Laparoscopic Gastrectomy for Early Gastric Cancer

Waldemar Adelsdorfer, MD, Dulce Momblan, MD, Cedric Adelsdorfer, MD, Elizabeth Pando, MD, Salvadora Delgado, MD, Raul Almenara, MD, Ainitze Ibarzabal, MD, Antonio Lacy, MD. Hospital Clinic de Barcelona

Laparoscopic gastrectomy in early gastric cancer
Introduction
The incidence of early gastric cancer has increased in recent years, up to 50% in some countries, like Japan. Laparoscopic gastrectomy is a complex procedure and requires experienced surgeons. The aim of this study was to evaluate the surgical outcomes and oncological medium-term results of a series of patients undergoing laparoscopic gastrectomy for early gastric cancer.
Patients and Methods
Prospective study of consecutive patients undergoing laparoscopic gastrectomy for early gastric cancer between January 2005 and October 2010. Early gastric cancer was defined according to Japanese Classification of gastric carcinoma. We analyze the demographic and clinical variables, surgical outcomes, morbidity and postoperative mortality, and oncologic outcomes.
Results
27 laparoscopic gastrectomy were performed, 15 total, 9 subtotals and 3 partial. The average age was 67 ± 16, 59.3% were female. 74.1% had co-morbidity. 63% were ASA II. 92.6% of the cases were symptomatic, 33.3% had anemic syndrome, 25.9% upper gastrointestinal bleeding and 25.6% abdominal pain. The location of the tumor was 11.1% in the upper third, middle third 55.6% and lower third 33.3%. pTNM Stage was 0 in 11.1%, 59.3% IA and 29.6% IB. Mean operative time was 243 minutes ± 81. Conversion in 1 patient due to difficulty in mobilizing the tumor. Regional lymphadenectomy in 18.5%. Lymphadenectomy D1 in 25.9% and D2 55.6% The average of lymph nodes retrieved was 12 ± 9. R0 resection was performed in 100% of cases. They had to be re-operated 3 patients, 1 for intra-abdominal collection and 2 for bleeding. Operative morbidity was 22.2%, 1 patient presented suture failure of conservative management. There was no operative mortality. The hospital stay was 9 ± 6 days. The median follow-up was 26 months. Overall survival was 90.5% at 36 months. Specific disease-survival was 83.3% at 36 months. The overall recurrence rate was 7.4% (2 / 27), 1 with local recurrence (81 years) and 1 with liver metastases (84 years). Disease-free survival was 84% at 36 months.
Conclusions
Laparoscopic gastrectomy in early gastric cancer is a feasible and safe procedure in hands of experienced surgeons with comparable oncologic outcomes to open surgery. The surgical outcomes and oncology results are similar to other publications. There was no operative mortality in our series.

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