Laparoscopic Gastrectomy with Lymph Node Dissection for Gastric Cancer

Bac Nguyen Hoang, PhD, Long Vo Duy, MD, Long Tran Cong Duy, MD, Thuan Nguyen Duc, MD. University Medical Center, Ho Chi Minh city, Viet Nam

Background Laparoscopic gastrectomy with lymph node dissection for gastric cancer is emerging in Viet Nam as a technique that may offer benefits for patients. But the controversy surrounding this procedures for gastric adenocarcinoma involves whether lymphadenectomy and other oncologic features of the resection are equivalent to the open technique. The purpose of this study was to evaluate technical feasibility, the safety, oncologic efficacy and the early outcomes of laparoscopic gastrectomy with lymph node dissection for gastric adenocarcinoma.

Methods This was a prospective, case-series with a total of 55 patients affected gastric adenocarcinoma between March 2007 and May 2010, at University Medical Center, Hochiminh city, Vietnam. Of this 55 patients, 50 patients underwent laparosopic distal gastrectomy and 5 patients underwent laparoscopy- assisted total gastrectomy. The extracorporeal anastomosis was performed by using the hand-sewn technique. Demographics, ASA status, pTNM stage, histological type of the tumor, tumor diameter, operative time, intraoperative blood loss, number of resected lymph nodes, postoperative complications and 1-year, 2-year, 3-year overall survival rates were studied to assess outcomes of this procedure.

Results There were 25 women and 30 men with a mean age of 55 years. In all patients, the procedures were completed laparoscopically with D2 resection, without any conversion. For total gastrectomy, a Roux-en-Y reconstruction was performed, and a Billroth II reconstruction was used in subtotal gastrectomy. Stages of the tumor were IA in 9 (16.4%) patients, IB in 5 (9.1%), II in 8 (14.5%), IIIA in 20 (36.4%), IIIB in 9 (16.4%), and IV in 4 (7.3%) patients. The mean operating time was 173 ± 21 minutes. The estimated intraoperative blood loss was 112 ± 16 ml, and no transfusion was required. The mean number of resected lymph nodes was 28.6 ± 12.4. All resected margin was negative. No patients occurred postoperative leakage. The mean hospital length of stay was 6.6 ± 0.5 days. The overall postoperative complication rates were 7.3% (4 patients), including wound infections (n = 3 patients) and intra-abdominal abscesses (n = 1 patient), but no reoperation was required . The histological types were well differentiated in 27 cases (49.1%), moderately differentiated in 16 cases (29.1%) and poorly differentiated in 12 cases (21.8%). No mortality was observed. One-year, two-year and three-year overall survival rates were 90.1%, 81.8% and 72.3%, respectively.

Conclusions The results of current study suggested that laparoscopic gastrectomy for gastric cancer is technical feasibility, oncological efficacy and safe technique. Additional benefits of decreased postoperative complications and decreased length of hospital stay make this a preferable appoach for selected patients.