Yoshiyuki Kawakami, PhD, Hidenori Fujii, PhD, Yuki Hirose, PhD. Japanese Red Cross Fukui Hospital
Aims: We previously reported that laparoscopic gastrectomy for advanced gastric cancer could be feasible with some difficult situation such in cases with D2 lymph node dissection for metastasis. Thus we introduced laparoscopic surgery after chemotherapy for unresectable gastric cancer as conversion surgery. It is expected that our technique could be useful for treating these cases.
Methods: From April of 2010 to March of 2014, 79 consecutive patients with advanced gastric cancer diagnosed as cStage IIIA/IIIB/IV were indicated for chemotherapy regimen of Docetaxel/CDDP/TS1 (DCS), CDDP/TS1 (CS), Docetaxel/TS1 (DS). We conducted to study our technique of laparoscopic gastrectomy as conversion surgery for 2 patients expected for R0/R1 resection.
Results: Clinical records of 79 cases of gastrectomy for advanced gastric cancer (From April of 2010 to March of 2014) were analyzed retrospectively in background factors, operative time and number of dissected lymph nodes, length of hospital stay. Of them, Average age: 66.8, Male/Female: 22/ 7, Primary factors of unresectability were distant metastasis for lymph node (N factor) 4 cases, metastasis for peritoneum (P factor) 3, liver metastasis (H factor) 7. DCS: 1/CS: 20/DS: 8. Average periods for chemotherapy were 2 kur (DCS)/4.7(CS)/5.8(DS). Evaluation according to RECIST were PR/SD: 1 case/0(DCS), 11/1(CS), 4/0(DS). Histological therapeutic values of primary tumor were G2: 0 case/G1b: 0/G1a: 0/G0: 1(DCS), G2: 2/G1b: 6/G1a9/G0: 3(CS) and G2: 2/G1b: 0/G1a: 2/G0: 4(DS).R0 resection: 1 case(DCS), 6(CS), 3(DS), R1 resection: 0(DCS), 5(CS), 2(DS) and R2 resection: 0(DCS), 8(CS), 3(DS). R0 resection and down staging with 1 case (DCS), 5(CS) and 2(DS), G2 with 2 cases (CS) and 2(DSC). Our 2 male cases of average age of 61.0, had primary factor of unresectability of liver metastasis (H factor). Chemotherapy regimen was CS for 1 with G0 and DS for 1 with G1a. The average number of dissected lymph nodes was 8 in both cases and the median operative time was 189 min. and 289 in each. While in open surgery group the average number of dissected lymph nodes was 12 in DCS treated group, 29.4(CS) and 16.6(DS) in each. The median operative time was 322(DCS), 249(CS) and 208(DS). No major postoperative complications were observed in laparoscopic surgery cases.
Conclusions: We conclude that our technique for laparoscopic surgery after chemotherapy for unresectable gastric cancer as conversion surgery could be useful for reducing invasiveness while keeping a safety and an oncologic curative effect as an attractive advantage in managing this condition.