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Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis
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Abstract
Background
Advanced minimally invasive techniques including robotic surgery are being employed with increasing frequency around the world, primarily in order to improve the surgical outcomes of laparoscopic gastrectomy (LG). We conducted a systematic review and meta-analysis to evaluate the feasibility, safety and efficacy of robotic gastrectomy (RG).
Methods
Studies, which compared surgical outcomes between LG and RG, were retrieved from medical databases before May 2017. Outcomes of interest were estimated as weighted mean difference (WMD) or risk ratio (RR) using the random-effects model. The software Review Manage version 5.1 was used for all calculations.
Results
Nineteen comparative studies with 5953 patients were included in this analysis. Compared with LG, RG was associated with longer operation time (WMD = −49.05 min; 95% CI: -58.18 ~ −39.91, P < 0.01), less intraoperative blood loss (WMD = 24.38 ml; 95% CI: 12.32 ~ 36.43, P < 0.01), earlier time to oral intake (WMD = 0.23 days; 95% CI: 0.13 ~ 0.34, P < 0.01), and a higher expense (WMD = −3944.8 USD; 95% CI: -4943.5 ~ −2946.2, P < 0.01). There was no significant difference between RG and LG regarding time to flatus, hospitalization, morbidity, mortality, harvested lymph nodes, and cancer recurrence.
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Most cited references56
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Japanese gastric cancer treatment guidelines 2014 (ver. 4)
Preface to the English edition This English edition was made based on the Japanese version published as a book in 2014. Our policy in compiling this edition was to attempt not to include new evidence that emerged since the publication of the Japanese version so as to maintain consistency of the two editions. However, for some particularly important issues, we provided additional comments and new references reflecting the new evidence. Preface Version 4 of the Japanese Gastric Cancer Treatment Guidelines was completed in May 2014, incorporating new evidence that includes those delivered as a quick bulletin in the website of the Japan Gastric Cancer Association after publication of the previous version. It remains largely conformed to the textbook style, but a new section consisting of clinical questions and answers (Q&A) was added to address some important clinical issues for which hard evidence is unavailable. To compile this version, the guideline committee nominated several working groups, each assigned to make relevant contributions to unsolved issues on the following topics: (1) surgery and lymphadenectomy for junctional cancer, (2) clinical pathway, (3) follow-up after curative surgery, (4) treatment of technically resectable metastatic cancer, (5) risk calculation for surgical intervention and (6) treatment of cancer of the gastric remnant. Of these, tentative consensuses were reached on the first three topics that were included as new sections in the text, whereas further discussion was deemed necessary for the last two topics. The clinical importance of the fourth topic and lack of hard evidence related to that topic prompted the committee to establish a Q and A section to provide tentative best answers to important clinical questions on technically resectable metastatic cancer. Major points of revision in the current version are listed below: The section on types and definitions of gastric surgery has been revised. An algorithm showing the tentative standard of the extent of lymphadenectomy that can be recommended for junctional cancer less than 4 cm in diameter has been presented. Laparoscopic distal gastrectomy for clinical stage I cancer was upgraded from an investigational treatment to an option in general practice. Chemotherapeutic regimens were classified into three recommendation categories based on the level of evidence and consensus among the committee members. A revision was made to the definition of curative resection among tumors of expanded indication for endoscopic resection. Additional descriptions were given on the biopsy-derived scar and component of “muc” in the submucosa of the endoscopy-resected specimen. Clinical questions were raised on treatment strategy for technically resectable metastatic cancer and chemotherapy for patients for whom evidence-based standard treatment may not be applicable, and the tentative but best possible answers were provided. Exemplary samples of the clinical pathway for