J Minim Invasive Surg.  2017 Dec;20(4):137-142. 10.7602/jmis.2017.20.4.137.

Laparoscopic D1+ Lymph Node Dissection for Gastric Cancer in Jehovah's Witness Patients: a 1:3 Matched Case Control Study

• Lee JK
• Kim YJ
• Park S

• KMID: 2414840
• DOI: http://doi.org/10.7602/jmis.2017.20.4.137

Abstract

PURPOSE
Laparoscopic gastrectomy in early gastric cancer patients is accepted as standard, but it is sometimes challenging for patients who refuse blood transfusions such as Jehovah's Witness (JW) patients, because of the risk of bleeding related to radical lymph node dissection. This study aimed to confirm the adequacy and safety of laparoscopic gastrectomy with D1+ lymphadenectomy in JW patients.
METHODS
From January 2009 to December 2015, 265 gastric cancer patients underwent laparoscopic gastrectomy in our institute. Among them, there were 25 JW, and they were statistically matched with 75 patients from the control groups depending on age, sex, and body mass index (BMI). In a retrospective review, patient laboratory values and their pathology results were analysed.
RESULTS
There was no significant difference when comparing the clinical characteristics of JW and control groups. There was no statistically significant difference in blood loss or operation time between the two groups. Mean blood loss was 202.4±172.6 ml in the JW group and 179.7±163.8 ml in the control group (p=0.556). The number of retrieved lymph nodes was 27.8±13.9 in the JW group and 29.3±12.1 in the control group (p=0.607). Haemoglobin and haematocrit were measured after surgery and there was no statistically significant difference between the two groups.
CONCLUSION
Laparoscopic D1+ gastrectomy in a JW may be performed with an equivalent risk to the control group. Laparoscopic gastrectomy can be applied to Jehovah's Witnesses if the specialied cancer center has sufficient experience in stomach cancer surgery, even if there is not enough experience in bloodless surgery.

Keyword

Jehovah's Witness; Laparoscopic gastrectomy; D1+ lymphadenectomy

MeSH Terms

Blood Transfusion
Bloodless Medical and Surgical Procedures
Body Mass Index
Case-Control Studies*
Gastrectomy
Hemorrhage
Humans
Jehovah's Witnesses
Lymph Node Excision*
Lymph Nodes*
Pathology
Retrospective Studies
Stomach Neoplasms*