J Gastric Cancer.  2012 Mar;12(1):18-25.

Long-Term Outcomes and Feasibility with Laparoscopy-Assisted Gastrectomy for Gastric Cancer

• Kim KH
• Kim MC
• Jung GJ
• Kim HH

Abstract

PURPOSE
Recently, laparoscopy-assisted gastrectomy (LAG) has been widely accepted modality for early gastric cancer in Korea. The indication of LAG may be extended in an experienced institution. In our institution, the first case of laparoscopy-assisted gastrectomy (LAG) for gastric cancer was performed in May 1998. We retrospectively reviewed the long-term oncologic outcomes over 12 years to clarify the feasibility of LAG for gastric cancer.
MATERIALS AND METHODS
The authors retrospectively analyzed 753 patients who underwent LAG for gastric cancer, from May 1998 to August 2010. We reviewed clinicopathological features, postoperative outcomes, mortality and morbidity, recurrence, and survival of LAG for gastric cancer.
RESULTS
During the time period, 3,039 operations for gastric cancer were performed. Among them, 753 cases were done by LAG (24.8%). There were 69 cases of total gastrectomy, 682 subtotal gastrectomies, and 2 proximal gastrectomies. According to TNM stage, 8 patients were in stage 0, 619 in stage I, 88 in stage II, and 38 in stage III. The operation-related complications occurred in 77 cases (10.2%). Median follow-up period was 56.2 months (range 0.7~165.6 months). Twenty-five patients (3.3%) developed recurrence, during the follow-up period. The overall 5-year and disease free survival rates were 97.1% and 96.3%, respectively.
CONCLUSIONS
The number of postoperative complications and survival rates of our series were comparable to the results from that of other reports. The authors consider LAG to be a feasible alternative for the treatment of early gastric cancer. However, rationale for laparoscopic surgery in advanced gastric cancer has yet to be determined.

Keyword

Laparoscopy; Gastric cancer; Survival

MeSH Terms

Disease-Free Survival
Follow-Up Studies
Gastrectomy
Humans
Korea
Laparoscopy
Postoperative Complications
Recurrence
Retrospective Studies
Stomach Neoplasms
Survival Rate

Figure

• 

  Fig. 1 Annual results of laparoscopy-assisted gastrectomy. LAG = laparoscopy-assisted gastrectomy.

• 

  Fig. 2 Survival characteristics of patients. The overall 5 year survival rate (A) and disease free survival rate (B) of all 753 patients were 97.1% and 96.3%, respectively.

• 

  Fig. 3 Comparison of overall 5-year survival rate (A) and disease free survival rate (B) according to TNM stage based on the 7th edition of the American Joint Committee on Cancer staging criteria. Overall 5-year and disease free survival rates of stage 0, I, II, and III were 100, 99.3, 89.5, and 76.1% and 100, 98.3, 89.4, 80.2, and 78.2%, respectively.

Reference

1. van de Velde CJ, Peeters KC. The gastric cancer treatment controversy. J Clin Oncol. 2003. 21:2234–2236.

2. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007. 245:68–72.

3. Kim MC, Kim KH, Kim HH, Jung GJ. Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol. 2005. 91:90–94.

4. Kim MC, Kim HH, Jung GJ. Surgical outcome of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer. Eur J Surg Oncol. 2005. 31:401–405.

5. Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y. Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years' experience. Surg Laparosc Endosc Percutan Tech. 2002. 12:204–207.

6. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010. 251:417–420.

7. Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hatakawa Y, et al. Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy. Gastric Cancer. 2001. 4:98–102.

8. So KO, Park JM. Totally laparoscopic total gastrectomy using intracorporeally hand-sewn esophagojejunostomy. J Gastric Cancer. 2011. 11:206–211.

9. Tanaka N, Katai H, Saka M, Morita S, Fukagawa T. Laparoscopy-assisted pylorus-preserving gastrectomy: a matched case-control study. Surg Endosc. 2011. 25:114–118.

10. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, editors. American Joint Committee on Cancer (AJCC) cancer staging manual. 2002. 6th ed. New York, NY: Springer.

11. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 2010. 7th ed. New York: Springer.

12. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011. 14:113–123.

13. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004. 350:2050–2059.

14. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994. 4:146–148.

15. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi JJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008. 248:721–727.

16. Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer. 1999. 2:230–234.

17. Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH. Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc. 2009. 23:1252–1258.

18. Shuang J, Qi S, Zheng J, Zhao Q, Li J, Kang Z, et al. A case-control study of laparoscopy-assisted and open distal gastrectomy for advanced gastric cancer. J Gastrointest Surg. 2011. 15:57–62.

19. Kitamura K, Yamaguchi T, Taniguchi H, Hagiwara A, Sawai K, Takahashi T. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol. 1997. 64:42–47.

20. Kunisaki C, Shimada H, Nomura M, Akiyama H. Appropriate lymph node dissection for early gastric cancer based on lymph node metastases. Surgery. 2001. 129:153–157.

21. Nomura S, Kaminishi M. Surgical treatment of early gastric cancer. Dig Surg. 2007. 24:96–100.

22. Adachi Y, Shiraishi N, Kitano S. Modern treatment of early gastric cancer: review of the Japanese experience. Dig Surg. 2002. 19:333–339.

23. Sasako M, Saka M, Fukagawa T, Katai H, Sano T. Surgical treatment of advanced gastric cancer: Japanese perspective. Dig Surg. 2007. 24:101–107.

24. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005. 19:168–173.

25. An JY, Heo GU, Cheong JH, Hyung WJ, Choi SH, Noh SH. Assessment of open versus laparoscopy-assisted gastrectomy in lymph node-positive early gastric cancer: a retrospective cohort analysis. J Surg Oncol. 2010. 102:77–81.

26. Song J, Lee HJ, Cho GS, Han SU, Kim MC, Ryu SW, et al. Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Recurrence following laparoscopy-assisted gastrectomy for gastric cancer: a multicenter retrospective analysis of 1,417 patients. Ann Surg Oncol. 2010. 17:1777–1786.

27. Tokunaga M, Hiki N, Fukunaga T, Ohyama S, Yamada K, Yamaguchi T. Better prognosis of T2 gastric cancer with preoperative diagnosis of early gastric cancer. Ann Surg Oncol. 2009. 16:1514–1519.

28. Lee J, Kim W. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol. 2009. 100:693–698.

29. Hwang SH, Park do J, Jee YS, Kim MC, Kim HH, Lee HJ, et al. Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. Arch Surg. 2009. 144:559–564.

30. Fujiwara M, Kodera Y, Misawa K, Kinoshita M, Kinoshita T, Miura S, et al. Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery. J Am Coll Surg. 2008. 206:138–143.