Laparoscopic Surgery In Gastric Cancer: Why Aren’t We There Yet?

M. Mahir Ozmen, MD, MS, FACS, FRCS, Tevfik T Sahin, MD, PhD, Sibel Gelecek, MD, Ismail Bilgic, MD, Emre Gundogdu, MD, Emir Guldogan, MD, Munevver Moran, MD. Hacettepe University, Medical School, Department of Surgery and Ankara Numune Hospital, Department of Surgery, Ankara.

Background and Aim:
The efficacy and oncologic safety of laparoscopic surgery has been confirmed by various studies. Nevertheless; the role of laparoscopic surgery in gastric cancer is still controversial.

Patients and Methods:
14 patients who underwent laparoscopic surgery for gastric cancer were evaluated in terms of surgical technique, oncologic and surgical outcomes and complications.
Results:
There were 10 male and 4 female patients. The mean age of the patients was 56(35-70) years and tumors were located in gastric antrum in 4 patients, antrum-corpus in 2 patients, cardia in 3 patients, corpus-cardia in 3 patients and corpus in 2 patients. One patient had T1, 4 patient had T2, 6 patients had T3 and 3 patients had T4 tumors. 6 patients (2 Female) with antral tumors received distal subtotal gastrectomy (STG) plus D1 (1), D1.5 (D1 α, β) (3) and D2 (2) lymph node dissection. The remaining 8 patients (2 Female) received total gastrectomy (TG) plus D1.5 (D1 α,β) (2) or D2 (8) lymph node dissection. 4 of the 8 patients that received TG underwent concomitant splenectomy. For the patients that underwent STG the mean dissected lymph node numbers were 8 nodes in D1, 15,3(9-22) in D1.5 and 48(28-68) in D2. On the other hand; TG-D1.5 dissection had a mean dissected lymph node number of 21(16-26) and for TG-D2 it was 40(20-62). There was one patient with subhepatic abscess in the postoperative period. Abscess was drained subcutaneously and an enterocutaneous fistula developed that was treated with endoscopic Tisseel® application in postoperative 21st day. One patient with anastomotic stricture was treated by a single dilatation session in postoperative 2nd month.
Conclusion:
Total or subtotal gastrectomy with D1 (D1α, β) dissection can effectively and safely performed laparoscopically without compromising the oncological principles. However; there are still technical problems for D2 dissection and it requires experience. In addition to all, lymph node dissection groups should be redefined for laparoscopic approach.
 

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