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Bittar V, Boneli MF, Reis PCA, Felix N, Braga MAP, Rocha KM, Fogaroli LO, Costa GB, Comini AC, Amaral G, Marini DC, Camandaroba MPG. Laparoscopic Versus Open Gastrectomy for Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials. J Gastrointest Cancer 2024:10.1007/s12029-024-01048-0. [PMID: 38564116 DOI: 10.1007/s12029-024-01048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Laparoscopy-assisted gastrectomy (LAG) is a well-established surgical technique in treating patients with early gastric cancer. However, the efficacy and safety of LAG versus open gastrectomy (OG) in patients with advanced gastric cancer (AGC) remains unclear. METHODS We systematically searched PubMed, Embase, and Cochrane Library in June 2023 for RCTs comparing LAG versus OG in patients with AGC. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for binary and continuous endpoints, respectively. We performed all statistical analyses using R software version 4.3.1 and a random-effects model. RESULTS Nine RCTs comprising 3827 patients were included. There were no differences in terms of intraoperative complications (RR 1.14; 95% CI 0.72 to 1.82), number of retrieved lymph nodes (MD -0.54 lymph nodes; 95% CI -1.18 to 0.09), or mortality (RR 0.91; 95% CI 0.30 to 2.83). LAG was associated with a longer operative time (MD 49.28 minutes; 95% CI 30.88 to 67.69), lower intraoperative blood loss (MD -51.24 milliliters; 95% CI -81.41 to -21.06), shorter length of stay (MD -0.83 days; 95% CI -1.60 to -0.06), and higher incidence of pancreatic fistula (RR 2.44; 95% CI 1.08 to 5.50). Postoperatively, LAG was also superior to OG in reducing bleeding rates (RR 0.44; 95% CI 0.22 to 0.86) and time to first flatus (MD -0.27 days; 95% CI -0.47 to -0.07), with comparable results in anastomotic leakage, wound healing issues, major complications, time to ambulation, or time to first liquid intake. In the long-term analyses at 3 and 5 years, there were no significant differences between LAG and OG in terms of overall survival (RR 0.99; 95% CI 0.96 to 1.03) or relapse-free survival (RR 0.99; 95% CI 0.94 to 1.04). CONCLUSION This meta-analysis of RCTs suggests that LAG may be an effective and safe alternative to OG for treating AGC; albeit, it may be associated with an increased risk for pancreatic fistula.
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Affiliation(s)
- Vinicius Bittar
- Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil.
| | - Mauricio Ferreira Boneli
- Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil
| | | | - Nicole Felix
- Universidade Federal de Campina Grande, Campina Grande, Brazil
| | | | - Kian M Rocha
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo O Fogaroli
- Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil
| | - Gamaliel B Costa
- Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil
| | | | - Gustavo Amaral
- Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil
| | - Danyelle Cristine Marini
- Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil
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Yang Q, Zhang C, Zhou H, Wang W, Shan B, Yue C, Gao R, Guo Z, Wang Y, Ji G, Li X. Short- and long-term outcomes of laparoscopic versus open gastrectomy after neoadjuvant chemotherapy: A case-control study using a propensity score matching method. Surg Open Sci 2023; 16:111-120. [PMID: 37840945 PMCID: PMC10568558 DOI: 10.1016/j.sopen.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023] Open
Abstract
Background Neoadjuvant chemotherapy (NACT) is increasingly becoming the recommended treatment for locally advanced gastric cancer (LAGC) with promising results. According to previous reports, few studies have evaluated the benefits of laparoscopic gastrectomy (LG) after NACT. Methods 135 patients from our center who underwent gastrectomy with NACT were available, including 41 patients of LG and 94 OG between July 2018 and July 2022. To reduce selection bias, we used the nearest neighbor method and set caliper = 0.2 for 3:1 matching between LG and OG groups for propensity score matching method (PSM). After PSM, the matched 41 patients with LG and 80 patients with OG formed the cohort, respectively. Univariate and multivariate Cox analyses were performed on all variables to determine independent risk factors associated with survival. Results LG had a longer operating time compared to OG [260.00 min (220.00 min, 300.00 min) vs. 200.00 min (160.00 min, 260 min), P < 0.001]. The estimated blood loss, metastatic lymph nodes (LN), total LN examined, postoperative hospital stays, blood transfusion (P>0.05) and the incidence of postoperative complications did not show statistical differences from the OG group (P = 0.084). The type of surgery (LG vs. OG) did not show a significant risk propensity in the univariate and multivariate Cox analysis (HR = 0.69, P = 0.36, 95 % CI: 0.31-1.53). Through the Kaplan-Meier curves, a certain trend showed that the LG group had a better long-term survival outcomes than the OG group, although there was no statistical difference between two groups (P>0.05). Conclusion LG is a promising treatment option for LAGC patients receiving NACT and had an acceptable safety and efficacy compared to OG.
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Affiliation(s)
- Qinchuan Yang
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Changming Zhang
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- Shaanxi University of Chinese Medicine, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Haikun Zhou
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Weidong Wang
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Bo Shan
- Department of Ultrasound, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Chao Yue
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Ruiqi Gao
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Zhiyu Guo
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Yannian Wang
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Gang Ji
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
| | - Xiaohua Li
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China
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Yu CD, Zhang K. Efficacy and safety of laparoscopic vs open gastrectomy after neoadjuvant therapy for locally advanced gastric cancer. World J Clin Cases 2023; 11:7795-7805. [DOI: 10.12998/wjcc.v11.i32.7795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/10/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) is widely accepted as a minimally invasive approach for the treatment of early gastric cancer. However, its role in locally advanced gastric cancer (LAGC) after neoadjuvant therapy (NAT) remains controversial. This study aimed to compare the efficacy and safety of LG vs open gastrectomy (OG) after NAT for the treatment of LAGC.
AIM To compare the efficacy and safety of LG vs OG after NAT for LAGC.
METHODS We conducted a prospective study of 76 patients with LAGC who underwent NAT followed by LG (n = 38) or OG (n = 38) between 2021 and 2023. The primary endpoint was overall survival (OS), and the secondary endpoints were disease-free survival (DFS), surgical complications, and quality of life (QOL).
RESULTS The two groups had comparable baseline characteristics, with a median follow-up period of 24 mo. The 3-year OS rates in the LG and OG groups were 68.4% and 60.5%, respectively (P = 0.42). The 3-year DFS rates in the LG and OG groups were 57.9% and 50.0%, respectively (P = 0.51). The LG group had significantly less blood loss (P < 0.001), a shorter hospital stay (P < 0.001), and a lower incidence of surgical site infection (P = 0.04) than the OG group. There were no significant differences in other surgical complications between the groups, including anastomotic leakage, intra-abdominal abscess, or wound dehiscence. The LG group had significantly better QOL scores than the OG group regarding physical functioning, role functioning, global health status, fatigue, pain, appetite loss, and body image at 6 months postoperatively (P < 0.05).
CONCLUSION LG after NAT is a viable and safe alternative to OG for the treatment of LAGC, with similar survival outcomes and superior short-term recovery and QOL. LG patients had less blood loss, shorter hospitalizations, and a lower incidence of surgical site infections than OG patients. Moreover, the LG group had better QOL scores in multiple domains 6 mo postoperatively. Therefore, LG should be considered a valid option for patients with LAGC who undergo NAT, particularly for those who prioritize postoperative recovery and QOL.
