG, respectively). No transfusion was required in the two groups. The mean number of resected lymph nodes was 31.4 ± 15.3 in the OG group and 29.3±12.4 in the LG (P>0.5). All resected margin was negative and no patients occurred postoperative leakage and mortality in the 2 groups. A significant differences were found in the median hospital length of stay (8,2±2,1 vs. 6±1,5 days; p=0.03), and the overall postoperative complications (13.8% vs. 7,2%; p=0.025), (OG vs. LP, respectively). The postoperative complications include the wound infections (10 vs. 3 patients), intra-abdominal abscesses (2 vs. 1 patients), deep wound dehiscence (1 vs. 0 patient), and minor medical disorders (5 vs. 2 patients), (OG vs. LG, respectively). One patients with wound dehiscence in the OG group was required reoperation to close the abdominal wall but no reoperation was required in LG group. Three-year overall survival rates were 72.4% and 75.8% in the OG and LG groups, respectively (P>0.5).
Conclusions: Laparoscopic gastrectomy for gastric adenocarcinoma is comparable to the open approach with regard to oncologic principles of resection, with equivalent margin status and adequate lymph node retrieval, demonstrating technically feasibility and equivalent 3-years survival. Additional benefits of decreased postoperative complications, decreased length of hospital stay make this a preferable approach for selected patients.

Session Number: SS18 – Foregut
Program Number: S100

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