management of patients who underwent gastrectomy and the follow-up schedule after surgery for gastric cancer were presented. The description of tumor status (T/N/M and stage) in this guideline remains to be based on the third English edition of the Japanese Classification of Gastric Carcinoma [1], which is identical to that in the 7th edition of the International Union Against Cancer (UICC)/TNM. Treatments Algorithm of standard treatments to be recommended in clinical practice The algorithm is shown in Fig. 1. Fig. 1 Algorithm of standard treatments Investigational treatments The following treatments show promise but are as yet to be established as the standard. They should be prospectively evaluated in appropriate clinical research settings. Patient consent for investigational treatments should be sought and the rationale behind them given. The following constitute investigational treatments: Endoscopic submucosal dissection under the expanded criteria [see “Tumors indicated for endoscopic resection as an investigational treatment (expanded indication)”]. Laparoscopic surgery for advanced cancer and those in need of total gastrectomy. Local tumor resection. Neoadjuvant chemotherapy. Adjuvant chemotherapy using agents other than S-1. Neoadjuvant chemoradiotherapy. Adjuvant chemoradiotherapy. Surgery Types and definitions of gastric surgery Curative surgery Standard gastrectomy Standard gastrectomy is the principal surgical procedure performed with curative intent. It involves resection of at least two-thirds of the stomach with a D2 lymph node dissection. Non-standard gastrectomy In non-standard gastrectomy, the extent of gastric resection and/or lymphadenectomy is altered according to tumor stages. Modified surgery The extent of gastric resection and/or lymphadenectomy is reduced (D1, D1+, etc.) compared to standard surgery. Extended surgery (1) Gastrectomy with combined resection of adjacent involved organs. (2) Gastrectomy with extended lymphadenectomy exceeding D2. Non-curative surgery Palliative surgery Serious symptoms such as bleeding or obstruction may develop in a patient with advanced/metastatic gastric cancer. Surgery to relieve symptoms may then be considered an option, and palliative gastrectomy or gastrojejunostomy is selected depending on the resectability of the primary tumor and/or surgical risks. Stomach-partitioning gastrojejunostomy has been reported to result in superior function compared to simple gastrojejunostomy [2]. Reduction surgery The role of gastrectomy is unclear in patients with metastatic gastric cancer in the absence of urgent symptoms such as bleeding or obstruction. Reduction surgery aims to prolong survival or to delay the onset of symptoms by reducing tumor volume. (Additional comments in this English edition) No evidence in support of reduction surgery was found in an international cooperative randomized controlled trial (REGATTA, JCOG0705/KGCA01 [3]). Extent of gastric resection Surgery for gastric cancer Surgery for gastric cancer is defined as follows in the order of the stomach volume to be resected. Total gastrectomy Total resection of the stomach including the cardia and pylorus. Distal gastrectomy Stomach resection including the pylorus. The cardia is preserved. In the standard gastrectomy, two-thirds of the stomach is resected. Pylorus-preserving gastrectomy (PPG) Stomach resection preserving the upper third of the stomach and the pylorus along with a portion of the antrum. Proximal gastrectomy Stomach resection including the cardia (esophagogastric junction). The pylorus is preserved. Segmental gastrectomy Circumferential resection of the stomach preserving the cardia and pylorus. Local resection. Non-resectional surgery (bypass surgery, gastrostomy, jejunostomy). Determination of gastric resection Resection margin A sufficient resection margin should be ensured when determining the resection line in gastrectomy with curative intent. Proximal margin of at least 3 cm is recommended for T2 or deeper tumors with an expansive growth pattern (types 1 and 2) and 5 cm for those with an infiltrative growth pattern (types 3 and 4). When these rules cannot be observed, it is advisable to examine the proximal resection margin by frozen section. For tumors invading the esophagus, a 5-cm margin is not necessarily required, but frozen section examination of the resection line is desirable to ensure an R0 resection. For T1 tumors, a gross resection margin of 2 cm should be obtained. When the tumor border is unclear, preoperative endoscopic marking by clips of the tumor border based on biopsy results will be