Sub-total Laparoscopic Gastrectomy Provides an Appropriate Oncologic Procedure in Selected Patients With Antral Adenocarcinoma

Samantha Benlolo, Jonathan Cools-lartigue, MD, Victoria Marcus, MD, Lorenzo Ferri, MD PhD. Department of Surgery McGill University Health Center, Department of Pathology McGill University Health Center, Steinberg-Bernstein Center for Minimally Invasive Surgery


Introduction: Laparoscopic gastrectomy (LG) is being employed with increasing frequency in the management of gastric cancer. However, the short-term benefit and oncologic adequacy of this approach remains incompletely characterized, precluding its routine employment in many institutions. Accordingly, we sought to evaluate the results of LG in patients with distal gastric adenocarcinoma compared to those undergoing open surgery.?

Methods: All patients undergoing gastrectomy from 2005-11 at a North American university hospital were identified from a prospectively collected database. In an attempt to limit confounding factors, we elected to study only patients undergoing resection of distal gastric adenocarcinoma. Patients undergoing subtotal gastrectomy for antral adenocarcinoma were divided into two groups depending on the surgical approach (laparoscopic gastrectomy LG vs open gastrectomy OG). LG and OG were compared in terms of patient demographics, histologic tumor type, tumor size, adequacy of oncologic resection (lymphadenectomy and R0 resection), AJCC stage, incidence and severity of post-operative complications, and hospital length of stay. Post-operative complications were classified according to the scale proposed by Clavien (0 = none; 1-2 = minor; 3-5 = major). Data are presented as median (range). Mann-Whitney U and Fischer’s exact test were used to determine significance (*p<0.05).

?Results: One hundred and seven patients underwent gastrectomy over the study period, of which 37 were subtotal gastrectomies for antral adenocarcinoma (LG=17: OG=20). Patient age (LG=75yrs (52-86):OG=76yrs (49-87)) and sex (LG=12/17 male: OG 11/20 male) did not differ between the two groups. Tumor size was similar (LG = 4cm(1-6.5):OG=4cm(1.5-10), but there were more stage I cancers in the LG group (11/17 vs 3/20)*. No difference was observed in those who achieved R0 resection (LG= 15/17(88%):OG=18/20(90%)). There was no difference in lymph node retrieval (LN= 26(12-84): OG=27(12-89)) between the two groups, but more OG patients received a formal D2 dissection (LG=10/17(59%): OG =16/20(80%))NS. Patients in the OG group were more likely to harbor positive lymph nodes and in greater numbers than patients in the LG group (LG= 0(0-19):OG=2(0-14))*. There was a trend for decreased rate, and severity of complications (none/minor/major), in patients undergoing laparoscopic resection (LG 10/5/2 : OG 8/7/5). This translated into more LG patients that were discharged by post-operative day 5 than OG (6/17(35%) vs 0/20)*.?

Conlusions: In selected patients, laparoscopic gastrectomy is associated with improved short-term outcomes, and provides an appropriate oncologic resection compared to the open approach. Additional prospective randomized studies are required to further define the role of laparoscopy in the resection of gastric cancer


Session Number: Poster – Poster Presentations
Program Number: P222
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