Open Gastrectomy Group Research Articles

Change of carcinomacmbryonic-antigen and dopa decarboxylase in the peritoneal irrigation fluid from patients undergoing Da Vinic robotic, laparoscopic or open radical gastrectomy for gastric cancer

Objective To explore the change of carcinomacmbryonic-antigen (CEA) and dopa decarboxylase (DDC) in the peritoneal irrigation fluid from patients undergoing Da Vinic robotic,laparoscopic and open radical gastrectomy for gastric cancer.Methods The clinical data of 126 patients undergoing radical gastrectomy for gastric cancer at the Southwest Hospital from January 2013 to March 2014 were retrospectively analyzed.There were 42 patients in the Da Vinic robotic radical gastrectomy group (RRG group),42 in the laparoscopic radical gastrectomy group (LRG group) and 42 in the open radical gastrectomy group (ORG group).The preoperative and postoperative peritoneal irrigation fluids were collected,respectively.Concentrations of CEA and DDC in the peritoneal irrigation fluids were detected by the enzyme-linked immunosorbent assay (ELISA).The quantitative data were analyzed using the t test and the chi-squared test,the multiple comparison were analyzed using the least significance difference (LSD) and the count data were analyzed using the chi-square test and nonparametric test.Results The preoperative and postoperative concentrations of CEA in the RRG group,LRG group and ORG group were (242 ± 189)xg/L,(221 ± 174)μg/L,(257 ± 135) μg/L and (1 262 ± 785) μg/L,(1 172 ± 699) iμg/L,(2 996 ± 1 947) μg/L,respectively.The preoperative and postoperative concentration of DDC in the RRG group,LRG group and ORG group were (8 ±5)μg/L,(7 ±4)μg/L,(8 ±6)μg/L and (87 ±55) μg/L,(81 ±52) pg/L,(146 ± 135)μg/L,respectively.No significant differences were observed for the preoperative concentrations of CEA and DDC in the 3 groups (F =0.491,0.161,P ＞ 0.05),and the postoperative concentration of CEA and DDC in the 3 groups were significantly different (F =27.214,6.865,P ＜ 0.05).The postoperative concentration of CEA and DDC in the ORG group were significantly higher than those in the RRG group and LRG group (P ＜ 0.05),while no significant differences in the postoperative concentration of CEA and DDC were observed between the LRG group and RRG group (P ＞ 0.05).The preoperative and postoperative concentrations of CEA and DDC were significantly increased in all the 3 groups,with a significant difference when compared with the preoperative concentrations of CEA and DDC (t =-11.053,-11.700,-9.780,-10.261,-9.955,-6.969,P ＜0.05).Conclusion The postoperative concentration of CEA and DDC in the peritoneal irrigation fluid after Da Vinic robotic radical gastrectomy is significant decreased when compared with the open radical gastrectomy,while no significant difference is observed between the Da Vinci robotic radical gastrectomy and the laparoscopic radical gastrectomy,which is helpful for preventing CEA-and DDC-mediated abdominal metastasis of gastric cancer. Key words: Gastric neoplasms; Da Vinic robotic surgery system; Laparoscopy; Carcino-embryonic antigen ; Dopa decarboxylase

Application of laparoscopic-assisted radical gastrectomy in elderly patients

Objective To study the application value of laparoscopic-assisted radical gastrectomy in elderly patients.Methods 114 elderly patients with gastric cancer were randomly divided into observation group and control group.55 patients in the observation group received laparoscopic-assisted radical gastrectomy ,59 patients in the con-trol group received traditional open radical gastrectomy .The operation time,blood loss,postoperative ambulation time, postoperative hospital stay and other information were compared .Results The operative time ,blood loss and postop-erative ambulation ,postoperative hospital stay in the observation group were significantly better than those in the con -trol group（t=12.195,8.562,8.072,10.252,all P〈0.05）.In the observation group,18 patients had marked effect, effective in 33 cases,ineffective in 4 cases,the total effective rate was 92.7%.In the control group,21 cases had marked effect,effective in 34 cases,ineffective in 4 cases,the total effective rate was 93.2%,the difference between the two groups was not significant （χ2 =0.069,P〉0.05）.Conclusion The efficacy of laparoscopic-assisted radical gastrectomy is similar with traditional open radical gastrectomy ,and laparoscopic-assisted radicalgastrectomy has ad-vantages of minimally invasive ,faster recovery ,especially suitable for elderly patients with gastric cancer . Key words: Laparoscopy; Radical gastrectomy; Stomach neoplasms; Aged

A laparoscopic gastrectomy approach decreases the incidence and severity of emergence agitation after sevoflurane anesthesia.

