Laparoscopy-assisted Gastrectomy For Gastric Cancer Research Articles

Feasibility of Laparoscopy-assisted Gastrectomy for Gastric Cancer in Elderly Patients: A Case-Control Study.

The present study evaluated the safety and effectiveness of laparoscopic gastrectomy (LG) in elderly gastric cancer patients. This study included 78 gastric cancer patients aged 80 years or above [39 in the LG group and 39 in the open gastrectomy group (matched)]. Patient characteristics, surgical outcomes, survival time, and immunonutritional status were compared. Mean blood loss was significantly lower in the LG group, although the operation time did not differ. There were no significant differences in the number of dissected lymph nodes, postoperative morbidity, mortality, total hospital stay, and the causes of death. The prognostic nutritional index and skeletal muscle index at 1 year were better maintained in the LG group than in the open gastrectomy group. The overall and relapse-free survivals did not differ. LG may be feasible in elderly patients with gastric cancer. A prospective randomized controlled trial should be conducted to confirm its efficacy.

Hidden Blood Loss and Its Influential Factors After Laparoscopy-Assisted Gastrectomy for Gastric Cancer.

Laparoscopy-assisted gastrectomy (LAG) is a minimally invasive procedure for the treatment of gastric cancer. It is generally thought that a minimally invasive technique results in less visible blood loss during the surgery. Nevertheless, a meaningful perioperative hidden blood loss (HBL) is often ignored. In this study, we investigated the amount of HBL and the influential factors after LAG for gastric cancer. A retrospectively analyzed clinical data of 62 consecutive patients who underwent laparoscopy-assisted total or distal gastrectomy at our center from May 2016 to May 2017. The HBL was calculated according to Gross's and Nadler's formula. The data of patient gender, age, height, weight, body mass index, preoperative and postoperative hematocrit, postoperative drainage, albumin loss, diabetes mellitus, and hypertension were analyzed by multivariate linear regression analysis. The type of surgical reconstruction was analyzed by one-way analysis of variance. The difference between the preoperative blood pressure and postoperative blood pressure was measured by paired sample t-test and boxplot. The HBL was 322.2 ± 195.9 mL (64.3% ± 14.1% in total blood loss [TBL]), the TBL was 475.6 ± 222.8 mL, and the hemoglobin (HB) loss was 15.0 ± 8.7 (11.5% ± 6.1% of HB level loss). Multivariate linear regression analysis revealed that gender, hypertension, and albumin loss between preoperation and postoperation are influential factors of HBL in patients after LAG for gastric cancer. Compared to male patients, female patients are positively associated with HBL. In our study, we found HBL is a significant segment of TBL and is much larger than what we considered previously in LAG for gastric cancer. Gender, hypertension, and albumin loss are significantly correlated with HBL. Therefore, paying attention to HBL is significant for promoting clinical treatment and ensuring patients' safety.

Safety of Laparoscopy Assisted Gastrectomy for Gastric Cancer, Including Advanced Cancers

Purpose: Laparoscopy-assisted gastrectomy (LAG) is considered an alternative treatment option for gastric cancer. LAG is safe, however the long-term oncologic efficacy and survival of patients including those with advanced gastric cancer have not been assessed. The aim of this study was to evaluate long-term outcomes and survival of patients with gastric cancer, including advanced cases, who underwent LAG performed by a single surgeon. Methods: Between January 2006 and December 2010, 161 patients with gastric cancer underwent LAG performed by a single surgeon. Clinicopathological data were collected retrospectively along with data on survival and prognosis. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Results: A total of 161 patients diagnosed with gastric cancer underwent LAG. Postoperative morbidity occurred in 12 patients. The median OS was 67.0 months (range, 1.0~97.0 months), and the median DFS was 67.0 months (range, 1.0~97.0 months). T stage, N stage, TNM stage, lymphatic invasion, and venous invasion influenced overall survival and disease recurrence. The OS rates according to N stage were 96.8% for N0, 94.4% for N1, 45.5% for N2, and 42.9% for N3. Conclusion: The current study showed that LAG for gastric cancer, including advanced gastric cancer, is technically feasible with acceptable long-term oncologic outcomes.

Impact of comorbidities on postoperative complications in patients undergoing laparoscopy-assisted gastrectomy for gastric cancer.