helpful for decision making regarding the resection line. Selection of gastrectomy The standard surgical procedure for clinically node-positive (cN+) or T2-T4a tumors is either total or distal gastrectomy. Distal gastrectomy is selected when a satisfactory proximal resection margin (see above) can be obtained. Pancreatic invasion by tumor requiring pancreaticosplenectomy necessitates total gastrectomy regardless of the tumor location. Total gastrectomy with splenectomy should be considered for tumors that are located along the greater curvature and harbor metastasis to no. 4sb lymph nodes, even if the primary tumor could be removed by distal gastrectomy. For adenocarcinoma located on the proximal side of the esophagogastric junction, esophagectomy and proximal gastrectomy with gastric tube reconstruction should be considered, similarly to surgery for esophageal cancer. For cT1cN0 tumors, the following types of gastric resection can be considered according to tumor location. Pylorus-preserving gastrectomy (PPG): for tumors in the middle portion of the stomach with the distal tumor border at least 4 cm proximal to the pylorus. Proximal gastrectomy: for proximal tumors where more than half of the distal stomach can be preserved. Segmental gastrectomy and local resection under sentinel navigation are still regarded as investigational treatments. Lymph node dissection Extent of lymph node dissection The extent of systematic lymphadenectomy is defined as follows according to the type of gastrectomy conducted. When the extent of lymphadenectomy performed does not fully comply with the D level criteria, the lymph node station that has been additionally resected or left in situ could be recorded as in the following examples: D1 (+No. 8a), D2 (−No. 10). However, when sending data to the nationwide database, the D level needs to be strictly decided upon and should be downgraded if resection of any of the lymph node stations that should have been resected was omitted. Total gastrectomy (Fig. 2) D0: Lymphadenectomy less than D1. D1: Nos. 1–7. D1+: D1 + No. 8a, 9, 11p. D2: D1 + No. 8a, 9, 10, 11p, 11d, 12a. For tumors invading the esophagus, D1+ includes: No. 110*, D2 includes No. 19, 20, 110 and 111. Fig. 2 The extent of lymphadenectomy after total gastrectomy. The numbers correspond to the lymph node station as defined in the Japanese Classification of Gastric Carcinoma (1). Complete dissection of the nodes in blue denotes D1 dissection, the nodes in orange D1+ and the nodes in red D2 Distal gastrectomy (Fig. 3) D0: Lymphadenectomy less than D1. D1: No. 1, 3, 4sb, 4d, 5, 6, 7 D1+: D1 + No. 8a, 9 D2: D1 + No. 8a, 9, 11p, 12a. Fig. 3 The extent of lymphadenectomy after distal gastrectomy. The numbers correspond to the lymph node station as defined in the Japanese Classification of Gastric Carcinoma (1). Complete dissection of the nodes in blue denotes D1 dissection, the nodes in orange D1+ and the nodes in red D2 Pylorus-preserving gastrectomy (Fig. 4) D0: Lymphadenectomy less than D1. D1: No. 1, 3, 4sb, 4d, 6, 7. D1+: D1 + No. 8a, 9. Fig. 4 The extent of lymphadenectomy after pylorus-preserving gastrectomy. The numbers correspond to the lymph node station as defined in the Japanese Classification of Gastric Carcinoma (1). Complete dissection of the nodes in blue denotes D1 dissection and the nodes in orange D1+ Proximal gastrectomy (Fig. 5) D0: Lymphadenectomy less than D1. D1: No. 1, 2, 3a, 4sa, 4sb, 7. D1+: D1 + No. 8a, 9, 11p. Fig. 5 The extent of lymphadenectomy after proximal gastrectomy. The numbers correspond to the lymph node station as defined in the Japanese Classification of Gastric Carcinoma (1). Complete dissection of the nodes in blue denotes D1 dissection and the nodes in orange D1+ For tumors invading the esophagus, D1 + includes No. 110*. *No. 110 lymph nodes (lower thoracic para-esophageal nodes) in gastric cancer invading the esophagus are those attached to the lower part of the esophagus that is removed to obtain a sufficient resection margin. Indications for lymph node dissection In principle, a D1 or a D1+ lymphadenectomy is indicated for cT1N0 tumors and D2 for cN+ or cT2-T4 tumors. Since the pre- and intraoperative diagnoses of lymph node metastases remain unreliable, a D2 lymphadenectomy should be performed whenever nodal involvement is suspected. D1 lymphadenectomy A D1 lymphadenectomy is indicated for T1a tumors that do not meet the criteria for EMR/ESD, and for cT1bN0 tumors that are histologically of differentiated type and 1.5 cm or smaller in diameter. D1+ lymphadenectomy A D1+ lymphadenectomy is indicated for cT1N0 tumors