Comparison of outcomes for laparoscopically assisted and open radical distal gastrectomy with lymphadenectomy for advanced gastric cancer

Abstract

Laparoscopically assisted gastric surgery has become an option for the treatment of early gastric cancer. However, the feasibility and safety of laparoscopically assisted gastrectomy for advanced gastric cancer has rarely been studied. This study evaluated the short- and long-term outcomes of laparoscopically assisted distal gastrectomy (LADG) for advanced gastric cancer. The study retrospectively analyzed the clinical and follow-up data for 346 cases after LADG and for 313 cases after conventional open distal gastrectomy (ODG) used to treat advanced gastric cancer from January 2004 to June 2009 at the authors' hospital. The surgical safety, postoperative complications, survival rate, and recurrence and metastasis of cancer were compared between the LADG and ODG groups. The average time for the LADG and ODG procedures did not differ significantly (211±56 vs 204±41min), but bleeding during the operation and incision length in the LADG group were significantly less than in the ODG group. The proximal and distal margins of tumors were, respectively, 6.25±2.04 and 5.68±1.71cm in the LADG group compared with 6.29±2.11 and 5.62±1.59cm in the ODG group. Neither intergroup difference was significant. The number of lymph node dissections also was similar in the two groups: 33.2±12.5 in the LADG group and 32.8±15.6 in the ODG group. The incidence of postoperative complications in the LADG group (6.7%) was significantly lower than in the ODG group (13.1%). During the follow-up period of 6 to 72months (average, 37months), the survival rates were 87.2% at 1year, 57.2% at 3years, and 50.30% at 5years in the LADG group compared with 87.1% at 1year, 54.1% at 3years, and 49.2% at 5years in the ODG group (all similar between the groups). The differences in recurrence and metastasis between the two groups were not statistically significant. Laparoscopically assisted gastrectomy for advanced gastric cancer is safe and effective. In this study, it did not differ significantly from open surgery in terms of survival rate or recurrence after surgery based on long-term follow-up evaluation. It can achieve the same beneficial effects as open surgery, and it has the advantages of a small operation wound, less bleeding, good safety, rapid postoperative recovery, and fewer complications.