Laparoscopic Radical D2 Gastrectomy for Gastric Cancer Management in Two Level IV Institutions in Colombia

jorge alberto bernal mesa, md, fernando arias amezquita, md, evelyn astrid dorado alban, md. Americas Clinic Ces University, Fundacion Santa Fe Bogota

SUMMARY:
Gastric cancer is the leading cause of cancer death worldwide and the third in prevalence, in our setting the highest percentage corresponds to advanced stages with 50% commitment T4 and 80% nodal .
This verified the impact on the prognostic factor of lymph node dissection.

In 1991 Kitano described the first video-assisted gastrectomy, turning in a minimally invasive option for cancer. The radical lymph node dissection is defined in> 15 nodes, node index < 20, free margins .

OBJECTIVE
Evaluating the radical surgical laparoscopic gastrectomy in the surgical management of patients with gastric cancer determined by the nodal index and resection margins, as well as the immediate postoperative complications, mortality and recurrence.
METHODS.
Descriptive retrospective study over a period of five years (January 2005 – July 2010) with an initial cohort of 136 patients at two Level IV institutions in Colombia: Clinica Las Americas Oncology Institute of Medellin and Fundacion Santa Fe de Bogota.

RESULTS
Final cohort: 64 patients distributed as follows: 7 Fundación Santa Fe de Bogota and 57 of the Institute of Clinical Oncology lasAmericas.
The age and sex distribution was homogeneous in both groups: 27 women (42.2%) and 37 men (57.8%)
The patients were mainly bleeding 29% and epigastric pain 37%
10.5% (6) had family history of gastric cancer
The average age was 60-80 years.
All patients underwent preoperative endoscopy: 58% of antral lesions and 26% of the gastric body, CTA with 46% total commitment of the gastric wall and nodal 22% commitment.
laparoscopic staging was performed in all patients.

The subtotal gastrectomy were 80% and 20% Total. Mean operative time was between 180 and 300 minutes, being more prolonged in total gastrectomy.
100% of patients had bleeding> 500 cc.
The final pathology results showed:
72% bad and moderately differentiated adenocarcinomas, 67% ulcerated, 82% intestinal type, diffuse 17%, 96% involve the serosa, 100% free margins, lymph node count between15 to 30: 72% and > 30: 20 % nodal index < 20: 87%.
Early complications 7% (4) consist of: 2 leaks from the duodenal stump, a colonic lesion by the drain, a pulmonary embolism, an evisceration.
No procedure-related mortality

Average hospital stay 5 days
Feed and flatus: 3 day postoperative
2 day postoperative ambulation.

CONCLUSIONS
• laparoscopic radical gastrectomy for gastric neoplasms management is feasible in highly complex centers with advanced laparoscopic service with comparable oncological results to open procedures with free margins, adequate lymph node count, with a low complication rate and very low recurrence rate.
• In addition, these patients have a lower hospital stay with early onset of mouth, lower blood loss, without postoperative nutritional support early resumption of activities.


Session: Poster
Program Number: P262
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