Compared to open gastrectomy (OG), laparoscopic gastrectomy (LG) has improved short-term outcomes and equivalent oncological outcomes. In this study, a potential short-term advantage of LG over OG, reduced risk of emergence agitation, was evaluated. This retrospective study compared LG versus OG with respect to emergence agitation in 400 adult patients who underwent sevoflurane anesthesia. In all cases, a serial Richmond Agitation-Sedation Scale (RASS) assessment was performed in the postanesthesia care unit (PACU). Patients with a RASS score ≥+1 at any time were considered to have emergence agitation. Severe agitation was defined as a RASS score of +3 or +4. This study included 214 OG group subjects and 186 LG group subjects in the analysis. The overall incidence of emergence agitation was significantly lower in the LG group than the OG group (23.7 vs. 43.5%, p<0.001). The LG group had a significantly lower incidence of severe agitation than the OG group (1.1 vs. 4.7%, p=0.035). Multivariate logistic regression analysis demonstrated that the type of surgery (OG vs. LG), as well as current smoking, total dose of rescue opioids used in the PACU, and maximum pain score in the PACU, were independent risk factors for emergence agitation (odds ratio, 1.984; 95% confidence interval, 1.249-3.153; p=0.004). Patients with emergence agitation had significantly increased PACU stays (p=0.024). Compared to an open approach, a laparoscopic gastrectomy approach can provide the short-term benefit of decreased emergence agitation.

Impact of different pneumoperitioneal pressure on pathomorphism and function of intestines following laparoscopic radical gastrectomy

To investigate the influence of different pressures of CO2 pneumoperitioneum on pathomorphism and function of intestines following laparoscopic gastrectomy (LG). Forty-eight gastric cancer patients were prospectively enrolled in the study. Among them, 36 patients scheduled for elective LG were randomly assigned to low pressure group (LP), middle pressure (MP), and high pressure group (HP) with 12 cases in each group. The CO2 pneumoperitoneum pressure was maintained at 8-10 mmhg in LP, 11-13 mmhg in MP, and 14-16 mmhg in HP. The control group was open gastrectomy group (OG) in 12 cases. The intestinal pathomorphism and level of plasma D-lactic acid before, during and after operation, and postoperative intestinal function of four groups were examined and compared. There were no statistical differences in preoperative data among the four groups(all P>0.05). LG group was associated with a lower rate of surgical complications than OG (8.3% vs. 41.7%, P<0.05). No obvious damage of intestinal mucosa was found in OG group. Damage degree of intestinal mucosa after operation in LP, MP and HP groups was 0-1, 1-2, and 2-3 respectively. There was significant change in intestinal pathomorphism after operation in both HP and MP groups. The levels of D-lactic acid before operation were not significantly different among all the four groups, but increased significantly in each group after operation (all P<0.05). HP group had the highest level of plasma D-lactic acid and presented with delayed bowel sound return (4.5 d), time to first flatus (5.4 d), and intake (6.0 d) as compared to the other 3 groups (all P<0.05). Laparoscopic radical gastrectomy is safe and minimally invasive. Higher pneumoperitoneal pressure is harmful to the recovery of intestinal mucosa and function. Therefore the pneumoperitioneum pressure should be maintained as low as possible under clear visualization during operation.

Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymphadenectomy for advanced gastric cancer

BackgroundThe aim of this study was to compare surgical outcomes and oncologic efficacy of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy (OG) for advanced gastric cancer. MethodsFor this study, 87 consecutive advanced gastric cancer (AGC) patients who underwent LAG with D2 lymph node dissection between April 2005 and October 2009 were enrolled, compared with 87 AGC patients who underwent OG during the same period. ResultsOperative procedure and surgical margin were similar between the 2 groups. The operative time was significantly longer in the LAG group than the OG group, while the estimated blood loss was significantly less in the LAG group. There were no significant differences in postoperative complications and in the number of lymph nodes retrieved. The use of analgesic drugs was significantly less after LAG. Length of postoperative stay was significantly shorter in the LAG group. The 5-year overall survival rate and recurrence-free survival rate were comparative between the 2 groups. ConclusionThis 5-year case–control study presented that laparoscopy-assisted gastrectomy may be a safe and acceptable procedure in terms of long-term results for AGC.