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Affiliation(s)
- Chang-Da Yu
- Department of General Surgery, Jiujiang First People’s Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Ke Zhang
- Department of General Surgery, Jiujiang First People’s Hospital, Jiujiang 332000, Jiangxi Province, China
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Trastulli S, Desiderio J, Lin JX, Reim D, Zheng CH, Borghi F, Cianchi F, Norero E, Nguyen NT, Qi F, Coratti A, Cesari M, Bazzocchi F, Alimoglu O, Brower ST, Pernazza G, D'Imporzano S, Azagra JS, Zhou YB, Cao SG, Guerra F, Liu T, Arcuri G, González P, Staderini F, Marano A, Di Nardo D, Parisi A, Huang CM, Tebala GD. Open vs robotic gastrectomy with D2 lymphadenectomy: a propensity score-matched analysis on 1469 patients from the IMIGASTRIC prospective database. Langenbecks Arch Surg 2023; 408:302. [PMID: 37555850 DOI: 10.1007/s00423-023-03032-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Comparative data on D2-robotic gastrectomy (RG) vs D2-open gastrectomy (OG) are lacking in the Literature. Aim of this paper is to compare RG to OG with a focus on D2-lymphadenectomy. STUDY DESIGN Data of patients undergoing D2-OG or RG for gastric cancer were retrieved from the international IMIGASTRIC prospective database and compared. RESULTS A total of 1469 patients were selected for inclusion in the study. After 1:1 propensity score matching, a total of 580 patients were matched and included in the final analysis, 290 in each group, RG vs OG. RG had longer operation time (210 vs 330 min, p < 0.0001), reduced intraoperative blood loss (155 vs 119.7 ml, p < 0.0001), time to liquid diet (4.4 vs 3 days, p < 0.0001) and to peristalsis (2.4 vs 2 days, p < 0.0001), and length of postoperative stay (11 vs 8 days, p < 0.0001). Morbidity rate was higher in OG (24.1% vs 16.2%, p = 0.017). CONCLUSION RG significantly expedites recovery and reduces the risk of complications compared to OG. However, long-term survival is similar.
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Affiliation(s)
- Stefano Trastulli
- Department of Digestive and Emergency Surgery, Azienda Ospedaliera Santa Maria, 05100, Terni, Italy
| | - Jacopo Desiderio
- Department of Digestive and Emergency Surgery, Azienda Ospedaliera Santa Maria, 05100, Terni, Italy
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Daniel Reim
- Klinik Und Poliklinik Für Chirurgie, Klinikum Rechts Der Isar, Technische Universität München, 81675, Munich, Germany
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Felice Borghi
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce E Carle Hospital, 12100, Cuneo, Italy
| | - Fabio Cianchi
- Digestive Surgery Unit, Department of Experimental and Clinical Medicine, "Careggi" Hospital, University of Florence, 50134, Florence, Italy
| | - Enrique Norero
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Catolica de Chile, 8207257, Santiago, Chile
| | - Ninh T Nguyen
- Irvine Medical Center, Department of Surgery, Division of Gastrointestinal Surgery, University of California, Orange, CA, 92868, USA
| | - Feng Qi
- Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Andrea Coratti
- Department of General and Emergency Surgery, Division of General and Emergency Surgery, School of Robotic Surgery, "Misericordia" Hospital, 58100, Grosseto, Italy
| | - Maurizio Cesari
- Department of General Surgery, Hospital of Città Di Castello, USL1 Umbria, 06012, Città Di Castello, Italy
| | - Francesca Bazzocchi
- Department of Surgery, Fondazione IRCCS Casa Sollievo Della Sofferenza, 71013, San Giovanni Rotondo, Italy
| | - Orhan Alimoglu
- Department of General Surgery, School of Medicine, Istanbul Medeniyet University, 34000, Istanbul, Turkey
| | - Steven T Brower
- Department of Surgical Oncology and HPB Surgery, Englewood Hospital and Medical Center, Englewood, NJ, 07631, USA
| | - Graziano Pernazza
- Robotic General Surgery Unit, Department of Surgery, San Giovanni-Addolorata Hospital, 00184, Rome, Italy
| | - Simone D'Imporzano
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Medical University of Pisa, 56124, Pisa, Italy
| | - Juan-Santiago Azagra
- Unité Des Maladies de L'Appareil Digestif Et Endocrine, Centre Hospitalier de Luxembourg, 1210, Luxembourg, Luxembourg
| | - Yan-Bing Zhou
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Shou-Gen Cao
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Francesco Guerra
- Department of General and Emergency Surgery, Division of General and Emergency Surgery, School of Robotic Surgery, "Misericordia" Hospital, 58100, Grosseto, Italy
| | - Tong Liu
- Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Giacomo Arcuri
- Division of Surgery, "S.Maria Della Misericordia" Hospital, 06129, Perugia, Italy
| | - Paulina González
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Catolica de Chile, 8207257, Santiago, Chile
| | - Fabio Staderini
- Digestive Surgery Unit, Department of Experimental and Clinical Medicine, "Careggi" Hospital, University of Florence, 50134, Florence, Italy
| | - Alessandra Marano
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce E Carle Hospital, 12100, Cuneo, Italy
| | - Domenico Di Nardo
- Department of Digestive and Emergency Surgery, Azienda Ospedaliera Santa Maria, 05100, Terni, Italy
| | - Amilcare Parisi
- Department of Digestive and Emergency Surgery, Azienda Ospedaliera Santa Maria, 05100, Terni, Italy
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Giovanni Domenico Tebala
- Department of Digestive and Emergency Surgery, Azienda Ospedaliera Santa Maria, 05100, Terni, Italy.
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Pang HY, Chen XF, Chen LH, Yan MH, Chen ZX, Sun H. Comparisons of perioperative and long-term outcomes of laparoscopic versus open gastrectomy for advanced gastric cancer after neoadjuvant therapy: an updated pooled analysis of eighteen studies. Eur J Med Res 2023; 28:224. [PMID: 37408041 DOI: 10.1186/s40001-023-01197-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Outcomes of laparoscopic surgery in advanced gastric cancer patients who received neoadjuvant therapy represent a controversial issue. We performed an updated meta-analysis to evaluate the perioperative and long-term survival outcomes of laparoscopic gastrectomy (LG) versus conventional open gastrectomy (OG) in this subset of patients. METHODS Electronic databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure were comprehensively searched up to May 2023. The short-term and long-term outcomes of LG versus OG in advanced gastric cancer patients undergoing neoadjuvant therapy were evaluated. Effect sizes with 95% confidence intervals were always assessed using random-effects model. The prospective protocol was registered with PROSPERO (CRD42022359126). RESULTS Eighteen studies (2 randomized controlled trials and 16 cohort studies) involving 2096 patients were included. In total, 933 patients were treated with LG and 1163 patients were treated with OG. In perioperative outcomes, LG was associated with less estimated blood loss (MD = - 65.15; P < 0.0001), faster time to flatus (MD = - 0.56; P < 0.0001) and liquid intake (MD = - 0.42; P = 0.02), reduced hospital stay (MD = - 2.26; P < 0.0001), lower overall complication rate (OR = 0.70; P = 0.002) and lower minor complication rate (OR = 0.69; P = 0.006), while longer operative time (MD = 25.98; P < 0.0001). There were no significant differences between the two groups in terms of proximal margin, distal margin, R1/R2 resection rate, retrieved lymph nodes, time to remove gastric tube and drainage tube, major complications and other specific complications. In survival outcomes, LG and OG were not significantly different in overall survival, disease-free survival and recurrence-free survival. CONCLUSION LG can be a safe and feasible technique for the treatment of advanced gastric cancer patients receiving neoadjuvant therapy. However, more high-quality randomized controlled trials are still needed to further validate the results of our study.
