Francesco Feroci, MD, Elisa Lenzi, MD, Maddalena Baraghini, MD, Stefano Cantafio, MD, Luca Moraldi, MD, Katrin C Kroning, MD, Marco Scatizzi, MD. General Surgery Department, Misericordia e Dolce Hospital, Prato, Italy.
Background: In a non specialized setting, laparoscopic gastrectomy for advanced diseases remains controversial, particularly given to the technical demands of the learning curve required to perform an adequate resection with D2 lymph node dissection.
Methods: Inclusion criteria for this statistically generated case–control study were all patients who underwent subtotal laparoscopic gastrectomies from January 2006 until June 2009 for gastric adenocarcinoma both early and advanced, compared with matched patients who underwent the same procedure in an open fashion during the same period. Patient demographics, presenting symptoms/signs and tumour locations, surgical outcome, postoperative complications, pathologic findings and overall survival were collected on a prospectively maintained database.
Results: Fifty case-matched patients were evaluated (25 laparoscopic versus 25 open). Body Mass Index (BMI) was significantly lower for LDG group as the number of patients with previous abdominal operation (p<0.05). Operative time was significantly longer (p<0.05) for LDG, 240±65 min, than ODG, 180±49. Benefits for LDG (p<0.05) were observed among surgical short-term outcome (Postoperative hospital stay, ambulation, first bowel movement, first flatus, first stool, first eating and use of analgesic drugs) and postoperative non surgical site complications (cardiopulmonary, urinary etc). Forty-two months overall survival was similar (p=0.646) between the two groups.
Conclusion: Laparoscopic gastrectomy is a safe technique in a non-academic hospital setting; in
selected patients it seems to be equivalent to open gastric resection ones in terms of margin status
and adequate lymph node retrieval; furthermore the laparoscopic approach is associated with additional benefits as a decreased length of hospital stay, a decreased narcotic use and fewer complications.
Program Number: P253