Short-term efficacy of laparoscopy-assisted vs open radical gastrectomy in gastric cancer.

To investigate the short-term benefits of laparoscopic radical gastrectomy (LARG) and open radical gastrectomy (ORG) in patients with gastric cancer. A total of 400 patients with gastric cancer aged ≤ 65 years who were treated at General Hospital of Lanzhou Military Region were enrolled. Among these, 200 patients underwent LARG between October 2008 and August 2012 (LARG group); and 200 patients underwent ORG between March 2000 and September 2008 (ORG group). The short-term therapeutic benefits between the two groups were analyzed. The LARG procedure offered significantly better benefits to the patients compared to the ORG procedure, including less intraoperative blood loss (103.1 ± 19.5 mL vs 163.0 ± 32.9 mL, P < 0.0001), shorter postoperative hospital stay (6.8 ± 1.2 d vs 9.5 ± 1.6 d, P < 0.0001), less frequent occurrence of postoperative complications (6.5% vs 13.5%, P = 0.02), shorter time to mobilization (1.0 ± 0.3 vs 3.3 ± 0.4 d, P < 0.0001), shorter time to bowel opening (3.3 ± 0.7 d vs 4.5 ± 0.7 d, P < 0.0001), and shorter time to normal diet (3.0 ± 0.4 vs d 3.8 ± 0.5 d, P < 0.0001). However, LARG required a longer time to complete than the ORG procedure (192.3 ± 20.9 min vs 180.0 ± 26.9 min, P < 0.0001). Compared to ORG, LARG is safer, more effective, and less invasive for treating gastric cancer, with better short-term efficacy.

Laparoscopic versus open gastrectomy for gastric cancer: Long-term oncologic results

Data are lacking regarding the oncologic safety of laparoscopic gastrectomy (LG) for the treatment of gastric cancer. The aim of this study was to compare the long-term outcomes of LG with open gastrectomy (OG) for the treatment of gastric cancer. A total of 1,874 patients underwent curative distal or total gastrectomy for gastric adenocarcinoma between May 2003 and December 2009 and were included in this retrospective study. Recurrence-free survival and recurrence pattern were compared according to each tumor stage, and a subgroup analysis was performed in advanced gastric cancer patients who underwent D2 lymphadenectomy. Of 1,874 patients, 816 were treated with OG and 1,058 with LG. No differences were observed in recurrence-free survival rates between the LG and the OG groups for any tumor stage. The number of harvested lymph nodes was similar between the two groups when analyzed according to tumor progression, operative procedure, and extent of lymphadenectomy. There were no differences between the 2 groups when we compared recurrence patterns after stratifying for tumor stage. The subgroup analysis in advanced gastric cancer patients who underwent D2 lymphadenectomy showed that there was no difference in the recurrence-free survival rates for any tumor stage between the 2 groups. Multivariate analysis indicated that the type of operative approach did not influence recurrence in either early or advanced gastric cancer patients. LG for gastric cancer is an oncologically safe procedure with comparable long-term outcomes with OG.

The short-term outcome in esophagogastric junctional adenocarcinoma patients receiving total gastrectomy: Laparoscopic versus open gastrectomy – A retrospective cohort study

ObjectiveThis study aimed to compare the quality of life in Siewert type II esophagogastric junctional adenocarcinoma patients receiving either laparoscopic total gastrectomy or open total gastrectomy. MethodsFrom Sep 1, 2008 to May 1, 2012, totally 204 consecutive patients with Siewert type II esophagogastric junctional adenocarcinoma were involved in this retrospective study. Patients were assigned to receive either laparoscopic total gastrectomy or open total gastrectomy. Details concerning the postoperative outcomes and the quality of life questionnaire were collected and compared. ResultsTotally 104 patients were involved in the open gastrectomy group and 100 in the laparoscopic gastrectomy group. No differences were noted between the groups in demographics, blood loss, anastomotic leak, anastomotic stricture, hospital stay, reoperation and in-hospital mortality. Totally 188 cases of patients (92.16%) responded to the questionnaire measures during the entire follow-up period, including 93 (93%) in the laparoscopic group and 95 (91.35%) in the open group. The score of every scale and item in laparoscopic group improved much more quickly comparing with the open group, suggesting that patients in laparoscopic group recovered much more quickly than those in open group. ConclusionsLaparoscopic total gastrectomy could lead to a significant improvement of the short-term benefits for patients with esophagogastric junctional adenocarcinoma as compared with open group.