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Affiliation(s)
- Hua-Yang Pang
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiu-Feng Chen
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Li-Hui Chen
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Meng-Hua Yan
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Zhi-Xiong Chen
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Hao Sun
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China.
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Lei X, Wang Y, Shan F, Li S, Jia Y, Miao R, Xue K, Li Z, Ji J, Li Z. Short-and long-term outcomes of laparoscopic versus open gastrectomy in patients with gastric cancer: a systematic review and meta-analysis of randomized controlled trials. World J Surg Oncol 2022; 20:405. [PMID: 36566193 PMCID: PMC9789553 DOI: 10.1186/s12957-022-02818-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/29/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) for gastric cancer has rapidly developed and become more popular in recent decades. Additional high-quality randomized controlled trial (RCT) studies comparing LG versus open gastrectomy (OG) for gastric cancer (GC) have been published in recent years. An updated systematic review is warranted. The aim of our meta-analysis was to comprehensively evaluate the short- and long-term outcomes of LG versus OG for GC. MATERIALS AND METHODS The PubMed, Embase, Web of Science, and Cochrane Center Register of Controlled Trials databases were comprehensively searched to identify RCTs comparing LG versus OG for GC published between January 1994 and December 7, 2021. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane Collaboration and the Quality of Reporting of Meta-analyses (QUORUM) guidelines. All RCTs comparing the short- and long-term outcomes of LG with those of OG were included. A random effects model was adopted with significant heterogeneity (I2 > 50%), while a fixed effects model was employed in all other cases (I2 ≤ 50%). RESULTS A total of 26 RCTs with 8301 patients were included in this meta-analysis. The results indicated that the intraoperative complication rate was comparable between the LG group and the OG group (OR=1.14, 95% CI [0.76, 1.70], I2=0%, p=0.53). The LG group had fewer postoperative complications than the OG group (OR=0.65, 95% CI [0.57, 0.74], I2=26%, p<0.00001). However, the severe postoperative complication rate and perioperative mortality were comparable between the two groups (OR=0.83, 95% CI [0.67, 1.04], I2=10%, p=0.10; OR=1.11, 95% CI [0.59, 2.09], I2=0%, p=0.74, respectively). The number of lymph nodes retrieved by the LG group was less than that of the OG group (MD=-1.51, 95% CI [-2.29, -0.74], I2=0%, p<0.0001). The proximal resection margin distance in the LG group was shorter than that in the OG group (MD=-0.34, 95% CI [-0.57, -0.12], I2=23%, p=0.003), but the distal resection margin distance in the two groups was comparable (MD=-0.21, 95% CI [-0.47, 0.04], I2=0%, p=0.10). The time to first ambulation was shorter in the LG group than in the OG group (MD=-0.14, 95% CI [-.26, -0.01], I2=40%, p=0.03). The time to first flatus was also shorter in the LG group than in the OG group (MD=-0.15, 95% CI [-0.23, -0.07], I2=4%, p=0.0001). However, the first time on a liquid diet was comparable between the two groups (MD=-0.30, 95% CI [-0.64, 0.04], I2=88%, p=0.09). Furthermore, the postoperative length of stay was shorter in the LG group than in the OG group (MD=-1.26, 95% CI [-1.99, -0.53], I2=90%, p=0.0007). The 5-year overall survival (OS) was comparable between the two groups (HR=0.97, 95% CI [0.80, 1.17], I2=0%, p=0.73), and the 5-year disease-free survival (DFS) was also similar between the LG group and OG group (HR=1.08, 95% CI [0.77, 1.52], I2=0%, p=0.64). CONCLUSION LG is a technically safe and feasible alternative to OG with the advantages of a fewer postoperative complication rate, faster recovery of gastrointestinal function, and greater cosmetic benefit for patients with GC. Meanwhile, LG has comparable long-term outcomes to OG for GC.
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Affiliation(s)
- Xiaokang Lei
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Yinkui Wang
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Fei Shan
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Shuangxi Li
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Yongning Jia
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Rulin Miao
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Kan Xue
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Zhemin Li
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Jiafu Ji
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Ziyu Li
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
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Wu D, Song QY, Li XG, Xie TY, Lu YX, Zhang BL, Li S, Wang XX. 3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study. World J Gastrointest Surg 2022; 14:754-764. [PMID: 36157370 PMCID: PMC9453325 DOI: 10.4240/wjgs.v14.i8.754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/02/2022] [Accepted: 07/31/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach (CRS), but its clinical efficacy remains controversial.
AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy (3DLAG) with open gastrectomy (OG) for CRS.
METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up, we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival (OS) rates were compared between the two groups.
RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score, initial disease state (benign or malignant), primary surgical anastomosis method, interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss (188.33 ± 191.35 mL vs 305.83 ± 303.66 mL; P = 0.045) and smaller incision (10.86 ± 3.18 cm vs 20.06 ± 5.17 cm; P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG (14.0 ± 7.17 vs 10.73 ± 6.82; P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups (1.56 ± 2.84 vs 2.35 ± 5.28; P = 0.413). The complication rate (8.3% vs 20.8%; P = 0.207) and intensive care unit admission rate (5.6% vs 14.5%; P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval (CI): 72.4%-95.6%] and 73.3% (95%CI: 60.0%-89.5%) respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3% (95%CI: 76.4%-99.8%) and 75.6% (95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups (P = 0.68).
CONCLUSION Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.
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Affiliation(s)
- Di Wu
- Medical School of Chinese PLA, Beijing 100853, China
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Ying Song
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiong-Guang Li
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Tian-Yu Xie
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi-Xun Lu
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Ben-Long Zhang
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Shuo Li
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Xin-Xin Wang
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
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Ramos MFKP, Pereira MA, Dias AR, Ribeiro U, Zilberstein B, Nahas SC. Laparoscopic gastrectomy for early and advanced gastric cancer in a western center: a propensity score-matched analysis. Updates Surg 2021; 73:1867-1877. [PMID: 34089146 DOI: 10.1007/s13304-021-01097-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/19/2021] [Indexed: 02/05/2023]
Abstract
The employment of laparoscopic gastrectomy (LG) in the management of gastric cancer (GC) is increasing. Despite recent results from randomized trials, its effectiveness and oncological results in different scenarios remain controversial, especially in western centers. The aim of this study was to compare the short-term outcomes and survival of LG with open gastrectomy (OG) for GC. We reviewed all GC patients who underwent curative gastrectomy from a prospective database. Propensity score-matched (PSM) analysis including 10 variables was conducted to reduce patient selection bias using a 1:1 case-control match. A total of 530 GC were eligible for inclusion (438 OG and 92 LG). Older age, lower hemoglobin levels, total gastrectomy, larger tumor size, greater depth of tumor invasion and advanced pTNM stage was more frequent in the OG group. After PMS analysis, 92 patients were matched in each group. All variables assigned in the score were well matched. LG group had a slightly higher number of retrieved lymph nodes (42.3 vs 37.6), however, without reaching statistical significance (p = 0.072). No differences were recorded about the frequency of major postoperative complications (POC) and mortality rates between OG and LG groups (12% vs 15.2%, p = 0.519, respectively). In survival analysis, after matching, there was no difference in survival between the two groups. Multivariate analysis showed that only ASA and pN stage were independent factor associated with survival after PSM. In conclusion, laparoscopic gastrectomy was a safe and effective surgical technique for gastric cancer, with short-term and oncological outcomes comparable to open surgery.