BackgroundComorbidity is a predictor of postoperative complications (PCs) in gastrectomy. However, it remains unclear which comorbidities are predictors of PCs in patients who undergo laparoscopy-assisted gastrectomy (LAG). Clinically, insufficient lymphadenectomy (LND) is sometimes performed in high-risk patients, although the impact on PCs and outcomes remains unclear.MethodsWe retrospectively studied 529 patients with gastric cancer (GC) who underwent LAG. PCs were defined as grade 2 or higher events according to the Clavien-Dindo classification. We evaluated various comorbidities as risk factors for PCs and examined the impact of insufficient LND on PCs in patients with risky comorbidities.ResultA total of 87 (16.4%) patients had PCs. There was no PC-related death. On univariate analysis, heart disease, central nervous system (CNS) disease, liver disease, renal dysfunction, and restrictive pulmonary dysfunction were significantly associated with PCs. Both liver disease and heart disease were significant independent risk factors for PCs on multivariate analysis (odds ratio [OR] = 3.25, p = 0.022; OR = 2.36, p = 0.017, respectively). In patients with one or more risky comorbidity, insufficient LND did not significantly decrease PCs (p = 0.42) or shorten GC-specific survival (p = 0.25).ConclusionIn patients who undergo LAG for GC, the presence of heart disease or liver disease is an independent risk factor for PC. Insufficient LND (for example, D1+ for advanced GC) might be permissible in high-risk patients, because although it did not reduce PCs, it had no negative impact on GC-specific survival.

Robot-assistedvslaparoscopy-assisted gastrectomy for gastric cancer: A meta-analysis based on 3518 subjects

Robot-assisted vs laparoscopy-assisted gastrectomy for gastric cancer: A meta-analysis based on 3518 subjects

Preoperative assessment of perigastric vascular anatomy by multidetector computed tomography angiogram for laparoscopy-assisted gastrectomy

We aimed at investigating the efficacy of multidetector computed tomography (MDCT) angiogram reconstructed using the maximum intensity projection (MIP) technique for the assessment of perigastric vascular anatomy before laparoscopy-assisted gastrectomy (LAG) for gastric cancer. Seventy-one patients who underwent LAG were enrolled in the study. Contrast-enhanced scans of the portal venous phase were performed by a MDCT scanner. The CT images were reconstructed using thin-slab MIP. The anatomic variations in the inflow and the location of the left gastric vein (LGV) were detected. The patterns of perigastric arterial origins were divided according to Michels' classification. The intraoperative blood loss on LAG was compared before and after MDCT angiography was introduced in the study. The LGV flowed into the portal vein in 31 patients; the splenic vein, 25 patients; and the junction of these two veins, 15 patients. The LGV passed to the dorsal and ventral sides of the common hepatic artery in 30 and 13 patients and to the dorsal and ventral sides of the splenic artery in 8 and 20 patients, respectively. Michels' type II was found in one patient; type V, in three patients; and type VI, in two patients. The LGV location detected by MDCT was confirmed during surgery in all cases. Intraoperative blood loss after introduction of the MDCT angiography was significantly less than that before its introduction (p = 0.0032). An MDCT angiogram reconstructed using the MIP technique is effective for assessing the perigastric vascular anatomy before LAG for gastric cancer.