other than the above. D2 lymphadenectomy A D2 lymphadenectomy is indicated for potentially curable T2-T4 tumors as well as cT1N+ tumors. The role of splenectomy for complete resection of Nos. 10 and 11 nodes had long been an issue of controversy, and the final results of a randomized trial (JCOG 0110) are awaited. In the meantime, complete clearance of No. 10 nodes by splenectomy should be considered for potentially curable T2-T4 tumors invading the greater curvature of the upper stomach. (Additional comments in this English edition) The randomized trial (JCOG 0110) was concluded and revealed non-inferiority of spleen preservation in terms of overall survival. Splenectomy should not be performed unless the primary T2-T4 tumor either directly invades the spleen or is located in the greater curvature of the upper stomach [4]. D2+ lymphadenectomy Gastrectomy with extended lymphadenectomy beyond D2 is classified as a non-standard gastrectomy. Its role has been discussed as follows. The benefit of prophylactic para-aortic lymphadenectomy was denied by the randomized trial, JCOG 9501 [5]. Although a R0 resection may be possible for tumors with para-aortic nodal involvement without other non-curative factors, the prognosis of this population is poor. Nevertheless, neoadjuvant chemotherapy followed by D2+ is a promising option (refer to CQ1). The role of No. 14v lymphadenectomy in distal gastric cancer is controversial. Dissection of No. 14v had been a part of D2 gastrectomy defined by the 13th edition of the Japanese Classification of Gastric Carcinoma, but was excluded from the previous version (version 3) of the Japanese Gastric Cancer Treatment Guidelines and remains that way in the current version. However, D2 (+No. 14v) may be beneficial for patients who are suspected to harbor metastasis to the No. 6 nodes. Involvement of No. 13 nodes is defined as M1 in the current version. However, D2 (+No. 13) lymphadenectomy may be an option in a potentially curative gastrectomy for tumors invading the duodenum [6]. Junctional cancer In the Japanese Classification of Gastric Carcinoma, junctional cancer has been defined as cancer (adenocarcinoma or squamous cell carcinoma) with its center located within 2 cm of the esophago-gastric junction. There is no consensus over the type of resection and the extent of lymphadenectomy that could be a standard of care for this category. In 2012–2013, the Japanese Gastric Cancer Association and Japan Esophageal Society joined forces to conduct a nationwide surveillance of junctional cancer of ≤4 cm diameter, and retrospective data of 3177 patients operated on between 2001 and 2010 were collected from 273 institutions. An algorithm showing the tentative standard in the extent of lymphadenectomy based on the tumor location, histology and T-categories was constructed based on this surveillance (Fig. 6). The anatomical border between Nos. 19 and 20 and among Nos. 110, 111 and 112 cannot be defined clearly. Therefore, lower mediastinal nodes and hiatal nodes were each treated as one lymph node station in the current analysis. Dissection of No. 3b can be omitted when performing proximal gastrectomy. A prospective phase II study by the same joint force to further investigate this issue is on-going. Fig. 6 Algorithm showing the tentative standard in the extent of lymphadenectomy for junctional cancer based on the tumor location, histology and T-categories Miscellaneous Vagal nerve preservation It is reported that preservation of the hepatic branch of the anterior vagus and/or the celiac branch of the posterior vagus contributes to improving postoperative quality of life through reducing post-gastrectomy gallstone formation, diarrhea and/or weight loss. In case of PPG, the hepatic branch should be preserved to maintain the pyloric function. Omentectomy Removal of the greater omentum is usually integrated in the standard gastrectomy for T3 (SS) or deeper tumors. For T1/T2 tumors, the omentum more than 3 cm away from the gastroepiploic arcade may be preserved. Bursectomy For tumors penetrating the serosa of the posterior gastric wall, bursectomy (removal of the inner peritoneal surface of the bursa omentalis) may be performed with the aim of removing microscopic tumor deposits in the lesser sac. There is no evidence that bursectomy reduces peritoneal or local recurrence, and it should be avoided in T1/T2 tumors to prevent injury to the pancreas and/or adjacent blood vessels. A small-scale randomized controlled trial recently suggested a survival benefit for bursectomy in T3/T4a tumors [7]. A large-scale multi-institutional