S J MacLellan, MD, H MacKay, MD, L Jacks, MSc AStat, Z Kassam, MD FRCP, T Conrad, MD, I Khalili, MD, J Ringash, MD MSc FRCPC, A Okrainec, MDCM MHPE FACS FRCSC. University Health Network, University of Toronto, Toronto, ON, Canada. Princess Margaret Hospital, Toronto, ON, Canada.
Use of laparoscopic-assisted gastrectomy has gained acceptance as a treatment option for early gastric cancer. Its role in advanced gastric cancer however remains unclear. The objective of this study was to assess survival outcomes and patterns of recurrence for patients undergoing laparoscopic assisted gastrectomy compared to open surgery for advanced gastric cancer.
We reviewed consecutive patients with gastric cancer, treated with resection and adjuvant chemoradiation (45Gy/25 with 5FU-based chemotherapy), at a single quaternary care comprehensive cancer center between Jan. 1, 2000 and Nov. 30, 2009. Of 203 patients, 21 were treated with laparoscopic-assisted gastrectomy. These patients were compared to open surgery, and evaluated for overall survival (OS), relapse-free survival (RFS), and site of first disease recurrence.
Among 21 patients in the laparoscopic group, median age was 61.3 (28.2-76.6) and median follow-up was 21.3 (6.7 – 50.4) months; 71% were male. Most had AJCC/UICC TNM v6 stage II (33%) or III (52%) disease. These demographic characteristics were similar in both the laparoscopic and open groups. The incidence of recurrence for patients with advanced gastric cancer was 38.1% (8/21) in the laparoscopic group, and 36.8% (67/182) in the open group. In the laparoscopic group, the site of first recurrence was distant in 3 patients, peritoneal in 4, and mixed in 1 (locoregional and distant). There was no significant difference in recurrence patterns when compared to patients undergoing open resection. In the open group, recurrence was distant in 26, peritoneal in 12, locoregional in 15, and 14 presented with a mixed pattern. The 3-year RFS was 58.0% (50 – 66), and was not statistically significant between the two groups by Gray’s test (p=0.32). The 3-year OS was 65.9% (58 – 73), and was not significantly different between the groups on univariate (p=0.92) or multivariate (p=0.54) analyses.
Our study suggests laparoscopic assisted gastrectomy is an oncologically safe procedure for advanced gastric cancer with comparable outcomes to open gastrectomy.
Program Number: S041