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Affiliation(s)
- Marcus Fernando Kodama Pertille Ramos
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01246-000, Brazil.
| | - Marina Alessandra Pereira
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01246-000, Brazil
| | - André Roncon Dias
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01246-000, Brazil
| | - Ulysses Ribeiro
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01246-000, Brazil
| | - Bruno Zilberstein
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01246-000, Brazil
| | - Sergio Carlos Nahas
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01246-000, Brazil
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van der Wielen N, Daams F, Rosati R, Parise P, Weitz J, Reissfelder C, Diez Del Val I, Loureiro C, Parada-González P, Pintos-Martínez E, Vallejo FM, Achirica CM, Sánchez-Pernaute A, Campos AR, Bonavina L, Asti ELG, Poza AA, Gilsanz C, Nilsson M, Lindblad M, Gisbertz SS, van Berge Henegouwen MI, Romario UF, De Pascale S, Akhtar K, Bonjer HJ, Cuesta MA, van der Peet DL, Straatman J. Health related quality of life following open versus minimally invasive total gastrectomy for cancer: Results from a randomized clinical trial. Eur J Surg Oncol 2021; 48:553-560. [PMID: 34503850 DOI: 10.1016/j.ejso.2021.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Minimally invasive techniques show improved short-term and comparable long-term outcomes compared to open techniques in the treatment of gastric cancer and improved survival has been seen with the implementation of multimodality treatment. Therefore, focus of research has shifted towards optimizing treatment regimens and improving quality of life. MATERIALS AND METHODS A randomized trial was performed in thirteen hospitals in Europe. Patients were randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG) after neoadjuvant chemotherapy. This study investigated patient reported outcome measures (PROMs) on health-related quality of life (HRQoL) following OTG or MITG, using the Euro-Qol-5D (EQ-5D) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, modules C30 and STO22. Due to multiple testing a p-value < 0.001 was deemed statistically significant. RESULTS Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. A response compliance of 80% was achieved for all PROMs. The EQ5D overall health score one year after surgery was 85 (60-90) in the open group and 68 (50-83.8) in the minimally invasive group (P = 0.049). The median EORTC-QLQ-C30 overall health score one year postoperatively was 83,3 (66,7-83,3) in the open group and 58,3 (35,4-66,7) in the minimally invasive group (P = 0.002). This was not statistically significant. CONCLUSION No differences were observed between open total gastrectomy and minimally invasive total gastrectomy regarding HRQoL data, collected using the EQ-5D, EORTC QLQ-C30 and EORTC-QLQ-STO22 questionnaires.
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Affiliation(s)
- Nicole van der Wielen
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands.
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | | | - Paolo Parise
- Department of Surgery, San Raffaele Hospital, Milan, Italy
| | - Jürgen Weitz
- Department of of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | - Carlos Loureiro
- Department of Surgery, Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Elena Pintos-Martínez
- Department of Surgery, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | - Emanuele L G Asti
- Department of Surgery, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | | | - Carlos Gilsanz
- Department of Surgery, Hospital Del Sureste, Madrid, Spain
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | | | - Khurshid Akhtar
- Department of Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H Jaap Bonjer
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | - Miguel A Cuesta
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center Location VU University Medical Center, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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10
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Chen L, Wang Q, Liu Y, Wang Y, Li Y, Dan J, Wang J. A meta-analysis of robotic gastrectomy versus open gastrectomy in gastric cancer treatment. Asian J Surg 2021:S1015-9584(21)00485-1. [PMID: 34366190 DOI: 10.1016/j.asjsur.2021.07.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/04/2021] [Accepted: 07/21/2021] [Indexed: 12/31/2022] Open
Abstract
Robotic gastrectomy (RG) shows potential as an alternative to open gastrectomy (OG), the gold standard in the surgical management of gastric cancer (GC). This meta-analysis was conducted to compare the short-term efficacy and safety of RG versus OG for GC.A systematic literature search was conducted on RG with OG for GC in randomized and semi-randomized controlled trials and observational studies. Published materials and conference papers in English and trace references included in the literature were manually searched. The retrieval period was set to end in February 2021. The quality of the included studies was evaluated, and meta-analysis was conducted using the software STATA 15.1. Eleven studies with 6693 patients were included. Major blood loss (weighted mean differences (WMD) = -114.63, 95 % CI, -182.37-46.88, P = 0.001), hospital stay (WMD = -2.21, 95 % CI, -4.32-0.09, P = 0.041), and postoperative complications (odds ratio (OR) = OR = 0.57, 95 % CI, 0.35-0.93, P = 0.025) were fewer in the RS group, and R0 resection (odds ratio (OR) = 6.26, 95 % CI, 2.733-14.35, P = 0.000) occurred more frequently in the RG group than in the OG group. But positive lymph nodes (WMD = -2.09, 95 % CI,-3.73-0.45, P = 0.012) occurred less frequently in the RG group than in the OG group, and operative time was longer in the RG group than in the OG group (WMD = 83.21, 95 % CI, 19.88-146.55, P = 0.010). RG not only provides a technique for the treatment of GC but is also safe and feasible. This finding needs to be verified by multicenter, large-sample randomized controlled trials in the future.
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Lin GS, Huang XY, Lu J, Wu D, Zheng HL, Xu BB, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Lin GT, Huang ZN, Lin JL, Huang CM. A good preoperative immune prognostic index is predictive of better long-term outcomes after laparoscopic gastrectomy compared with open gastrectomy for stage II gastric cancer in elderly patients. Surg Endosc 2021. [PMID: 34076769 DOI: 10.1007/s00464-021-08461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/17/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND It remains inconclusive whether laparoscopic gastrectomy (LG) has better long-term outcomes when compared with open gastrectomy (OG) for elderly gastric cancer (EGC). We attempted to explore the influence of the immune prognostic index (IPI) on the prognosis of EGCs treated by LG or OG to identify a population among EGC who may benefit from LG. METHODS We included 1539 EGCs treated with radical gastrectomy from January 2007 to December 2016. Propensity score matching was applied at a ratio of 1:1 to compare the LG and OG groups. The IPI based on dNLR ≥ cut-off value (dNLR) and sLDH ≥ cut-off value (sLDH) was developed, characterizing two groups (IPI = 0, good, 0 factors; IPI = 1, poor, 1 or 2 factors). RESULTS Of the 528 EGCs (LG: 264 and OG: 264), 271 were in the IPI = 0 group, and 257 were in the IPI = 1 group. In the entire cohort, the IPI = 0 group was associated with good 5-year overall survival (OS) (p = 0.001) and progression-free survival (PFS) (p = 0.003) compared to the IPI = 1 group; no significant differences in 5-year OS and PFS between the LG and OG groups were observed. In the IPI = 1 cohort, there was no significant difference in OS or PFS between the LG and OG groups across all tumor stages. However, in the IPI = 0 cohort, LG was associated with longer OS (p = 0.015) and PFS (p = 0.018) than OG in stage II EGC, but not in stage I or III EGC. Multivariate analysis showed that IPI = 0 was an independent protective factor for stage II EGC receiving LG, but not for those receiving OG. CONCLUSION The IPI is related to the long-term prognosis of EGC. Compared with OG, LG may improve the 5-year survival rate of stage II EGC with a good IPI score. This hypothesis needs to be further confirmed by prospective studies.