Personalized medicine for laparoscopic gastrectomy in gastric cancer

Predictive medicine is crucial for improving medical quality and health. Traditionally, epidemiological studies are used for patient’s outcome with a disease in the pretreatment setting to predict outcomes before therapeutic intervention with surgery, drugs, or both. Given the heterogeneity and complexity of chronic multifactorial disorders, such as cancer, emerging biomedical research is based on genomics, epigenomics, and microRNAs along with systems computational biology and mathematical models for the development of novel biomarkers and more accurate predictions [1, 2]. Based on the establishment and success of laparoscopic resection for colorectal cancer to improve quality of life by equal oncological outcomes compared with open surgery, laparoscopic gastrectomy has rapidly evolved during the past decade [3–10]. Pretreatment identification of gastric patients at risk for developing early postoperative complications or recurrence after laparoscopic gastrectomy has crucial clinical implications. In general for cancer, such markers can guide a tailored treatment for improving patient’s outcomes and this is a major goal of personalized medicine [11]. In the December issue of Surgical Endoscopy, Yoshikawa et al. [12] evaluated several markers that might be clinical useful for patients who are going to undergo laparoscopic gastrectomy for gastric cancer. The authors have classified 66 patients who underwent laparoscopy assisted gastrectomy (LAG) into two groups: body mass index (BMI) [\25 BMI-L group: n = 53; C25 BMI-H group: n = 13] and visceral fat areas (VFAs) [\100 cm AF-L group: n = 35; C100 cm AF-H group: n = 31]. Yoshikawa et al. [12] report that the BMI did not impact postoperative complications (p = 0.18) or blood loss (p = 0.21), whereas by contrast VFA significantly influenced complications, blood loss, and number of lymph nodes retrieved. The authors conclude that the area of visceral fat tissue assessed by CT and software was useful to predict risks of LAG and postoperative complications with higher precision compared with BMI. This study evaluated the area of visceral fat tissue and provides a new aspect for identifying predictive and prognostic markers for LAG for gastric cancer. However, it is limited not only by its retrospective nature but also by the very small number of patients in subgroups evaluated. Therefore, it could be considered an underpowered study for assessing valid significant differences. However, the data provided are promising and the authors may perform a study with large and accurate samples of patients to validate the potential impact of the area of visceral fat tissue in patients undergoing laparoscopic gastrectomy. Development of robust biomarkers for personalized cancer treatment has been proven to be much more difficult and complicated than we have supposed. Personalized medicine can improve dramatically the outcome in public health, but much more research work is needed. In the era of next-generation sequencing for whole-genome sequencing, functional genomics, transcriptomics, and epigenomics, new directions are being shaped. Assembling large-scale omics data together with clinical data and integrating all of this genome and clinical information into computational and mathematical models could result in the development of systems biology and systems medicinebased biomarkers [13–32]. C. Hottenrott (&) Chirurgische Klinik, St. Elisabethenkrankenhaus, Ginnheimer Strase 3, 60487 Frankfurt, Germany e-mail: info@gastricbreastcancer.com

Personalized medicine for laparoscopic gastrectomy used to treat gastric cancer

We appreciate Professor Christ of Hottenrott’s interest in our article entitled visceral fat area (VFA). Is superior to body mass index (BMI) as a predictive factor for risk with laparoscopy-assisted gastrectomy for gastric cancer published in the December 2010 issue of Surgical Endoscopy [1]. I reply to his valuable comments. In our study, VFA was useful for predicting risks of laparoscopically assisted gastrectomy and postoperative complications with higher precision than BMI retrospectively. We agree that this study could be considered as underpowered because it was limited not only by its retrospective nature but also by the very small number of patients in the subgroups. However, another large-sample report (n = 152) also indicated that a high VFA can predict technical difficulties during laparoscopic gastric surgery as well as postoperative complications. Blood loss showed a significant correlation with VFA (P = 0.03). Also, VFA was more correlated with postoperative complications than BMI (P = 0.007 vs 0.07) [2]. Because this study was conducted retrospectively, we should perform a prospective study with large and accurate samples to validate the potential impact of the VFA on patients undergoing laparoscopic gastrectomy. Finally, I hope I have clarified the comments proposed by Professor Hottenrott.

Long-Term Outcomes and Feasibility with Laparoscopy-Assisted Gastrectomy for Gastric Cancer

PurposeRecently, laparoscopy-assisted gastrectomy (LAG) has been widely accepted modality for early gastric cancer in Korea. The indication of LAG may be extended in an experienced institution. In our institution, the first case of laparoscopy-assisted gastrectomy (LAG) for gastric cancer was performed in May 1998. We retrospectively reviewed the long-term oncologic outcomes over 12 years to clarify the feasibility of LAG for gastric cancer.Materials and MethodsThe authors retrospectively analyzed 753 patients who underwent LAG for gastric cancer, from May 1998 to August 2010. We reviewed clinicopathological features, postoperative outcomes, mortality and morbidity, recurrence, and survival of LAG for gastric cancer.ResultsDuring the time period, 3,039 operations for gastric cancer were performed. Among them, 753 cases were done by LAG (24.8%). There were 69 cases of total gastrectomy, 682 subtotal gastrectomies, and 2 proximal gastrectomies. According to TNM stage, 8 patients were in stage 0, 619 in stage I, 88 in stage II, and 38 in stage III. The operation-related complications occurred in 77 cases (10.2%). Median follow-up period was 56.2 months (range 0.7~165.6 months). Twenty-five patients (3.3%) developed recurrence, during the follow-up period. The overall 5-year and disease free survival rates were 97.1% and 96.3%, respectively.ConclusionsThe number of postoperative complications and survival rates of our series were comparable to the results from that of other reports. The authors consider LAG to be a feasible alternative for the treatment of early gastric cancer. However, rationale for laparoscopic surgery in advanced gastric cancer has yet to be determined.

Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case-control study

The aim of this study was to clarify the technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG) for gastric cancer compared with open gastrectomy (OG). Between April 2002 and March 2008, a series of 623 patients with gastric cancer underwent R0 gastrectomy (314 LAG patients and 309 OG patients). Age, gender, lymph node dissection, and pathological stage were matched by propensity scoring, and 212 patients (106 LAG and 106 OG) were selected for analysis after the exclusion of 40 patients who had proximal gastrectomy. Intraoperative factors, postoperative morbidity, long-term quality of life (QOL), and survival were evaluated. Moreover, these outcomes were also compared between the laparoscopy-assisted total gastrectomy (LATG) and the open total gastrectomy (OTG). There was no significant difference in preoperative characteristics between the two patient groups. Regarding intraoperative characteristics, blood loss was significantly lower in the LAG group (143 ml) than in the OG group (288 ml), while operation time was significantly longer in the LAG group (273 min) than the OG group (231 min). The degree of lymph node dissection and number of retrieved lymph nodes did not differ between the two groups. There were no significant differences in postoperative courses or overall and disease-specific survival (89.8% vs. 83.6%, P = 0.0886; 100% vs. 95.2%, P = 0.1073) except time to first flatus and time to use of nonsteroidal anti-inflammatory derivatives between the two groups. Significantly fewer patients felt wound pain in the LAG group 1 year after surgery. Analyses between the LATG and OTG groups showed similar results. LAG for gastric cancer may be both feasible and safe. However, it will be necessary to conduct a well-designed randomized controlled trial comparing short-term and long-term outcomes between LAG and OG in a larger number of patients.

Omental infarction caused by laparoscopy-assisted gastrectomy for gastric cancer: CT findings

To investigate the computed tomography (CT) imaging features of omental infarction in patients who underwent laparoscopy-assisted gastrectomy (LAG) for gastric cancer. A retrospective study was performed on 390 patients who underwent LAG for gastric cancer. Two radiologists evaluated the CT images for the presence of omental infarction. The CT pattern was characterized at initial presentation and the evolutional changes were evaluated. The initial CT appearance of omental infarctions were categorized into the following four types: type 1 (ill-defined, heterogeneous, fat density lesion); type 2 (well-defined fat density lesion with rim enhancement); type 3 (well-defined heterogeneous lesion with fat component); and type 4 (well-defined heterogeneous lesion without a fat component). Of the 390 patients involved, nine patients (2.3%; six male and three female with a mean age of 57 years) were diagnosed with omental infarction. Infarctions averaged 4.1 cm (range 2-7.3 cm) in diameter. Among nine patients with omental infarction, two patients had type 1 lesions, two had type 2, two had type 3, and three type 4. All infarctions became smaller and better defined with evolution. In two patients who presented with type 1 lesions on initial CT, each lesion was progressed to type 2 and type 3 on follow-up CT. In two patients with type 3 lesions on initial CT, the lesions changed to type 4 on follow-up CT. An awareness of the various CT features and evolutional changes in omental infarction after LAG for gastric cancer can help ensure the correct diagnosis and to avoid misdiagnosis for omental implants.

Visceral fat area is superior to body mass index as a predictive factor for risk with laparoscopy-assisted gastrectomy for gastric cancer

