Comparative study of laparoscopy-assisted versus open subtotal gastrectomy for pT2 gastric cancer

Abstract

Purpose: Laparoscopy-assisted distal gastrectomy (LADG) is a widely accepted surgery for early gastric cancer. However, its use in advanced gastric cancer has rarely been studied. The aim of this study is to investigate the feasibility and survival outcomes of LADG for pT2 gastric cancer.

Materials and methods: Between January 2004 and December 2009, we evaluated 67 and 52 patients who underwent open distal gastrectomy (ODG) and LADG, respectively, with diagnosis of pT2 gastric cancer. The clinicopathological characteristics, postoperative outcomes, and survival were retrospectively compared between the two groups.

Results: There were statistically significant differences in the proximal margin of the clinicopathological parameters. The operation time was significantly longer in LADG than in ODG (207.7 vs. 159.9 minutes). There were 6 (9.0%) and 5 (9.6%) complications in ODG and LADG, respectively. During follow-up periods, tumor recurrence occurred in 7 (10.4%) patients of the ODG and in 4 (7.7%) patients of the LADG group. The 5-year survival rate of ODG and LADG was 88.6% and 91.3% (p=0.613), respectively. In view of lymph node involvement, 5-year survival rates were 96.0% in ODG versus 97.0% in LADG for patients with negative nodal metastasis (p=0.968) and 80.9% in ODG versus 78.7% in LADG for those with positive nodal metastasis (p=0.868).

Conclusion: Although prospective study is necessary to compare LADG with open gastrectomy for the treatment of advanced gastric cancer, laparoscopy-assisted distal gastrectomy might be considered as an alternative treatment for some pT2 gastric cancer.

Fig. 1

Comparison of 5-year survival rate for pT2 gastric cancer between ODG and LADG. There was no statistically difference between both groups (p=0.446). ODG, open distal gastrectomy; LADG, laparoscopy-assisted distal gastrectomy.

Fig. 2

Comparison of 5-year survival rate for pT2 gastric cancer between ODG and LADG according to lymph node metastasis. The 5 year survival rates of negative nodal metastasis (A) between both groups were 96.0% and 97.0% (p=0.968), and those of positive nodal metastasis (B) were 80.9% and 78.7% (p=0.868), respectively. ODG, open distal gastrectomy; LADG, laparoscopy-assisted distal gastrectomy.