Incidence and risk factors for postsurgical gastroparesis syndrome after laparoscopic and open radical gastrectomy

BackgroundThe aim of this study was to investigate the differences and influencing factors for postsurgical gastroparesis syndrome incidence after laparoscopic and open radical gastrectomy.MethodsClinical data were collected for 563 patients who underwent open radical gastrectomy for gastric cancer and 72 cases receiving laparoscopic radical gastrectomy. We retrospectively analyzed the incidence of postsurgical gastroparesis syndrome, clinical features, course of disease, and risk factors of these two groups.ResultsThere was no statistical difference for the incident rate of postsurgical gastroparesis syndrome between laparoscopic and open radical gastrectomy (6.9% vs. 3.7%, P > 0.05). Preoperative outflow tract obstruction and Billroth II anastomosis were the two risk factors for postsurgical gastroparesis syndrome in the open radical gastrectomy group and the laparoscopic surgery for gastric cancer group. The same results were obtained from logistic regression statistical analysis. Age greater than 70 years was also one of the risk factors for postsurgical gastroparesis syndrome in the open radical gastrectomy group (P < 0.05).ConclusionsLaparoscopic radical gastrectomy for gastric cancer does not increase the incident rate of postsurgical gastroparesis syndrome.

National outcomes and uptake of laparoscopic gastrectomy for cancer in England

Gastrectomy remains the mainstay of curative treatment for gastric cancer, yet it is associated with significant postoperative mortality. The laparoscopic approach has been introduced in an attempt to improve surgical outcomes. This study examines the uptake of laparoscopic gastrectomy in England and quantifies postoperative mortality and morbidity following gastrectomy for cancer. A population-based study of a national administrative database was undertaken. Patients undergoing gastrectomy for cancer in any National Health Services hospital in England between April 2000 and March 2010 were included. The main outcome measures were mortality, morbidity and length of stay. A total of 10,713 patients underwent gastrectomy, of which 10,233 (95.5%) underwent open gastrectomy (OG), and 480 (4.5%) underwent laparoscopic gastrectomy (LG). There was no significant difference in 30-day in-hospital mortality between OG and LG (5.6% vs. 4.8%; p = 0.461). Medical complications occurred in 2,311 (22.6%) and 120 (25%) patients from OG and LG groups respectively (p = 0.217). Patients in the LG groups had a shorter hospital stay than OG with median (interquartile range) of 11 (8-17) versus 14 (11-19) days respectively (p < 0.001). Readmission and reoperation rates were 10.2 versus 12.1% (p = 0.175) and 4 versus 4.6% (p = 0.523) for OG and LG respectively. LG is increasingly being performed in England. Postoperative morbidity and mortality of LG is similar to that of OG, but it is associated with a shorter hospital stay. Data from randomised controlled trials evaluating long term survival and patients' reported outcomes are essential before the final judgement on the value of LG in the management of gastric cancer.

Outcomes After Laparoscopic or Open Distal Gastrectomy for Early-Stage Gastric Cancer

In a large nationwide administrative database of hospitalized patients, we investigated postoperative outcomes after laparoscopic or open distal gastrectomy in Japan. The benefits of laparoscopic gastrectomy, such as decreased length of stay and morbidity, have typically been evaluated only with limited data on the basis of small samples. : Using the Japanese Diagnosis Procedure Combination Database, we identified 9388 patients who were preoperatively diagnosed with stage I and II gastric cancer and underwent laparoscopic (n = 3937) or open (n = 5451) distal gastrectomy between July and December 2010. One-to-one propensity score matching was performed to compare in-hospital mortality, postoperative complication rates, length of stay, total costs, and 30-day readmission rates between the 2 groups. Patients with younger age, lower comorbidity index, or stage I cancer were more likely to receive laparoscopic gastrectomy. In the propensity-matched analysis with 2473 pairs, the laparoscopic gastrectomy group in comparison with the open gastrectomy group showed a slight reduction in median postoperative length of stay (13 days vs 15 days, P < 0.001) but a slight increase in median total costs (US $21,510 vs $21,024, P = 0.002). There were no significant differences in in-hospital mortality (0.36% vs 0.28%, P = 0.80), overall postoperative complications (12.9% vs 12.6%, P = 0.73), or 30-day readmission rates (3.2% vs 3.2%, P = 0.94). In this large nationwide cohort of patients with early-stage gastric cancer, laparoscopic gastrectomy was associated with a statistically significant but slight reduction in postoperative length of stay, but no differences between laparoscopic gastrectomy and open gastrectomy were detected in terms of early mortality and morbidity.

