Curability of laparoscopic gastrectomy for gastric cancer: An analysis of 10 years' experience

Abstract

Background. Laparoscopic gastrectomy is becoming widely used for the management of gastric cancer. To evaluate its oncologic feasibility, we analyzed the curability of laparoscopic gastrectomy based on our 10-year experience. Methods. All laparoscopic gastrectomies for gastric cancer performed in the past 10 years, with the exception of those converted to open surgery, were evaluated. The number of dissected lymph nodes and the proximal and distal distances between the primary lesion and resection lines were analyzed and compared among different procedures. Laparoscopic and open D2 resection were also compared. Results. Most of the 391 eligible patients fulfilled the oncologic requirement of current treatment guidelines. The mean proximal and distal distances were 3.73 ± 2.11 cm and 5.31 ± 3.26 cm, respectively. A distance of less than 1 cm occurred in only 10 patients proximally and 5 patients distally, with pathological examination results being negative. In each operation, an average of 22 lymph nodes were dissected (21.7 ± 12.1). Laparoscopic D2 resection possessed the same capacity as open surgery in terms of lymph node dissection. The proximal distance in open surgery was about 1 cm longer than that in laparoscopic gastrectomy (4.99 ± 2.59 cm vs 4.06 ± 1.87 cm; P = 0.038), while the difference between distal distances was not significant (6.94 ± 3.52 cm vs 7.24 ± 4.64 cm; P = 0.187). Conclusion. From the point of view of curability, laparoscopic operation is an oncologically safe procedure for the management of gastric cancer, at least for stage I and II disease. © 2008 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.