After adopting preoperative assessment of the perigastric vessels using 3D-CT and standardization of the procedures, obesity still influences smooth laparoscopy assisted gastrectomy (LAG). We evaluated the impact of body mass index (BMI) and area of visceral fat tissue on the risks of LAG. Sixty-six patients who underwent LAG for gastric cancer were included. The patients were divided into two groups by BMI (<25 BMI-L group: n = 53; ≥25 BMI-H group: n = 13) and area of intraperitoneal fat tissue (<100 cm(2) AF-L group: n = 35; ≥100 cm(2) AF-H group: n = 31), respectively. Fat scan(®), which was computer software operating on abdominal CT, was used to measure the visceral fat areas (VFA). The incidence of postoperative complications, operation time, intraoperative blood loss, and number of dissected lymph nodes were compared between each two groups. The incidence of postoperative complications of BMI-L and BMI-H groups was 11.3% and 30%, respectively (p = 0.18). The mean blood loss was 85 and 134 g, respectively (p = 0.21). There were no significant differences in operation time and the number of retrieved LNs. The incidence postoperative complications (29%) and mean blood loss (148 g) of then VFA-H group were significantly higher than those of the VFA-L group (5.7%, 48 g). The number of retrieved LNs of the VFA-H group (n = 25) was significantly lower than that of the VFA-L group (n = 34). There was no significant difference in operation time. In the VFA-H group, the incidence of postoperative complications and intraoperative blood loss increased, and the dissected number of LNs decreased. The area of visceral fat tissue was useful to predict risks of LAG and postoperative complications with higher precision compared with BMI.

Liver function alterations after laparoscopy-assisted gastrectomy for gastric cancer and its clinical significance

To evaluate the factors associated with liver function alterations after laparoscopy-assisted gastrectomy (LAG) for gastric cancer. We collected the data of gastrectomy patients with gastric cancer and divided them into 2 groups: open gastrectomy (OG) and LAG. We also collected the data of patients with colon cancer to evaluate the effect of liver manipulations during surgery on liver function alterations. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and alkaline phosphatase were measured on the preoperative day and postoperative day 1 (POD1), POD3, POD5, and POD7. No changes in liver function were observed after the operation in patients with colon cancer (n = 121). However, in gastric cancer patients (n = 215), AST and ALT levels increased until POD5 compared to those in colon cancer patients and these findings were observed both in the LAG and OG without a significant difference except at POD1. The mean hepatic enzyme levels at POD1 in the LAG group were significantly higher than those in the OG group (P = 0.047 for AST and P = 0.039 for ALT). The factors associated with elevated ALT on POD1 in patients with gastric cancer were body mass index (P < 0.001), operation time (P < 0.001), intraoperative hepatic injury (P = 0.048), and ligation of an aberrant left hepatic artery (P = 0.052) but not type of operation (OG vs LAG, P = 0.094). We conclude that the liver function alteration after LAG may have been caused by direct liver manipulation or aberrant hepatic artery ligation rather than the CO₂ pneumoperitoneum.

Clinical application of laparoscopic-assisted radical gastrectomy for advanced gastric cancer

Objective To study the feasibility and safety of laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer. Methods From June, 2006 to July 2009, 11 patients with gastric cancer received laparoscopy-assisted gastrectomy for gastric cancer. According to UICC TNM classification of gastric cancer, 6 cases were with Stage Ⅱ, 2 cases with Stage Ⅲ A, 1 case with Stage Ⅲ B, and 2 cases with Stage Ⅳ. Under the assistance of laparoscope, dissociation of the stomach and lymph nodes clearance were performed first; then gastrectomy was performed on a 6 cm incision, samples were collected, and alimentary tract was inoculated. Results Among the 11 cases, 2 cases were performed radical total gastrectomy, 1 case was performed proximal partial gastrectomy, 7 cases were performed distal partial gastrectomy and 1 case with open surgery. The mean operation time: 350 min for total gastrectomy, 320 min for proximal partial gastrectom,266 min for distal partial gastrectomy. The mean number of harvested lymph nodes was 21.3 (11-38), incisal edge was 5.6 (4.0-9.6) cm. The mean time was 72 (36-110) hrs for gastrointestinal function recovery, 59 (26-86) hrs for patients to take general activity, and 76 (48-116) hrs to take liquid food. No complication was observed. Conclusion Laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer is safe and feasible. Compared with open surgery, it also has the advantages of small wound and fast recovery. Key words: Stomach neoplasms; Laparoscope; Digestive system surgical procedures

Recurrence Following Laparoscopy-Assisted Gastrectomy for Gastric Cancer: A Multicenter Retrospective Analysis of 1,417 Patients