randomized trial to address this issue (JCOG 1001) was subsequently launched and has completed accrual. Combined resection of adjacent organ(s) For tumors in which the primary or metastatic lesion directly invades adjacent organs, combined resection of the involved organ may be performed in order to obtain an R0 resection. Approaches to the lower esophagus For gastric cancers invading less than 3 cm of the distal esophagus, a transhiatal abdominal approach is recommended [8]. Where a greater length of esophagus is involved, a transthoracic approach should be considered if the surgery is potentially curative. Laparoscopic surgery Laparoscopic surgery can be considered an option in general clinical practice to treat cStage I cancer that is indicated for distal gastrectomy. In the 2014 version of the guidelines by the Japan Society for Endoscopic Surgery, distal gastrectomy by the laparoscopic approach has been recommended for cStage I cancer (rated recommendation B). These decisions reflect the fact that the safety of the laparoscopic approach was proven in a prospective phase II study (JCOG0703) that involved only certified surgeons with sufficient experience [9] and that superiority in terms of short-term outcome has been reported through small-scale randomized trials and meta-analyses. However, surgeons will have to be aware that the learning-curve issue exists, and the indication for this approach should be decided discreetly in each institution based on the expertise of the staff members that participate in this type of surgery. Data regarding the long-term outcome are yet to be available, and results of pivotal phase III studies conducted in Japan (JCOG0912 [10]) and Korea (KLASS01 [11]) are awaited. As for more advanced cancer, there is currently no evidence to recommend a laparoscopic approach since randomized trials to look at safety and long-term outcome are currently ongoing (JLSSG0901, KLASS02). Regarding total gastrectomy by this approach, no prospective trial has been reported. Thus, laparoscopic total gastrectomy has been rated by the guidelines of the Japan Society for Endoscopic Surgery (2014) as recommendation C1 (may be considered for a patient in need of total gastrectomy, but no scientific evidence in support of the procedure is currently available). Those who consider challenging the procedure should plan to do so with sufficient caution since postoperative complications were reported to be significantly more frequent in the first year of its introduction. When conducting gastrectomy by the laparoscopic approach, informed consent should be obtained from all patients after providing sufficient information, including the lack of data regarding long-term consequences. Reconstruction after gastrectomy The following reconstruction methods are usually employed. Each has advantages and disadvantages. Functional benefits of the pouch reconstruction are yet to be established. Total gastrectomy Roux-en-Y esophagojejunostomy. Jejunal interposition. Double tract method. Distal gastrectomy Billroth I gastroduodenostomy. Billroth II gastrojejunostomy. Roux-en-Y gastrojejunostomy. Jejunal interposition. Pylorus-preserving gastrectomy Gastro-gastrostomy. Proximal gastrectomy Esophagogastrostomy. Jejunal interposition. Double tract method. Endoscopic resection Methods of endoscopic resection Endoscopic mucosal resection (EMR) The lesion, together with the surrounding mucosa, is lifted by submucosal injection of saline (normo- or hypertonic) and removed using a high-frequency steel snare. Endoscopic submucosal dissection (ESD) The mucosa surrounding the lesion is circumferentially incised using a high-frequency electric knife (usually insulation-tipped), and the submucosal layer is dissected from the proper muscle layer. Handling of endoscopically resected specimens Handling of resected specimens The resected specimens should be handled according to the rules described in the Japanese Classification of Gastric Carcinoma [1]. Definition of differentiated-type and undifferentiated-type carcinoma The tumor biopsy specimens and endoscopically resected tumors are histologically classified into either the differentiated or undifferentiated type. The former includes papillary adenocarcinoma (pap) and tubular adenocarcinoma (tub1, tub2), and the latter includes poorly differentiated adenocarcinoma (por1, por2) and signet-ring cell carcinoma (sig). Endoscopic dissection should be defined as non-curative if mucinous adenocarcinoma (muc) was found in the submucosal layer, regardless of whether it is considered to derive from the differentiated or