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12
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Lu J, Wu D, Xu BB, Xue Z, Zheng HL, Xie JW, Wang JB, Lin JX, Li P, Zheng CH, Huang CM. A matched cohort study of the failure pattern after laparoscopic and open gastrectomy for locally advanced gastric cancer: does the operative approach matter? Surg Endosc 2021; 36:689-700. [PMID: 33591445 DOI: 10.1007/s00464-021-08337-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/19/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Due to lacking evidence for confirming the efficacy of performing laparoscopic surgery for locally advanced gastric cancer (LAGC). Therefore, this study aimed to compare the static and dynamic failure patterns after laparoscopic gastrectomy (LG) and open gastrectomy (OG) in LAGC. METHODS A total of 1792 LAGC patients who underwent radical resection between January 2010 and January 2017 were divided into the LG group (n = 1557) and the OG group (n = 235). Propensity score matching was performed to balance the two groups. Dynamic hazard rates of failure were calculated using the hazard function. Early and late failure were defined as failure occurring before and after 2 years since surgery, respectively. RESULTS A total of 1175 patients with LAGC were included after matching (LG group, n = 940; OG, n = 235). The failure rate of the whole cohort was 43.2% (508/1175), accounting for 41.4% (389/940) and 50.6% (119/235) in the LG and OG groups, respectively. Although the two groups showed no significant differences in failure rate for any failure type, landmark analysis showed a lower early distant recurrence rate in the stage IIa-IIIb subgroup of the LG group (OG versus LG: 30.3% versus 21.1%, P = 0.004). The dynamic hazard rate peaked at 9.4 months (peak rate = 0.0186) before gradually declining. In stage IIa-IIIb patients, the hazard rate of the OG group remained significantly higher than that of the LG group within the first 2 years in terms of distant recurrence (peak rate: OG versus LG, 0.0091 versus 0.0055). CONCLUSION Given the differences in early failure between LG and OG, more intensive surveillance for distant recurrence within the first 2 years should be considered for patients with stage IIa-IIIb after OG.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Brandl A. An Invited Commentary on robotic surgery for gastric cancer in the West: A systematic review and meta-analyses of short-and long-term outcomes. Int J Surg 2020; 84:22-23. [PMID: 33075498 DOI: 10.1016/j.ijsu.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Andreas Brandl
- Champalimaud Centre for the Unknown, Digestive Unit, Lisbon, Portugal.
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14
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Salehi O, Vega EA, Kutlu OC, James D, Alarcon SV, Herrick B, Kozyreva O, Conrad C. Western population-based study of oncologic surgical quality and outcomes of laparoscopic versus open gastrectomy for gastric adenocarcinoma. Surg Endosc 2021; 35:4786-93. [PMID: 32909213 DOI: 10.1007/s00464-020-07959-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND While studies have reported improved morbidity of laparoscopic (LG) compared with open gastrectomy (OG), it remains unclear whether comparable oncologic outcomes can be achieved. This study aims at comparing not only short-term outcomes, including 30- and 90-day mortality, but also survival of LG vs OG. METHODS The National Cancer Database was searched for adult patients with histologically proven gastric cancer and complete information regarding M0 disease, tumor size, differentiation grade, T stage, nodal status, comorbidities, type of hospital, hospital stay, type of surgery, oncological treatment and survival data were included. Logistic regression analyses were performed to analyze margin status, 30- and 90-day mortality, and 30-day re-admission rate. Linear regression was performed for length of hospital stay and lymph node yield. Kaplan-Meier survival analyses were performed to evaluate median survival. Cox multivariable regression models were created to correct for confounders and identify factors affecting survival. RESULTS A query of the National Cancer Database identified 13,538 patients with complete dataset. A significant regression equation favoring LG for lymph node yield, hospital stay, and unplanned re-admission rate was identified. There was no significant effect of surgical approach on R1 margin rate, 30-day mortality, or 90-day mortality. Median survival was comparable between LG and OG (44.8 vs 40.2 months, p = 0.804). CONCLUSION LG offers a safe surgical approach to gastric cancer with shorter hospital stay and lower re-admission rates than OG, and also similar and sometimes improved operative oncologic quality parameters (margin, lymph node yield). More importantly, this Western series demonstrates that equivalent long-term outcomes of LG vs. OG are being achieved.
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15
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Li B, Yu-Hong Wong I, Siu-Yin Chan F, Chan KK, Lai-Yin Wong C, Law TT, Yat-Yin Kwok J, Law S. Comparison of laparoscopic versus open gastrectomy for gastric cancer. Surg Oncol 2020; 35:14-21. [PMID: 32781394 DOI: 10.1016/j.suronc.2020.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/13/2020] [Accepted: 06/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aimed to compare the short-term and long-term outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) for gastric cancer in a tertiary referral center in Hong Kong. METHODS Two hundred and ninety-four consecutive patients with gastric cancer who underwent radical gastrectomy with curative intent between January 2008 and December 2015 were analyzed. Data was prospectively collected and reviewed. Propensity score matching was applied at a ratio of 1:1 to compare the OG and LG groups. RESULTS After propensity score matching, operation duration (294.7 vs 231.8min, P < 0.01) was significantly longer while estimated blood loss (191.6 vs 351.0 ml, P = 0.01) was significantly less in LG group compared with OG. There were no significant differences in postoperative complications and mortality between LG and OG groups (postoperative complication rate, 35.2% vs 40.7%, P = 0.69; 90-day mortality rate, 1.9% vs 3.7%, P = 1.00). Three-year OS and 3-yr DFS of patients who underwent LG was not inferior to that of patients who had OG (P = 0.34; P = 0.51). However, there were significantly more peritoneal recurrences among the OG group than LG group (P < 0.01). CONCLUSIONS LG has comparable outcomes for gastric cancer, even in advanced tumors. We could appropriately increase the proportion of laparoscopic gastrectomy for gastric cancer.
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Affiliation(s)
- Bofei Li
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ian Yu-Hong Wong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Fion Siu-Yin Chan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kwan Kit Chan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Claudia Lai-Yin Wong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tsz-Ting Law
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | - Simon Law
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
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16
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Inokuchi M, Kumamaru H, Nakagawa M, Miyata H, Kakeji Y, Seto Y, Kojima K. Feasibility of laparoscopic gastrectomy for patients with poor physical status: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer 2020; 23:310-318. [PMID: 31332618 DOI: 10.1007/s10120-019-00993-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) is an established minimally invasive procedure for gastric cancer. However, it is controversial whether LG is useful for patients with poor physical status classified into higher classes of the American Society of Anesthesiologists physical status (ASA-PS) classification. The aim of this study was to determine the feasibility of LG in patients with ASA-PS class ≥ 3. METHODS We extracted data for a total of 28,160 patients with an ASA-PS class ≥ 3 who underwent distal or total gastrectomy for gastric cancer between January 2013 and December 2017 from the National Clinical Database Japan society for gastroenterological surgery registry. We developed a propensity score model from baseline demographics and comorbidities and matched patients undergoing LG to those undergoing open gastrectomy (OG) using a 1:1 ratio. Mortality and morbidities (within 30 days and in-hospital) were compared between the 6998 matched patient pairs. RESULTS In-hospital mortality was significantly lower in patients undergoing LG than in those undergoing OG (2.3% vs. 3.0%, p = 0.01), while the 30-day mortality was similar (1.6% vs. 1.5%). The length of hospital stay was significantly shorter in the LG group (median, 14 days vs. 17 days, p < 0.001). The LG group had a significantly lower incidence of postoperative complications in patients with any grade complication (20.3% vs. 22.5%, p = 0.002) as well as those with ≥ grade 3 complications (8.7% vs. 9.8%, p = 0.03). CONCLUSION LG was associated with decreased in-hospital mortality and a lower incidence of several postoperative complications when compared to OG among patients with poor physical condition.