The risk of recurrence and recurrence patterns after laparoscopy-assisted gastrectomy for gastric cancer remain unclear. The objective of this study is to assess recurrence and its timing, patterns, and risk factors following laparoscopy-assisted gastrectomy from multicenter data. A retrospective multicenter study was performed using data from 1,485 patients who had undergone laparoscopy-assisted gastrectomy for gastric cancer at ten institutions from 1998 to 2005. Recurrence and its timing and patterns were reviewed. Univariate and multivariate analyses were performed to identify risk factors for recurrence. Excluding 68 patients (9 postoperative mortalities, 1 synchronous distant metastasis, 2 nonadenocarcinomas, and 56 losses to follow-up), 50 of 1,417 patients (3.5%) had recurrences. Incidence of recurrence was 1.6% (19/1186) in early gastric cancer and 13.4% (31/231) in advanced gastric cancer. Recurrence occurred in 34 of 50 patients (68.0%) within 2 years of surgery, and in 45 of 50 patients (90.0%) within 3 years. The recurrence pattern was hematogenous in 17 patients (34.0%), peritoneal in 11 (22.0%), locoregional in 10 (20.0%), distant lymph nodes in 2 (4.0%), and mixed in 10 (20.0%). Advanced T-classification and lymph node metastases were risk factors for recurrence. Laparoscopy-assisted gastrectomy showed satisfactory long-term oncologic outcomes similar to those of open surgery. The study provides additional evidence suggesting that laparoscopy-assisted gastrectomy is a good alternative to open gastrectomy in patients with gastric cancer of relatively early stage, although results of a randomized controlled trial and more long-term follow-up are needed to provide conclusive evidence.

The Early Experience of Laparoscopy-assisted Gastrectomy for Gastric Cancer at a Low-volume Center

PurposeLaparoscopy-assisted gastrectomy (LAG) has become a technically feasible and safe procedure for early gastric cancer treatment. LAG is being increasingly performed in many centers; however, there have been few reports regarding LAG at low-volume centers. The aim of this study was to report our early experience with LAG in patients with gastric cancer at a low-volume center.Materials and MethodsThe clinicopathologic data and surgical outcomes of 39 patients who underwent LAG for gastric cancer between April 2007 and March 2010 were retrospectively reviewed.ResultsThe mean age was 68.3 years. Thirty-one patients had medical co-morbidities. The mean patient ASA score was 2.0. Among the 39 patients, 4 patients underwent total gastrectomies and 35 patients underwent distal gastrectomies. The mean blood loss was 145.4 ml and the mean operative time was 259.4 minutes. The mean time-to-first flatus, first oral intake, and the postoperative hospital stay was 2.8, 3.1, and 9.3 days, respectively. The 30-day mortality rate was 0%. Postoperative complications developed in 9 patients, as follows: anastomotic leakage, 1; wound infection, 1; gastric stasis, 2; postoperative ileus, 1; pneumonia, 1; cerebral infarction, 1; chronic renal failure, 1; and postoperative psychosis, 1.ConclusionsLAG is technically feasible and can be performed safely at a low-volume center, but an experienced surgical team and careful patient selection are necessary. Furthermore, for early mastery of the learning curve for LAG, surgeons need education and training in addition to an accumulation of cases.

Actual 3-Year Survival After Laparoscopy-Assisted Gastrectomy for Gastric Cancer

To analyze 3-year actual disease-free survival after laparoscopy-assisted gastrectomy for gastric cancer on the assumption that 3-year disease-free survival may represent 5-year overall survival. Retrospective analysis. Department of surgery of a university hospital. A total of 197 patients who underwent laparoscopy-assisted gastrectomy for gastric cancer from May 1998 to September 2007 and who were followed up for more than 3 years. Feasibility and long-term survival rate with survival analysis by the Kaplan-Meier method. Subtotal and total gastrectomies were performed in 178 and 19 patients, respectively. The scope of the lymph node dissections were D1 + beta (n = 152) and D2 (n = 45). There were 153, 28, 8, 6, 1, and 1 patients in stages Ia, Ib, II, IIIa, IIIb, and IV, respectively. The median follow-up was 45 months (range, 1-113 months), and there were 7 recurrences. Multivariate analysis of disease-specific survival showed that depth of invasion and lymph node metastasis influenced the prognosis independently. The actual 3-year disease-free survival rate for all patients was 96.9%. The 173 patients with early gastric cancer and 24 with advanced gastric cancer showed 98.8% and 79.1% actual 3-year disease-free survival rates, respectively. Laparoscopy-assisted gastrectomy is acceptable oncologically in early gastric cancer if 3-year disease-free survival represents 5-year overall survival. Laparoscopy-assisted gastrectomy may also play an important role in the treatment of advanced gastric cancer.

