Öz
Objective: Today, minimal invasive surgery has gained wide acceptance by general surgeons, even in complex oncological procedures. Despite the increased experience on laparoscopic distal gastrectomy, limited number of surgeons prefer laparoscopic total gastrectomy for proximal or middle-third gastric cancer, due to the concern of technical difficulties which can alter the quality of oncological outcomes. Methods: We retrospectively analyzed gastric cancer patients who underwent curative intent laparoscopic gastrectomy by single surgeon from October 2013 to April 2014. Five total gastrectomy + D2 (-No 10 and 11d) and 1 distal gastrectomy + D2 lymphadenectomy were analyzed for patient demographics, pathological characteristics, morbidity and in-hospital mortality. Results: The mean operating time was 255,8±37.2 minutes. The mean blood loss was 121.6±20.4 ml. In all patients, R0 resection were performed. The mean number of harvested lymph nodes were 22.6±7.3. The median number of metastatic lymph nodes was 16 (0-23). In one patient, less than 15 lymph nodes were retrieved. Complication rate was 33.3% (n=2). In one patient, who underwent laparoscopic distal gastrectomy, afferent loop syndrome developed. In another patient, who underwent total gastrectomy plus splenectomy a massive pulmoner embolism developed. The median hospital stay was 10 (6-18) days. Conclusion: With increased experience in advanced laparoscopic procedures, laparoscopic total gastrectomy may be considered as the first line treatment approach for gastric cancer patient even in a low-volume center. Key words: Gastric cancer, Laparoscopic gastrectomy, distal gastrectomy, total gastrectomy
Anahtar Kelimeler
Gastric cancer Laparoscopic gastrectomy distal gastrectomy total gastrectomy
Kaynakça
- Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted
- Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4:146-
- -
- Hur H, Jeon HM, Kim W. Laparoscopy-assisted distal gastrectomy
- with D2 lymphadenectomy for T2b advanced
- gastric cancers: three years’ experience. J Surg Oncol
- ;98:515-519.
- Hamabe A, Omori T, Tanaka K, et al. Comparison of longterm
- results between laparoscopy-assisted gastrectomy and
- open gastrectomy with D2 lymph node dissection for advanced
- gastric cancer. Surg Endosc 2012; 26:1702-1709.
- Viñuela EF, Gonen M, Brennan MF, et al. Laparoscopic
- versus open distal gastrectomy for gastric cancer: a metaanalysis
- of randomized controlled trials and high-quality
- nonrandomized studies. Ann Surg 2012; 255:446-456.
- Kim YW, Baik YH, Yun YH, et al. Improved quality of life
- outcomes after laparoscopy-assisted distal gastrectomy for
- early gastric cancer: results of a prospective randomized
- clinical trial. Ann Surg 2008; 248:721-727.
- Lee JH, Han HS, Lee JH. A prospective randomized study
- comparing open vs laparoscopy-assisted distal gastrectomy
- in early gastric cancer: early results. Surg Endosc 2005;
- :168-173.
- Ahn HS, Lee HJ, Yoo MW, et al. Changes in clinicopathological
- features and survival after gastrectomy for gastric
- cancer over a 20-year period. Br J Surg 2011;98:255-260.
- Suzuki H, Gotoda T, Sasako M, et al. Detection of early gastric
- cancer: misunderstanding the role of mass screening.
- Gastric Cancer 2006;9:315-319.
- Yalcin S, Gumus M, Kilickap S, et al. End-of-study results
- of Turkish gastric cancer patients from the global REGATE
- study. J BUON 2014; 19:377-387.
- Association JGC. Japanese gastric cancer treatment guidelines
- (ver. 3). Gastric Cancer 2011;14:113-123.
- Jeong O, Ryu SY, Zhao X-F, et al. Short-term surgical outcomes
- and operative risks of laparoscopic total gastrectomy
- (LTG) for gastric carcinoma: experience at a large-volume
- center. Surg Endosc 2012;26:3418-3425.
- Xiong J-J, Nunes QM, Huang W, et al. Laparoscopic vs
- open total gastrectomy for gastric cancer: a meta-analysis.
- World J Gastroenterol 2013;19:8114-8132.
- Bonenkamp JJ, Hermans J, Sasako M, et al. Extended
- lymph-node dissection for gastric cancer. N Engl J Med
- ;340:908-914.
- Danielson H, Kokkola A, Kiviluoto T, et al. Clinical outcome
- after D1 vs D2-3 gastrectomy for treatment of gastric
- cancer. Scand J Surg 2007;96:35-40.
- Maruyama K, Gunvén P, Okabayashi K, et al. Lymph node
- metastases of gastric cancer. General pattern in 1931 patients.
- Ann Surg 1989;210:596-602.
- Noguchi Y, Imada T, Matsumoto A, et al. Radical surgery
- for gastric cancer. A review of the Japanese experience.
- Cancer 1989;64:2053-2062.