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Affiliation(s)
- Mikito Inokuchi
- Department of Surgery, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonan-cho, Musashino, 180-8610, Tokyo, Japan.
| | - Hiraku Kumamaru
- Department of Health Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masatoshi Nakagawa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Health Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kazuyuki Kojima
- First Department of Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
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17
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Liao C, Feng Q, Xie S, Chen J, Shi Y. Laparoscopic versus open gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a meta-analysis. Surg Endosc 2020; 35:860-871. [PMID: 32076857 DOI: 10.1007/s00464-020-07458-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 02/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The potential advantages of laparoscopic gastrectomy (LG) compared with open gastrectomy (OG) for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) have not been fully clarified. The aim of this meta-analysis was to evaluate the safety and efficacy of LG for Siewert type II/III AEG, compared with OG. METHODS A comprehensive search was performed in various medical databases up to December 30, 2018. Seven non-randomized controlled trials comparing LG and OG for Siewert type II/III AEG were included. Outcomes evaluated including operation time, estimated blood loss, number of retrieved lymph nodes (LNs), post-operation complications, postoperative hospital stay, time to first flatus, time to ambulation, and overall survival (OS). RESULTS Seven studies of 1915 patients were included for meta-analysis. The estimated blood loss [weighted mean difference (WMD) = - 77.49, 95%CI - 111.84 to - 43.15; P < 0.00001] was significantly less and the postoperative hospital stay (WMD = - 1.98, 95%CI - 2.14 to - 1.83; P < 0.00001) was significantly shorter in the LG group than in the OG group, while the operation time, number of retrieved LNs, time to first flatus, and time to ambulation showed no significant difference between LG and OG groups. The overall postoperative complications [odds ratio (OR) 0.78, 95%CI 0.60-1.02; P = 0.07] in LG group were less than those in OG group, although the difference was not significant between the two groups. CONCLUSION LG can achieve short-term surgical outcomes comparable to OG, with respect to safety and efficiency in treatment of Siewert type II/III AEG.
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Affiliation(s)
- CunXiang Liao
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Qing Feng
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - ShaoHui Xie
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Jun Chen
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Yan Shi
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China.
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18
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Wong WJ, Tan ST, Yii RSL, Lau PC. Safety and feasibility of Laparoscopic Gastrectomy in a low-incidence country. Asian J Surg 2020; 43:451-453. [PMID: 31974052 DOI: 10.1016/j.asjsur.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- W J Wong
- Upper Gastro-Intestinal Surgery Unit, Department of General Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | - S T Tan
- Upper Gastro-Intestinal Surgery Unit, Department of General Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - R S L Yii
- Upper Gastro-Intestinal Surgery Unit, Department of General Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - P C Lau
- Department of Surgery, Pantai Hospital Kuala Lumpur, Malaysia.
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19
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Huang L, Liu H, Yu J, Lin T, Hu YF, Li TJ, Li GX. Long-Term Outcomes in Laparoscopic D2 Gastrectomy for Gastric Cancer: a Large Comprehensive Study Proposing Novel Hypotheses. J Gastrointest Surg 2019; 23:1349-1361. [PMID: 30478532 DOI: 10.1007/s11605-018-4008-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/09/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The long-term outcomes of laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for gastric cancer (GC) remain obscure, especially for advanced cancer and disease affecting the upper stomach and in older patients. This study aimed to comprehensively assess the long-term efficacy of LG for GC using a large prospective database. METHODS Totally, 1877 consecutive patients (1186 receiving LG and 691 OG) operated in 2004-2016 were analyzed, with a median follow-up of 63 months. Association of LG versus OG with disease-specific survival (DSS) and disease-free survival (DFS) overall and in various subgroups were investigated using multivariable Cox regression. Propensity score matching (PSM) was performed for sensitivity analysis. RESULTS Before PSM, overall, there was no significant association of LG versus OG with survival after multivariable adjustment; however, in subgroup analyses, LG was associated with superior DSS in patients aged ≥ 70 years and those with upper GC. No significant associations regarding DFS were observed overall or in stratifications. PSM analyses revealed that LG was associated with better DSS also in patients aged ≥ 70 years (hazard ratio (HR) = 0.33, 95% confidence interval (CI) = 0.15-0.72) and in those with upper GC (HR = 0.51, 95% CI = 0.29-0.91), and with better DFS in those with upper GC (HR = 0.60, 95% CI = 0.37-0.99). Multivariable analysis showed that age, hepatitis B, performance status, tumor histology, stage, and vascular invasion were significantly associated with post-LG survival. LG-specific nomograms were then constructed with concordance indexes of 0.814 (DSS) and 0.809 (DFS) and excellent calibration. CONCLUSIONS In this large institutional analysis, while LG for GC was associated with DSS and DFS similar to those for OG overall, non-inferior LG-associated survival especially DSS was observed in some subgroups rarely investigated in prospective or randomized settings. There could still be biases even after PSM due to confounders not accounted for in this observational study. However, these findings offer novel hypotheses for further validation.
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Affiliation(s)
- Lei Huang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Tian Lin
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Yan-Feng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Tuan-Jie Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Guo-Xin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
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20
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Li Z, Zhao Y, Lian B, Liu Y, Zhao Q. Long-term oncological outcomes in laparoscopic versus open gastrectomy for advanced gastric cancer: A meta-analysis of high-quality nonrandomized studies. Am J Surg 2019; 218:631-638. [PMID: 30712863 DOI: 10.1016/j.amjsurg.2019.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multicenter randomized controlled trials (RCTs) and several meta-analyses have confirmed that laparoscopic gastrectomy (LG) is a safe and feasible procedure for patients with locally advanced gastric cancer (AGC) in terms of short-term outcomes. However, the long-term oncological outcomes of LG for AGC are still needed for further evaluation. This study aimed to compare the long-term oncological outcomes of LG with open gastrectomy (OG) for patients with AGC. METHODS We performed a systematic literature search in various databases from January 1997 to August 2018. Studies comparing the long-term oncological outcomes between LG with OG were evaluated and data were extracted accordingly. We performed the meta-analysis using RevMan 5.3 software. RESULTS Fifteen studies with 4494 patients (2273 in LG group and 2221 in OG group) were included. The 5-year overall survival (OS) rate (HR 0.95, 95% CI 0.86 to 1.05, P = 0.28), disease-free survival (DFS) rate (HR 0.93, 95% CI 0.81 to 1.06, P = 0.27), and recurrence rate (OR 0.87, 95% CI 0.72 to 1.04, P = 0.13) were comparable in LG and OG. Subgroup analysis showed the publication year, study region, sample size, extent of resection, extent of lymphadenectomy, retrieved lymph nodes, proportion of stage III, and patients with serosa-positive (pT4a) did not influence the estimates. CONCLUSIONS For patients with AGC, LG is a feasible surgical procedure alternative to OG in terms of long-term oncological outcomes.
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Affiliation(s)
- Zhengyan Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
| | - Yan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Bo Lian
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Yezhou Liu
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Qingchuan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
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21
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Kodera Y, Yoshida K, Kumamaru H, Kakeji Y, Hiki N, Etoh T, Honda M, Miyata H, Yamashita Y, Seto Y, Kitano S, Konno H. Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer 2019; 22:202-213. [PMID: 29427039 DOI: 10.1007/s10120-018-0795-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now available for analysis. METHODS A retrospective cohort study was conducted using data from 32,144 patients who underwent total gastrectomy and were registered in the NCD database between January 2012 and December 2013. Mortality and morbidities were compared between patients who received LTG and those who underwent open total gastrectomy (OTG) in the propensity score-matched Stage I cohort and Stage II-IV cohort. RESULTS There was no significant difference in mortality rate between LTG and OTG in both cohorts. Operating time was significantly longer in LTG while the blood loss was smaller. In the Stage I cohort, LTG, performed in 33.6% of the patients, was associated with significantly shorter hospital stay but significantly higher incidence of readmission, reoperation, and anastomotic leakage (5.4% vs. 3.6%, p < 0.01). In the Stage II-IV cohort, LTG was performed in only 8.8% of the patients and was associated with significantly higher incidence of leakage (5.7% vs. 3.6%, p < 0.02) although the hospital stay was shorter (15 days vs. 17 days, p < 0.001). CONCLUSION LTG was more discreetly introduced than distal gastrectomy, but remained a technically demanding procedure as of 2013. This procedure should be performed only among the well-trained and informed laparoscopic team.