Laparoscopy-assisted total gastrectomy for gastric cancer: A multicenter retrospective analysis

Laparoscopy-assisted distal gastrectomy (LADG) has been applied to the treatment of gastric cancer, and there are now several publications regarding its safety and feasibility. In contrast, there have been few reports on laparoscopy-assisted total gastrectomy (LATG), because this procedure is performed less frequently and is technically more difficult to perform than LADG. The purpose of the present study was to evaluate short-term outcomes in a multicenter study of LATG, as well as its safety and feasibility. A retrospective multicenter study was carried out in Korea involving 1,485 patients who underwent laparoscopy-assisted gastrectomy for gastric cancer at 10 institutions between April 1998 and December 2005. Of these patients, 131 underwent LATG. We evaluated and analyzed the short-term outcomes and the clinicopathologic characteristics of the 131 patients. The mean (+/- SD) operation time was 270 +/- 79 min; 1 patient required conversion to an open procedure. The mean number of retrieved lymph nodes was 34.7. The mean duration of hospital stay was 11.3 days, and first intake of soft diet was at 5.8 days. The rate of postoperative morbidity was 19% (25/131 patients); there was no mortality. The most common postoperative morbidity was wound complications at the mini-laparotomy site, and there were 3 cases of anastomotic leakage. Six patients (5%) had recurrence of cancer, and 9 patients (7%) died during the follow-up period. Our results suggest that LATG is a safe and feasible procedure for gastric cancer patients. A prospective, multicenter, randomized trial of LATG is needed to confirm the efficacy of this procedure.

The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

Obesity is known to be associated with postoperative morbidity in gastric cancer surgery, but its impact on laparoscopy assisted gastrectomy (LAG) for gastric cancer has rarely been evaluated. The clinical data for 1,485 LAG procedures for gastric cancer in 10 institutions were reviewed. The patients were divided into high body mass index (BMI) (BMI > or = 25 kg/m(2); n = 432) and low BMI (BMI <25 kg/m(2); n = 1,053) groups, and their clinical outcomes were compared. The mean age and proportion of comorbid patients were higher in the high BMI group than in the low BMI group. Postoperative morbidity and mortality did not differ between the high BMI (15.7% and 0.9%) and low BMI (14% and 0.5%) groups (p = 0.37 and p = 0.29). Only the operation time and the number of retrieved lymph nodes were significantly different between the high BMI (242.5 min and 30.4) and low BMI (223.7 min and 32.6) groups (p < 0.001 and p = 0.005), especially for male patients undergoing surgery by surgeons who have performed 40 or fewer LAGs. High BMI itself may not increase operative morbidity after LAG for gastric cancer. However, when a surgeon is relatively inexperienced with LAG, a careful approach is required for male patients with a high BMI.

Risk Factors Associated with Complication Following Laparoscopy-Assisted Gastrectomy for Gastric Cancer: A Large-Scale Korean Multicenter Study

The aim of this multicenter retrospective study was to establish background data for future randomized clinical trial comparing open and laparoscopy-assisted gastrectomies (LAGs). We sought to evaluate the technical feasibility of LAG by determining the morbidity and mortality and identifying corresponding predictive factors. A retrospective multicenter study was carried out in Korea on 1,485 patients in who, LAG had been attempted for gastric cancer under the care of ten surgeons, at ten institutions, during the period spanning May 1998 to December 2005. Patient characteristics, operative outcomes, and postoperative morbidities and mortalities were analyzed. Overall morbidity and mortality rates were 14.0% and 0.6%, respectively. Complications included: wound problem (4.2%, n = 62), intraluminal bleeding (1.3%, n = 20), intra-abdominal abscess or fluid collection (1.3%, n = 19), anastomotic leakage (1.3%, n = 18), and intra-abdominal bleeding (1.3%, n = 18). By using multivariate analysis we found that the two most important risk factors associated with postoperative complications were presence of comorbidity in the patient and lack of experience on the part of the surgeon. LAG is a technically feasible, safe, and effective method for treating patients with gastric cancer. Extra caution in patients with comorbidities, and dedication to improving surgical proficiency in LAG, may decrease the risk of complications. Through this study, we have established the inclusion criteria for LAG. For our multicenter, prospective, randomized trials (NCT00452751), potential patients should have an American Society of Anesthesiology (ASA) score of less than 3, and surgeons performing the procedures should have experience with more than 50 cases of LAG.