Early results of a modified splenic hilar lymphadenectomy in laparoscopy-assisted total gastrectomy for gastric cancer with stage cT1-2: a case–control study

The aim of this study was to explore the feasibility and early outcomes of laparoscopy-assisted total gastrectomy with a modified splenic hilar lymphadenectomy for upper- and middle-third stage cT1-2 gastric cancer. A total of 97 patients diagnosed with upper- and middle-third stage cT1-T2 gastric cancer were enrolled. Patients were assigned to the laparoscopy-assisted total gastrectomy group (LATG, n = 41) or the open total gastrectomy group (OTG, n = 56). All patients underwent total gastrectomy with modified splenic hilar lymphadenectomy. The operative and postoperative measures, number of retrieved lymph nodes (LNs), and complications were compared between the two groups. The mean number of dissected LNs was not significantly different between the two groups: 23.1 ± 8.0 in the LATG group versus 24.2 ± 7.5 in the OTG group. Compared with the OTG group, the LATG group had less operative blood loss [104.2 ± 42.9 vs. 355.6 ± 51.3 ml (p < 0.0001)], shorter time to out-of-bed activities [14.4 ± 3.2 vs. 16.5 ± 1.2 h (p < 0.0001)], shorter time to first flatus [72.2 ± 16.2 vs. 78.4 ± 8.6 h (p = 0.017)], earlier resumption of soft diet [52.8 ± 21.6 vs. 74.2 ± 12.2 h (p < 0.0001)], and shorter postoperative hospital stay [9.7 ± 2.2 vs. 13.6 ± 3.6 days (p < 0.0001)]. However, LATG had a slightly longer operating time than OTG [235.7 ± 38.5 vs. 211.5 ± 33.2 min (p = 0.001)]. The operative complications rates for the LATG and OTG groups were not significantly different: 4.9 versus 5.4 %. For upper- and middle-third stage cT1-2 gastric cancer, a limited splenic hilar lymphadenectomy strategy seems to be safe and feasible, particularly for the number of retrieved LNs. However, this technique is not suitable for cT3 disease.

Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer without serosal invasion: a case control study

BackgroundThe application of laparoscopic surgery for advanced gastric cancer (AGC) remains questionable on account of technical difficulty of D2 lymphadenectomy, and there has been few large-scale follow-up results regarding the oncological adequacy of laparoscopic surgery compared with that of open surgeries for AGC. The aim of this study is to evaluate technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer without serosal invasion.MethodsFrom January 2008 to December 2012, 1114 patients with gastric cancer underwent D2 gastrectomy, including 336 T2 and T3 patients in term of depth of invasion. Of all 336 patients, 224 underwent LAG, while open gastrectomy (OG) performed on the other 112 patients. The comparison was based on the clinicopathologic characteristics, surgical outcome, and follow-up results.ResultsThere are not significant differences in clinicopathological characteristics between the two groups (P > 0.05). The operation time and first ambulation time was similar in the two groups. However, estimated blood loss, bowel function recovery time and duration of hospital stay were significantly less in the LAG group. No significant difference in morbidity and mortality was found between the LAG group and OG group (11.1% vs. 15.3%, P = 0.266; 0.9% vs. 1.8%, P = 0.859). The mean number of resected lymph nodes (LNS) between the LAG group and OG group was similar (30.6 ± 10.1 vs. 30.3 ± 8.6, P = 0.786). Furthermore, the mean number of removed LNS in each station was not significantly different in the distal gastrectomy and total gastrectomy (P > 0.05). No statistical difference was seen in 1 year survival rate (91.5% vs. 89.8% P > 0.05) and the survival curve after surgery between the LAG group and OG group.ConclusionLaparoscopy-assisted D2 radical gastrectomy is feasible, effective and has comparative oncological efficacy compared with open gastrectomy for advanced gastric cancer without serosal invasion.

PTU-170 A comparison of the early quality of life outcomes between open and laparoscopic oesophagogastric resectional surgery

IntroductionThere is a paucity of data directly comparing health related quality of life (HRQL) between laparoscopic and open oesophagogastric resections. This study aims to evaluate differences between these groups in...

