A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan

Abstract

Background: Laparoscopic surgery for gastric cancer is technically feasible, but it is not widely accepted because it has not been evaluated from the standpoint of oncologic outcome. We conducted a retrospective, multicenter study of a large series of patients in Japan to evaluate the short- and long-term outcomes of laparoscopic gastrectomy for early gastric cancer (EGC).

Methods: The study group comprised 1294 patients who underwent laparoscopic gastrectomy during the period April 1994 through December 2003 in 16 participating surgical units (Japanese Laparoscopic Surgery Study Group). The short- and long-term outcomes of these patients were examined.

Results: Distal gastrectomy was performed in 1185 patients (91.5%), proximal gastrectomy in 54 (4.2%), and total gastrectomy in 55 (4.3%); all were performed laparoscopically. The morbidity and mortality rates associated with these operations were 14.8% and 0%, respectively. Histologically, 1212 patients (93.7%) had stage IA disease, 75 (5.8%) had stage IB disease, and 7 (0.5%) had stage II disease (the UICC staging). Cancer recurred in only 6 (0.6%) of 1294 patients treated curatively (median follow-up, 36 months; range, 13-113 months). The 5-year disease-free survival rate was 99.8% for stage IA disease, 98.7% for stage IB disease, and 85.7% for stage II disease.

Conclusions: Although our findings may be considered preliminary, our data indicate that laparoscopic surgery for EGC yields good short- and long-term oncologic outcomes.

FIGURE 1. The disease-free survival rate in 1294 treated patients with early gastric cancer. The 5-year disease-free survival rate was 99.8% for stage IA, 98.7% for stage IB, and 85.7% for stage II. Tumor staging system is used with classification by the UICC staging.

FIGURE 2. The disease-free survival rate according to operation. The 5-year disease-free survival rate was 99.4% for LADG, 98.7% for LAPG, and 93.2% for LATG.