Long Vo Duy, PhD, MD, Bac Nguyen Hoang, Anh Nguyen Vu Tuan, Hai Nguyen Viet, Quoc Ho Le Minh. University Medical Center
Background: Gastric cancer is commom disease in Vietnam. Laparoscopic gastrectomy is widely used to treat early gastric cancer. But for advanced stage, there are many controversies due to no evidence and no long-term results. The aim of this study is to validate the efficacy and safety of laparoscopic subtotal gastrectomy for gastric cancer compared with open gastrectomy.
Method: This study was designed as a prospective, non-randomized clinical trial with a total of 622 patients affected gastric adenocarcinoma between July 2008 and June 2017, at University Medical Center, Hochiminh city, Vietnam. Of these, 310 (49.8%) patients were underwent open subtotal gastrectomy (OG), while 312 (50.2%) patients were to the laparoscopic subtotal 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 5-year overall survival rates were studied to assess outcome differences between the groups.
Results: In all patients, the procedures were completed with D2 resection. Laparoscopic subtotal gastrectomy was associated with significantly less blood loss (40 ± 15 ml in LG vs. 84 ± 26 ml in OG, p = 0.035) and post-operative hospital stay (7,2 ± 1,1 days in LG vs. 8.4 ± 1.5 days in OG, p = 0.042), but with similar operating time compared with the open gastrectomy (176 ± 24 minutes in LG vs. 182 ± 19 minutes in OG, p = 0.12). No significant difference in the number of lymph nodes dissected was observed between these two groups (32.4 ± 15.3 in LG vs. 30.3 ± 13.4 in OG, p = 0.085). All resected margin was negative in the 2 groups. The morbidity and mortality rates of the LG group were comparable to those of the OG group (11.6% vs. 13.5%, P = 0.065, and 0.2% vs. 0.2%, P = 0.084). Five-year overall survival rates were 65.4% and 63.8% in the LG and OG groups, respectively (P = 0.09).
Conclutions: Laparoscopic subtotal 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 5-years survival. Additional benefits of decreased blood loss and length of hospital stay make this a preferable approach for selected patients
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87814
Program Number: P438
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster