Evaluation of oncological adequacy of laparoscopic distal gastrectomy with special attention to lymph node dissection: a comparison with conventional open gastrectomy.

Abstract

Laparoscopic distal gastrectomy (LDG) with lymphadenectomy has been revealed to be a useful treatment for early gastric cancer but oncological adequacy is controversial. To assess the quality of lymphadenectomy, we evaluated the number of dissected lymph nodes and the non-compliance rate (defined as an absence of nodal tissue at a node station that should have been resected) and compared the data obtained from 102 patients treated by LDG with those from 90 patients treated by open distal gastrectomy (ODG). The numbers of nodes of Categories 1 and 2, which correspond respectively to perigastric and retroperitoneal nodes, did not differ significantly between the LDG group and the ODG group. In the LDG group compared to the ODG group, there were significantly more right paracardial nodes (No. 1) but there were significantly fewer infrapyloric nodes (No. 6). However, the difference in infrapyloric nodes (No. 6) became insignificant when we re-analyzed and compared the ODG group and the patients (n=42) whose LDGs were performed by two experienced laparoscopic surgeons. The curability of gastric cancer on LDG was almost equivalent to that of ODG from the viewpoint of lymph node dissection, if the LDG is performed by two experienced laparoscopic surgeons. These data suggested that LDG with lymphadenectomy could possibly be adopted for advanced gastric cancer treatment under proper quality control, such as that provided by an experienced laparoscopic team.