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Affiliation(s)
- Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Naoki Hiki
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Medical and Surgical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Yuichi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Hiroyuki Konno
- Hamamatsu University School of Medicine, Hamamatsu, Japan
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22
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Wei Y, Yu D, Li Y, Fan C, Li G. Laparoscopic versus open gastrectomy for advanced gastric cancer: A meta-analysis based on high-quality retrospective studies and clinical randomized trials. Clin Res Hepatol Gastroenterol 2018; 42:577-90. [PMID: 30146236 DOI: 10.1016/j.clinre.2018.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/28/2018] [Accepted: 04/12/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Additional studies comparing laparoscopic gastrectomy (LG) with open gastrectomy (OG) have been published, and the meta-analysis of this subject should be improved. METHODS Randomized controlled trials and high-quality retrospective studies, which compared LG and OG for advanced gastric cancer (AGC) treatment and were published in English and Chinese between January 2000 and February 2017, were selected through PubMed, EMBASE, and the Cochrane Library database by two reviewers independently. The Jadad Composite Scale and the Newcastle-Ottawa scale were used to evaluate the quality and risk of bias for all included studies. Operative outcomes, postoperative outcomes, postoperative morbidity, harvested lymph nodes and 5-year overall survival (OS) were considered as primary endpoints and were compared. RESULTS Fifteen studies including a total of 9337 cases (5000 in LG and 4337 in OG) were enrolled. LG showed longer operative time, less intraoperative blood loss, and quicker recovery after operations. Based on the subgroup analysis of the sample size, however, there was no difference in operative time between LG and OG. The number of harvested lymph nodes, 5-year OS, and postoperative morbidity were similar. CONCLUSION LG can be performed as an alternative to OG for AGC, with quicker postoperative recovery and comparable safety and efficacy.
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23
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Li Z, Shan F, Ying X, Xue K, Ji J. Laparoscopic versus open gastrectomy for elderly local advanced gastric cancer patients: study protocol of a phase II randomized controlled trial. BMC Cancer 2018; 18:1118. [PMID: 30445943 PMCID: PMC6240197 DOI: 10.1186/s12885-018-5041-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/05/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gastric cancer is one of the most common malignant tumors worldwide. With the rapid aging of global population, the number of elderly patients with local advanced gastric cancer is increasing. Surgery is the essential treatment for local advanced gastric cancer. However, elderly patients are at high risk of postoperative complications due to reduced functional reserve and increased comorbidities. Laparoscopic gastrectomy may be a promising surgery approach for elderly patients but its benefits remain controversial. We therefore proposed this randomized trial to evaluate the safety and efficacy of laparoscopic versus open gastrectomy for local advanced gastric cancer in patients aged 70 and above. METHODS The current study has a randomized, parallel controlled, single-center, open-label, superiority design with two arms. A sample of 180 local advanced gastric cancer patients aged 70 and above will be recruited in Peking University Cancer Hospital and Institute. Participants will be randomized to either receive open or laparoscopic gastrectomy. The primary outcome is surgical safety, including complication rate, reoperation rate, readmission rate, and mortality rate within 30 days after surgery. The secondary endpoints include postoperative rehabilitation status, one-year postoperative life quality, three-year overall and disease-free survival. Assessments will take place at baseline (before random assignment), at 30 days, one-year, and three-year after the surgery. The study has been approved by an ethical review board. DISCUSSION We hypothesized that laparoscopic gastrectomy is superior to open gastrectomy in terms of perioperative safety for local advanced gastric cancer patients aged 70 and above. If this hypothesis is statistically proved, the rational introduction of minimally invasive surgery technique in traditional gastrectomy can help improve the surgical safety for elderly patients, reduce patient financial burden, shorten hospital stay, and improve hospital beds turnover rate. Our research data will also provide high quality clinical evidence and data support for the conduction of multicenter phase III clinical trials. TRIAL REGISTRATION The study has been prospectively registered in ClinicalTrial.gov ( NCT03564834 ).
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Affiliation(s)
- Ziyu Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Fei Shan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Xiangji Ying
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Kan Xue
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Jiafu Ji
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
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24
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Xu Y, Hua J, Li J, Shi L, Xue H, Shuang J, Du J. Long-term outcomes of laparoscopic versus open gastrectomy for advanced gastric cancer: A large cohort study. Am J Surg 2018; 217:750-756. [PMID: 30055806 DOI: 10.1016/j.amjsurg.2018.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The adequacy of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC) treatment remains uncertain. There are few reports on the long-term outcomes of laparoscopic versus open gastrectomy (OG) in AGC using subgroups with adequate patient numbers; which may provide further evidence to validate the long-term efficacy of LAG in AGC. METHODS A retrospective cohort study included 1198 consecutive AGC patients underwent LAG or OG between September 2005 and October 2012 was conducted to compare the long-term outcomes. RESULTS Of the 1198 patients, 430 (35.9%) underwent LAG, and 768 (64.1%) underwent OG. Recurrences occurred in 203 patients (47.2%) in LAG group and in 387 patients (50.4%) in the OG group (P = 0.091). Five-year overall survival and disease-free survival rates of the two groups were similar, which is 51.2% vs. 46.7%, (P = 0.081) and 52.8% vs. 49.6%, (P = 0.091). The surgical approach (LAG or OG) did not influence the disease-free survival (HR 0.975, 95% CI 0.712 to 1.336; P = 0.875). CONCLUSIONS This study suggests that LAG with D2 lymphadenectomy may be a feasible and safe procedure for AGC treatment.
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Affiliation(s)
- Yonggang Xu
- Department of General Surgery, Huashan Hospital North, Fudan University, No. 108 Luxiang Road, 201907, Shanghai, China; Department of General Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, 200040, Shanghai, China
| | - Jin Hua
- Department of General Surgery, Huashan Hospital North, Fudan University, No. 108 Luxiang Road, 201907, Shanghai, China; Department of General Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, 200040, Shanghai, China
| | - Jipeng Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 West Changle Road, 710032, Xian, China
| | - Liubin Shi
- Department of General Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, 200040, Shanghai, China
| | - Hongyuan Xue
- Department of General Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, 200040, Shanghai, China
| | - Jianbo Shuang
- Department of General Surgery, 323 Hospital of PLA, No. 6 West Jianshe Road, 710054, Xian, China
| | - Jianjun Du
- Department of General Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, 200040, Shanghai, China; Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 West Changle Road, 710032, Xian, China.
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25
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Caruso S, Patriti A, Roviello F, De Franco L, Franceschini F, Ceccarelli G, Coratti A. Robot-assisted laparoscopic vs open gastrectomy for gastric cancer: Systematic review and meta-analysis. World J Clin Oncol 2017; 8:273-284. [PMID: 28638798 PMCID: PMC5465018 DOI: 10.5306/wjco.v8.i3.273] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/21/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the potential effectiveness of robot-assisted gastrectomy (RAG) in comparison to open gastrectomy (OG) for gastric cancer patients.
METHODS A comprehensive systematic literature search using PubMed, EMBASE, and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer. Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy. A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, morbidity, and hospital stay. Secondary among postoperative complications, wound infection, bleeding and anastomotic leakage were also analysed.