Meta-Analysis of Randomized Controlled Trials on Laparoscopic Gastrectomy vs. Open Gastrectomy for Distal Gastric Cancer

To evaluate the safety and practicability of laparoscopic gastrectomy (LG) by comparing the short-term and long-term outcomes of LG and open gastrectomy (OG) for gastric cancer. According to the criterion, randomized clinical trials (RCTs) were searched in MEDLINE, EMBASE, CNKI (in Chinese), WANFANG DATA (in Chinese), and Cochrane Controlled Trials Register from January 2000 to January 2012. The RCTs were prepared in accordance with the quality of reporting of meta-analyses statement. Intraoperative and early postoperative parameters, as well as long-term tumor recurrence were analyzed. Random effect meta-analyses were performed using odds ratios (ORs) and weighted mean differences (WMDs). Up to 8 RCTs with 782 patients were enrolled in the present meta-analysis (402 patients underwent LG (LG group) and 380 underwent OG (OG group)). The LG group had shorter wound lengths, less blood loss, more rapid bowel function recovery: first flatus and first food intake, lower overall complication rate and shorter hospital stay, whereas the LG group had longer operation times and less harvested lymph nodes. The tumor recurrence between the two groups had no significant difference. Considering its lower morbidity and enhanced postoperative recovery, LG is a safe technical alternative to OG for distal gastric cancer.

Comparative Analysis of Five-Year Survival Results of Laparoscopy-Assisted Gastrectomy versus Open Gastrectomy for Advanced Gastric Cancer: A Case-Control Study Using a Propensity Score Method

Background: The aim of this study was to investigate the surgical and oncologic outcomes of laparoscopy-assisted gastrectomy (LAG) and open gastrectomy (OG) for advanced gastric cancer (AGC) using the case-control method with a sufficient follow-up period. Patients and Methods: The authors retrospectively analyzed 89 patients who underwent LAG and 345 patients who underwent OG for AGC between August 1999 and June 2007. A total of 176 matched cases were included in the final analysis. Results: Except for tumor size and reconstruction, there were no statistically significant differences in the clinicopathological parameters between the two groups. Although operation time was significantly longer for LAG than OG (228.3 vs. 183.6 min, p < 0.0001), first flatus time and postoperative hospital stay without complications were significantly shorter in the LAG group (3.2 vs. 3.7 days, p < 0.0001; 7.0 vs. 10.4 days, p < 0.0001, respectively). Operation-related complications occurred in 7 cases (8.0%) in both groups. 13 patients (14.8%) in the LAG group and 15 patients (17.1%) in the OG group had recurrence. There was no statistically significant difference in the 5-year and disease-free survival rates between LAG and OG. Conclusions: LAG for AGC might be considered to be a minimally invasive surgery in some selected cases, although a well-designed prospective study comparing LAG with OG for AGC is needed.

Application of ultrasonic harmonic scalpel in open radical gastrectomy of proximal gastric cancer

Objective To explore the practicability and security of the ultracision harmonic scalpel in radical gastrectomy for patients with proximal gastric cancer.Methods 115 patients of stage Ⅰ ～ Ⅲ proximal gastric cancer undergone radical gastrectomy were analyzed retrospectively.65 patients were performed with ultracision harmonic scalpel,the other 50 patients were performed with conventional operation.The operative time,volume of intraoperative hemorrhage,length of incision,and postoperative complications were analyzed.Results There were significant difference in operative time ( 126.9 ± 20.7 ) min and ( 150.6 ± 31.7 ) min ( P ＜ 0.05 ),volume of intraoperative hemorrhage (105.7 ±40.3)ml and (171.7 ±63.2)ml(P＜0.01) and length of incision(17.2 ±2.1)cm and (20.3 ±2.3)cm (P ＜ 0.05 ).There was no significant difference in the postoperative complications between ultracisiou harmonic scalpel group and conventional group.All patients recovered without severe complications.Conclusion Radical resection of proximal gastric cancer using ultracision harmonic scalpel could shorten operative time,decrease intraoperative hemorrhage,shorten incision length,and the technique is convenient and safe. Key words: Stomach neoplasms; Gastrectomy; Ultracision harmonic scalpel

Radical distal gastrectomy in laparoscopic and open surgery: is it necessary for pancreatic capsule resection?