undifferentiated type. Histological predominance and intratumoral ulcerative findings (UL) A tumor consisting of components of both differentiated- and undifferentiated-type carcinoma is nevertheless classified into one of the two types according to the quantitative predominance. In addition, when more than one histological type is found in a tumor, all histological types are to be recorded in the order of quantitative predominance, e.g., tub2 > tub1. Diagnosis of UL(+) is principally made based on the histological evidence of ulcerative findings. However, endoscopic and/or radiological evidence should also be taken into consideration when making a conclusive diagnosis. A biopsy-derived scar is usually observed histologically as fibrosis restricted to small areas just beneath the muscularis mucosae. However, if it cannot be discriminated from the ulcer scar, it should be classified as UL(+). Indication for endoscopic resection (Fig. 7) Principles of indication Endoscopic resection is considered for tumors that have a very low possibility of lymph node metastasis and are suitable for en-bloc resection. Fig. 7 Algorithm showing treatment of early gastric cancer according to the histopathologic findings of the specimens resected by ESD Since compilation of the first version of this guideline, two independent sets of indications for the endoscopic resection have been provided: an absolute indication for standard EMR/ESD and an expanded indication for ESD to be considered as an investigational treatment. The evidence regarding curability of the latter technique remains insufficient, and the procedure should be offered with caution. Tumors indicated for endoscopic resection as a standard treatment (absolute indication) EMR or ESD is indicated as a standard treatment for the following tumor. A differentiated-type adenocarcinoma without ulcerative findings [UL(−)], of which the depth of invasion is clinically diagnosed as T1a and the diameter is ≤2 cm. Tumors indicated for endoscopic resection as an investigational treatment (expanded indication) Tumors of the following categories have very low possibility of lymph node metastasis when they are not accompanied with lymphovascular infiltration [ly(−), v(−)] and could be indicated for endoscopic resection [12, 13]. To avoid incomplete dissection, ESD rather than EMR should be performed. Since evidence on long-term survival is currently lacking, however, endoscopic treatment for these lesions should be considered investigational until trials such as JCOG0607 turn out to be positive. Tumors clinically diagnosed as T1a and Of differentiated-type, UL(−), but >2 cm in diameter. Of differentiated-type, UL(+), and ≤3 cm in diameter. Of undifferentiated-type, UL(−), and ≤2 cm in diameter. Local recurrence after EMR/ESD Local mucosal recurrence after EMR/ESD for tumors that had fulfilled the absolute indication could be considered to meet the criteria for expanded indication and may be treated by another ESD. However, given paucity of the evidence in terms of long-term survival, repeat ESD should be also considered as investigational. Curability of endoscopic resection Meticulous pathologic examination of the resected specimen is mandatory. Curability needs to be assessed based on both the results of the pathologic examination and facts based on the accumulated data. Two factors should be considered for curability assessment: completeness of the primary tumor removal and nil possibility of lymph node metastasis. Curative resection The resection is determined as curative when all of the following conditions are fulfilled: en bloc resection, tumor size ≤2 cm, histologically of differentiated type, pT1a, negative horizontal margin (HM0), negative vertical margin (VM0) and no lymphovascular infiltration (ly(−), v(−)). Curative resection for tumors of expanded indication The resection is considered as curative when all of the following conditions are fulfilled: En bloc resection, HM0, VM0, ly(−), v(−), and Tumor size >2 cm, histologically of differentiated type, pT1a, UL(−). Tumor size ≤3 cm, histologically of differentiated type, pT1a, UL(+). Tumor size ≤2 cm, histologically of undifferentiated type, pT1a, UL(−). Tumor size ≤3 cm, histologically of differentiated type, pT1b (SM1, 10 % reduction in the left ventricular ejection fraction, other safety data are currently under analysis and have not been published. There is currently no evidence in support of efficacy or safety for continuing with trastuzumab in case the patient was pretreated with a trastuzumab-containing regimen (trastuzumab beyond progression).
