Brief Article
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World J Gastroenterol. Jun 21, 2013; 19(23): 3672-3677
Published online Jun 21, 2013. doi: 10.3748/wjg.v19.i23.3672
Case-matched comparison of laparoscopy-assisted and open distal gastrectomy for gastric cancer
Wei Wang, Ke Chen, Xiao-Wu Xu, Yu Pan, Yi-Ping Mou
Wei Wang, Department of Gastrointestinal Surgery, Shaoxing People’s Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing 312000, Zhejiang Province, China
Ke Chen, Xiao-Wu Xu, Yu Pan, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Author contributions: Wang W conceived and designed the study; Mou YP, Xu XW, Chen K performed the operations; Chen K and Pan Y collected data; Wang W wrote the manuscript; and Mou YP revised the manuscript.
Supported by The key project Grant from the Science and Technology Department of Zhejiang Province, China, No. 2011C13036-2
Correspondence to: Yi-Ping Mou, MD, PhD, Professor, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. mouyiping2002@163.com
Telephone: +86-571-86006445 Fax: +86-571-86044817
Received: January 16, 2013
Revised: May 13, 2013
Accepted: May 18, 2013
Published online: June 21, 2013
Processing time: 155 Days and 0.8 Hours
Abstract

AIM: To compare short- and long-term outcomes of laparoscopy-assisted and open distal gastrectomy for gastric cancer.

METHODS: A retrospective study was performed by comparing the outcomes of 54 patients who underwent laparoscopy-assisted distal gastrectomy (LADG) with those of 54 patients who underwent open distal gastrectomy (ODG) between October 2004 and October 2007. The patients’ demographic data (age and gender), date of surgery, extent of lymphadenectomy, and differentiation and tumor-node-metastasis stage of the tumor were examined. The operative time, intraoperative blood loss, postoperative recovery, complications, pathological findings, and follow-up data were compared between the two groups.

RESULTS: The mean operative time was significantly longer in the LADG group than in the ODG group (259.3 ± 46.2 min vs 199.8 ± 40.85 min; P < 0.05), whereas intraoperative blood loss and postoperative complications were significantly lower (160.2 ± 85.9 mL vs 257.8 ± 151.0 mL; 13.0% vs 24.1%, respectively, P < 0.05). In addition, the time to first flatus, time to initiate oral intake, and postoperative hospital stay were significantly shorter in the LADG group than in the ODG group (3.9 ± 1.4 d vs 4.4 ± 1.5 d; 4.6 ± 1.2 d vs 5.6 ± 2.1 d; and 9.5 ± 2.7 d vs 11.1 ± 4.1 d, respectively; P < 0.05). There was no significant difference between the LADG group and ODG group with regard to the number of harvested lymph nodes. The median follow-up was 60 mo (range, 5-97 mo). The 1-, 3-, and 5-year disease-free survival rates were 94.3%, 90.2%, and 76.7%, respectively, in the LADG group and 89.5%, 84.7%, and 82.3%, respectively, in the ODG group. The 1-, 3-, and 5-year overall survival rates were 98.0%, 91.9%, and 81.1%, respectively, in the LADG group and 91.5%, 86.9%, and 82.1%, respectively, in the ODG group. There was no significant difference between the two groups with regard to the survival rate.

CONCLUSION: LADG is suitable and minimally invasive for treating distal gastric cancer and can achieve similar long-term results to ODG.

Keywords: Stomach neoplasms; Gastrectomy; Laparoscopy; Survival; Case matched study

Core tip: We retrospectively analyzed patients treated with laparoscopy-assisted distal gastrectomy (LADG) and compared the surgical and long-term outcomes of LADG and open distal gastrectomy for gastric cancer. Our analysis showed that LADG has the advantages of minimally invasive surgery, rapid recovery, and fewer complications. The effect of lymph node dissection and distance of excision margin were as good as those of open gastrectomy. Long-term follow-up showed no obvious differences compared to open surgery. LADG can achieve a radical effect similar to that of open surgery.