To explore the involvement of the pancreatic capsule during radical gastrectomy in gastric cancer. Pancreatic capsule samples were collected from the 83 cases (56 men and 27 women) during open radical gastrectomy and laparoscopic resection between January 2007 and July 2008. RT-PCR and immunohistochemistry were applied for tumor detection. There was a 2-year follow-up; the relationship of the pancreatic capsule involvement, tumor stage and survival rate were evaluated. Results from radical distal gastrectomy were combined with those of gastric cancer pancreatic capsule cleaning; clinical data, pathology, immunohistochemistry and RT-PCR were used to confirm the necessity of pancreatic capsule resection in laparoscopic radical gastrectomy. H&E staining of the pancreatic capsule showed no tumor existence in any of the 83 patients but immunohistochemistry showed CK20 positive cells in 20 patients (33.7%), while RT-PCR detected CK20 mRNA positive cells in 42 patients (50.6%). Cases with stage T1 and T2 were negative for CK20 in both RT-PCR and immunohistochemistry and the few cases with T3 and T4 were also negative in both RT-PCR and immunohistochemistry. The metastasis in the pancreatic capsule correlated mainly with the invasive serous membrane, lymph node metastasis and tumor stage (p<0.05) but not with gender and age (p>0.05). For T1 and T2 stage, there was no evidence of pancreatic capsule metastasis, which may facilitate the decision making of the pancreatic capsule resection during radical distal gastrectomy.

D2 dissection in laparoscopic and open gastrectomy for gastric cancer

To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. Clinicopathological data from 209 patients with gastric cancer, who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011, were analyzed retrospectively. Among these patients, 131 patients underwent laparoscopy-assisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG). The parameters analyzed included operative time, blood loss, blood transfusion, morbidity, mortality, the number of harvested lymph nodes (HLNs), and pathological stage. There were no significant differences in sex, age, types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)], and stages between the LAG and OG groups (P > 0.05). Among the two groups, 127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs, respectively. The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P = 0.233). In the same type of radical resection, there were no significant differences in the number of HLNs between the two groups (PG + D2: 21.7 ± 7.5 vs. 22.4 ± 9.3; DG + D2: 25.7 ± 11.0 vs. 22.3 ± 7.9; TG + D2: 30.9 ± 13.4 vs. 29.3 ± 10.4; P > 0.05 for all comparisons). Tumor free margins were obtained in all cases. Compared with OG group, the LAG group had significantly less blood loss, but a longer operation time (P < 0.001). The morbidity of the LAG group was 9.9%, which was not significantly different from the OG group (7.7%) (P = 0.587). The mortality was zero in both groups. Laparoscopic D2 dissection is equivalent to OG in the number of HLNs, regardless of tumor location. Thus, this procedure can achieve the same radicalness as OG.

Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer

Laparoscopy-assisted gastrectomy (LAG) has been established as a low-invasive surgery for early gastric cancer. However, it remains unknown whether it is applicable also for advanced gastric cancer, mainly because the long-term results of LAG with D2 lymph node dissection for advanced gastric cancer have not been well validated compared with open gastrectomy (OG). A retrospective cohort study was performed to compare LAG and OG with D2 lymph node dissection. For this study, 167 patients (66 LAG and 101 OG patients) who underwent gastrectomy with D2 lymph node dissection for advanced gastric cancer were reviewed. Recurrence-free survival and overall survival time were estimated using Kaplan-Meier curves. Stratified log-rank statistical evaluation was used to compare the difference between the LAG and OG groups stratified by histologic type, pathologic T status, N status, and postoperative adjuvant chemotherapy. The adjusted Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of LAG. The 5-year recurrence-free survival rate was 89.6% in the LAG group and 75.8% in the OG group (nonsignificant difference; stratified log-rank statistic, 3.11; P = 0.0777). The adjusted HR of recurrence for LAG compared with OG was 0.389 [95% confidence interval (CI) 0.131-1.151]. The 5-year overall survival rate was 94.4% in the LAG group and 78.5% in the OG group (nonsignificant difference; stratified log-rank statistic, 0.4817; P = 0.4877). The adjusted HR of death for LAG compared with OG was 0.633 (95% CI 0.172-2.325). The findings show that LAG with D2 lymph node dissection is acceptable in terms of long-term results for advanced gastric cancer cases and may be applicable for advanced gastric cancer treatment.