Abstract
BackgroundThe aim of this study was to analyze the oncological aspects of gastric cancer following laparoscopic gastrectomy with D2 lymphadenectomy (LG-D2).MethodsWe retrospectively evaluated the long-term outcomes of 354 patients who underwent LG-D2 for primary gastric cancer. Recurrence patterns and predictors of peritoneal metastasis were analyzed.ResultsMedian follow-up time was 43.8 months. Five-year overall survival rates for yp/pStages I, II, and III gastric cancer were 93.7, 78.5, and 42.2 %, respectively. Recurrence was observed in 86 patients. Peritoneal metastasis was the most frequent recurrence pattern (n = 51), followed by hepatic metastasis (n = 17). Lymphatic recurrence at distant sites was observed in 10 patients. No locoregional lymph node metastasis or local recurrence was seen. Nine of 51 cases of peritoneal recurrence were detected by probe laparoscopy. Peritoneal recurrence rates were significantly higher in yp/pT4 and yp/pN3 diseases compared with yp/pT ≤ 3 and yp/pN ≤ 2 diseases. Multivariate analyses demonstrated that yp/pT4, yp/pN3, tumor size ≥70 mm, vascular invasion, and undifferentiated tumors were predictors of peritoneal recurrence following LG-D2.ConclusionLong-term outcomes of gastric cancer following LG-D2, including recurrence patterns and predictors of peritoneal metastasis, were comparable to those following open D2 gastrectomy. LG-D2 showed good local control. Probe laparoscopy after LG may be effective in detecting peritoneal recurrence, which is not determined with less invasive examinations, including a CT scan. Future large-scale prospective studies are desirable to evaluate not only surgical but also oncological benefits and safety of LG-D2 for advanced gastric cancer.
Highlights
The aim of this study was to analyze the oncological aspects of gastric cancer following laparoscopic gastrectomy with D2 lymphadenectomy (LG-D2)
In 1999, we reported on the technical aspects of laparoscopic distal gastrectomy (LDG) with D2 lymphadenectomy (LDG-D2) and laparoscopic total gastrectomy with D2 lymphadenectomy (LTG-D2) (Uyama et al 1999a, b) as well as short- and long-term outcomes following LG for gastric cancer (Yoshimura et al 2011; Shinohara et al 2013)
Of the 103 patients who underwent LTG, splenectomy was performed in 61 patients, of which a combined distal pancreatectomy was performed in 22 patients
Summary
The aim of this study was to analyze the oncological aspects of gastric cancer following laparoscopic gastrectomy with D2 lymphadenectomy (LG-D2). A number of randomized controlled trials (Kim et al 2010; Katai et al 2010) have reported equivalent short-term outcomes, including the incidence of anastomotic leakage and a pancreatic fistula, following LDG with D1+ lymphadenectomy for ≤cT2N0 gastric cancer to those following an open distal gastrectomy (ODG), at least as long as LDG was performed by an experienced. In 1999, we reported on the technical aspects of LDG with D2 lymphadenectomy (LDG-D2) and laparoscopic total gastrectomy with D2 lymphadenectomy (LTG-D2) (Uyama et al 1999a, b) as well as short- and long-term outcomes following LG for gastric cancer (Yoshimura et al 2011; Shinohara et al 2013). We retrospectively analyzed long-term outcomes of 346 gastric cancer patients who underwent LG-D2, especially focusing on the recurrence pattern
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