Abstract
BackgroundLaparoscopic gastrectomy has been used as a superior alternative to open gastrectomy for the treatment of early gastric cancer. However, the application of laparoscopic D2 lymphadenectomy remains controversial. This study aimed to evaluate the feasibility and outcomes of laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer.ResultsBetween May 2016 and May 2018, twenty-five consecutive patients with gastric cancer underwent laparoscopic D2 gastrectomy: eighteen patients (72%) underwent distal gastrectomy, four patients (16%) underwent total gastrectomy, and three patients (12%) underwent proximal gastrectomy. The median number of lymph nodes retrieved was 18 (5–35). A positive proximal margin was detected in 2 patients (8%). The median operative time and amount of blood loss were 240 min (200–330) and 250 ml (200–450), respectively. Conversion to an open procedure was performed in seven patients (28%). The median hospital stay period was 8 days (6–30), and the median time to start oral fluids was 4 days (3–30). Postoperative complications were detected in 4 patients (16%). There were two cases of mortality (8%) in the postoperative period, and two patients required reoperation (8%).ConclusionsLaparoscopic gastrectomy with D2 lymphadenectomy can be carried out safely and in accordance with oncologic principles.
Highlights
Laparoscopic gastrectomy has been used as a superior alternative to open gastrectomy for the treatment of early gastric cancer
As experience in laparoscopic gastrectomy for early gastric cancer has increased, some surgeons have become concerned about the use of laparoscopic D2 lymphadenectomy in gastric cancer [7]
The inclusion criteria were as follows: pathologically proven adenocarcinoma of the stomach, clinical T1 and T2 tumors discovered during preoperative gastroscopy and abdominal computed tomography, patients with T3 or T4 tumors or those with nodal involvement who had shown a good response according to the Response Evaluation Criteria In Solid Tumors (RECIST) criteria 1.1 (> 30% decrease in tumor size) after neoadjuvant chemotherapy, adenocarcinoma of the cardia that regressed post-neoadjuvant chemotherapy, and patients with Eastern Cooperative Oncology Group (ECOG) performance status 0–2
Summary
Laparoscopic gastrectomy has been used as a superior alternative to open gastrectomy for the treatment of early gastric cancer. This study aimed to evaluate the feasibility and outcomes of laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer. Gastrectomy with proper lymphadenectomy is considered the cornerstone of treatment for potentially curable gastric cancer [1]. As experience in laparoscopic gastrectomy for early gastric cancer has increased, some surgeons have become concerned about the use of laparoscopic D2 lymphadenectomy in gastric cancer [7]. The extent of lymph node dissection is described according to the Japanese gastric cancer treatment guidelines. The draining lymph nodes of the stomach are divided into stations. Stations 1–6 are the perigastric lymph nodes along the lesser and greater curvature of the stomach. Stations 7–12 correspond to the lymph nodes around the left gastric artery (station 7), common hepatic artery (station 8), celiac trunk (station 9), splenic artery (stations 10 and 11), and hepatoduodenal ligament
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