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Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies.
Eduardo Viñuela, Mithat Gonen, Murray F. Brennan … (2012)
To perform a meta-analysis of high-quality published trials, randomized and observational, comparing laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) for gastric cancer. Controversy persists about the clinical utility of minimally invasive techniques for the treatment of gastric cancer. Prospective data is limited to a few small randomized trails. : Studies published from January 1992 to March 2010 that compare LDG and ODG were identified. No restrictions in pathologic stage were applied. All randomized controlled trials (RCTs) were included. Selection of high-quality, nonrandomized comparative studies (NRCTs) was based on a validated tool (Methodological Index for Nonrandomized Studies). Mortality, complications, harvested lymph nodes, operative time, blood loss, and hospital stay were compared using weighted mean differences (WMDs) and odds ratios (ORs). Twenty-five studies were included in the analyses, 6 RCTs and 19 NRCTs, compromising 3055 patients (1658 LDG, 1397 ODG). LDG was associated with longer operative times (WMD 48.3 minutes; P < 0.001) and lower overall complications (OR 0.59; P < 0.001), medical complications (OR 0.49; P = 0.002), minor surgical complications (OR 0.62; P = 0.001), estimated blood loss (WMD -118.9 mL; P < 0.001), and hospital stay (WMD -3.6 days; P < 0.001). Mortality and major complications were similar. Patients in the ODG group had a significantly higher number of lymph nodes harvested (WMD 3.9 nodes; P < 0.001), although the estimated proportion of patients with less than 15 retrieved nodes was similar (OR 1.26, P = 0.09). LDG can be performed safely with a shorter hospital stay and fewer complications than open surgery. The long-term significance of a difference of less than 5 nodes in the number of harvested lymph nodes remains unclear. Lymph node staging appears to be unaffected. These results need to be validated in Western patients with advanced gastric cancer.
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Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study.
Hyung Ho Kim, Sang-Uk Han, Min Kim … (2014)
The oncologic outcomes of laparoscopy-assisted gastrectomy for the treatment of gastric cancer have not been evaluated. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer in terms of long-term survival, morbidity, and mortality retrospectively.
Author and article information
Contributors
Ke Chen: chenke0301243@163.com
Yu Pan: panyu1013@126.com
Bin Zhang: doctorbinzhang@126.com
Hendi Maher: maherhend@qq.com
Xian-fa Wang: srrshwxf@163.com
Xiu-jun Cai: caixiujunzju@163.com
Journal
Journal ID (nlm-ta): BMC Surg
Journal ID (iso-abbrev): BMC Surg
Title:
BMC Surgery
Publisher:
BioMed Central
(London
)
ISSN
(Electronic):
1471-2482
Publication date
(Electronic):
24
August
2017
Publication date PMC-release: 24
August
2017
Publication date Collection: 2017
Volume: 17
Electronic Location Identifier: 93
Affiliations
Article
Publisher ID: 290DOI: 10.1186/s12893-017-0290-2
PMC ID: 5571509
PubMed ID: 28836986
SO-VID: d3f49622-05e6-4f9d-82d5-5471e83a081c
Copyright © © The Author(s). 2017
License:
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
History
Date
received
: 11
June
2017
Date
accepted
: 17
August
2017
Categories
Subject:
Research Article
Custom metadata
issue-copyright-statement © The Author(s) 2017
ScienceOpen disciplines: Surgery