RESULTS A total of 6 articles, 5 retrospective and 1 randomized controlled study, involving 6123 patients overall, with 689 (11.3%) cases submitted to RAG and 5434 (88.7%) to OG, satisfied the eligibility criteria and were included in the meta-analysis. RAG was associated with longer operation time than OG (weighted mean difference 72.20 min; P < 0.001), but with reduction in blood loss and shorter hospital stay (weighted mean difference -166.83 mL and -1.97 d respectively; P < 0.001). No differences were found with respect to overall postoperative complications (P = 0.65), wound infection (P = 0.35), bleeding (P = 0.65), and anastomotic leakage (P = 0.06). The postoperative mortality rates were similar between the two groups. With respect to oncological outcomes, no statistical differences among the number of harvested lymph nodes were found (weighted mean difference -1.12; P = 0.10).
CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.
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Liao G, Wen S, Xie X, Wu Q. Laparoscopic gastrectomy for remnant gastric cancer: Risk factors associated with conversion and a systematic analysis of literature. Int J Surg 2016; 34:17-22. [PMID: 27543820 DOI: 10.1016/j.ijsu.2016.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/30/2016] [Accepted: 08/10/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND In traditional opinion, history of abdominal surgery was the relative contraindication for Laparoscopic gastrectomy (LG) with high rate of conversion to Open gastrectomy (OG).Use of LG for treatment of remnant gastric cancer (RGC) has been documented in some case studies and controlled clinical trials. However, whether LG is superior, equal or inferior to OG in these patients is not clear. METHODS English language articles published between January 2005 and January 2016 were searched in MEDLINE, Embase and the Cochrane Database of Systematic Reviews. Main outcome measures were: conversion of LG to OG, operative time, intraoperative blood loss, tumor size, positive proximal resection margin, lymph node dissection, disease stage, post-operative resumption of oral intake, postoperative hospital stay, complications, mortality and follow-up findings. Published clinical data which was in the situation of conversion to OG was collected, and the factors associated with conversion to open surgery were examined. RESULTS Five non-randomized controlled trials and seven LG case studies were included in the systematic review. Meta-analysis of the data could not be performed due to high variation and heterogeneity in study design, study population, LG technique, and outcome measures among the included studies. Systematic analysis of the included studies showed that LG was associated with significantly shorter mean operative time, early resumption of oral intake, and shorter hospital stay, as compared to that with OG. No significant difference in complications was observed between the two groups. CONCLUSION LG in the hands of experienced surgeons is relative feasibility and safety for RGC. Previous surgical anastomosis, previous open surgery and surgical experience were associated with conversion to OG. However, these findings should be validated with robust prospective comparative studies.
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Affiliation(s)
- Guanqun Liao
- Department of General Surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan, China.
| | - Shunqian Wen
- Department of General Surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan, China
| | - Xueyi Xie
- Department of General Surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan, China
| | - Qing Wu
- Department of General Surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan, China
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Abstract
BACKGROUND Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. METHODS Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. RESULTS Overall, 26 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD, -3.63, 95 % CI, -4.66 to -2.60; P < 0.01), less blood loss (WMD, -161.37, 95 % CI, -192.55 to -130.18; P < 0.01), faster bowel recovery (WMD, -0.78, 95 % CI, -1.05 to -0.50; P < 0.01), and earlier ambulation (WMD, -0.95, 95 % CI, -1.47 to -0.44; P < 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.49, 95 % CI, -1.78 to 0.81; P = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P < 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. CONCLUSIONS For AGCs, LG appeared comparable with OG in short- and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.
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Affiliation(s)
- Yingjun Quan
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ao Huang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Min Ye
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ming Xu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Biao Zhuang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Bo Yu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Zhijun Min
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
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Kawabata R, Takiguchi S, Kimura Y, Imamura H, Fujita J, Tamura S, Fujitani K, Kishi K, Yamamoto K, Fujiwara S, Kurokawa Y, Mori M, Doki Y. A randomized phase II study of the clinical effects of ultrasonically activated coagulating shears (Harmonic scalpel) in open gastrectomy for gastric cancer. Surg Today 2015. [PMID: 26198895 DOI: 10.1007/s00595-015-1213-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The Harmonic Ace ultrasonic scalpel has been popular in abdominal surgery; however, only a few clinical studies have evaluated the efficacy of this device in radical open gastrectomy for gastric cancer. METHODS The present study was designed as a multicenter, prospective, randomized, controlled trial. Patients with resectable gastric cancer were randomly assigned to gastrectomy using the Harmonic scalpel or conventional monopolar electrosurgery. RESULTS A total of 248 patients were enrolled, and 123 patients were included in the Harmonic group and 114 patients were included in the conventional group. The demographics of the patients were well balanced between the groups. There was no significant difference in the length of the operation from skin incision to resection of the gastric specimen (141 ± 36 min in the Harmonic group vs. 147 ± 13 min in the conventional group; p = 0.276) nor in the amount of blood lost (365 ± 293 vs. 336 ± 272 mL; p = 0.434). There was also no significant difference in the incidence of surgical complications or the post-surgical hospital stay between the groups. CONCLUSION The Harmonic scalpel procedure was not superior to the conventional monopolar electrosurgery with regard to reducing the length of the operation, blood loss, postoperative complications, or postoperative hospital stay in radical open gastrectomy.
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Affiliation(s)
- Ryohei Kawabata
- Department of Surgery, Osaka Rosai Hospital, Osaka, Japan.,Department of Surgery, Sakai City Hospital, Osaka, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Yutaka Kimura
- Department of Surgery, Sakai City Hospital, Osaka, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | | | | | | | - Kentaro Kishi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | | | - Shinichi Fujiwara
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Kharbutli B, Velanovich V. Gastrointestinal symptomatic outcomes of laparoscopic and open gastrectomy. World J Gastrointest Surg 2009; 1:56-8. [PMID: 21160796 PMCID: PMC2999106 DOI: 10.4240/wjgs.v1.i1.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 08/25/2009] [Accepted: 09/02/2009] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the laparoscopic and the open gastrectomy approaches for short term morbidity, length of hospital stay and also long term gastrointestinal symptoms.
METHODS: Patients who have undergone gastrectomy had their medical records reviewed for demographic data, type of gastrectomy, short term morbidity, and length of hospital stay. Patients were contacted and asked to complete the Gastrointestinal Symptom Rating Scale (GSRS). The GSRS measures three domains of GI symptoms: Dyspepsia Syndrome (DS) for the foregut (best score 0, worse score 15), indigestion syndrome (IS) for the midgut (best score 0, worse score 12), and bowel dysfunction syndrome (BDS) for the hindgut (best score 0, worse score 16). Statistical analysis was done using the Mann-Whitney U-test.
RESULTS: We had complete data on 32 patients: 7 laparoscopic and 25 open. Of these, 25 had a gastroenteric anastomosis and 6 did not. The table shows the results as medians with interquartile range. Laparoscopic gastrectomy had a better score than open gastrectomy in the DS domain (0 vs 1, P = 0.02), while gastrectomy without anastomosis had a better score than gastrectomy with anastomosis in the IS domain (0 vs 1, P = 0.05).
CONCLUSION: Patients have little adverse gastrointestinal symptoms and preserve good gastrointestinal function after undergoing any type of gastrectomy. Laparoscopic approach had better dyspepsia and foregut symptoms. Performing an anastomosis led to mild adverse midgut and indigestion effects
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Affiliation(s)
- Bilal Kharbutli
- Bilal Kharbutli, Vic Velanovich, Division of General Surgery, Henry Ford Hospital, Detroit, MI 48202, United States
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