- Cuschieri A, Weeden S, Fielding J, et al. Patient survival
- after D1 and D2 resections for gastric cancer: long-term
- R. Aktimur et al. Initial experience with laparoscopic gastrectomy 17
- Dicle Tıp Derg / Dicle Med J www.diclemedj.org Cilt / Vol 42, No 1, 12-17
- results of the MRC randomized surgical trial. Surgical Cooperative
- Group. Br J Cancer 1999;79:1522-1530.
- Wang J, Dang P, Raut CP, et al. Comparison of a lymph
- node ratio-based staging system with the 7th AJCC system
- for gastric cancer: analysis of 18,043 patients from the
- SEER database. Ann Surg 2012;255:478-485.
- Wang W, Zhang X, Shen C, et al. Laparoscopic versus open
- total gastrectomy for gastric cancer: an updated meta-analysis.
- PLoS One 2014; 9:e88753.
- Poller DN. Method of specimen fixation and pathological
- dissection of colorectal cancer influences retrieval of
- lymph nodes and tumour nodal stage. Eur J Surg Oncol
- ;26:758-762.
- Dulucq J-L, Wintringer P, Stabilini C, et al. Laparoscopic
- and open gastric resections for malignant lesions: a prospective
- comparative study. Surg Endosc 2005;19:933-938.
- Du J, Zheng J, Li Y, et al. Laparoscopy-assisted total gastrectomy
- with extended lymph node resection for advanced
- gastric cancer--reports of 82 cases. Hepatogastroenterology
- ;57:1589-1594.
- Kim HS, Kim BS, Lee IS, et al. Comparison of totally
- laparoscopic total gastrectomy and open total gastrectomy
- for gastric cancer. J Laparoendosc Adv Surg Tech A
- ;23:323-331.
- Hallet J, Labidi S, Bouchard-Fortier A, et al. Oncologic
- specimen from laparoscopic assisted gastrectomy for gastric
- adenocarcinoma is comparable to D1-open surgery: the
- experience of a Canadian centre. Can J Surg 2013;56:249-
- -
- Huang K-H, Lan Y-T, Fang W-L, et al. Initial experience of
- robotic gastrectomy and comparison with open and laparoscopic
- gastrectomy for gastric cancer. J Gastrointest Surg
- ;16:1303-1310.
- Ye L-y, Liu D-r, Li C, et al. Systematic review of laparoscopy-assisted
- versus open gastrectomy for advanced gastric
- cancer. J Zhejiang Univ Sci B 2013;14:468-478.
Öz
Amaç: Günümüzde minimal invazif cerrahi genel cerrahlar tarafından kompleks onkolojik prosedürler için bile kullanılır hale gelmiştir. Ancak, laparoskopik distal gastrektomi deneyiminin artmasına rağmen, teknik zorlukların onkolojik sonuçları etkileyebileceği endişesi ile az sayıda cerrah total gastrektomi için laparoskopik yöntemi tercih etmektedir.Yöntemler: Eylül 2013 ile Nisan 2014 arasında tek cerrah tarafından küratif amaçlı laparoskopik gastrektomi uygulanmış mide kanseri hastalarını retrospektif olarak değerlendirdik. 5 total gastrektomi + D2 (-No 10 ve 11d) ve 1 distal gastrektomi + D2 lenfadenektomi hastası, demografik özellikler, patolojik karakteristikler, morbidite ve hastane mortalitesi açısından değerlendirildi. Bulgular: Ortalama ameliyat süresi 255,8±37,2 dakika, ortalama kan kaybı 121.6±20.4 mL idi. Tüm hastalara R0 rezeksiyon uygulandı. Çıkartılan lenf nodu ortalaması 22,6±7,3, metastatik lenf nodu ortancası 16 idi. 1 hastada 15’ten az lenf nodu çıkartıldı. Komplikasyon oranı %33,3 (n=2) idi; laparoskopik distal gastrektomi uygulanan bir hastada aferent loop sendromu gelişti; laparoskopik total gastrektomi ve splenektomi uygulanan diğer bir hastada masif pulmoner emboli gelişti. Ortanca hastanede kalım süresi 10 gündü.Sonuç: Laparoskopik cerrahi prosedürlerin uygulanmasında gelişen deneyim düzeyi ile birlikte, ileri gastrik kanser hastaları için, ileri laparoskopik işlemlerin az sayıda ve düşük yoğunlukta yapıldığı merkezlerde dahi laparoskopik total gastrektomi ilk düşünülecek tedavi seçeneği olabilir
Anahtar Kelimeler
Mide kanseri laparoskopik gastrektomi distal gastrektomi total gastrektomi
Kaynakça
- Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted
- Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4:146-
- -
- Hur H, Jeon HM, Kim W. Laparoscopy-assisted distal gastrectomy
- with D2 lymphadenectomy for T2b advanced
- gastric cancers: three years’ experience. J Surg Oncol
- ;98:515-519.
- Hamabe A, Omori T, Tanaka K, et al. Comparison of longterm
- results between laparoscopy-assisted gastrectomy and
- open gastrectomy with D2 lymph node dissection for advanced
- gastric cancer. Surg Endosc 2012; 26:1702-1709.
- Viñuela EF, Gonen M, Brennan MF, et al. Laparoscopic
- versus open distal gastrectomy for gastric cancer: a metaanalysis
- of randomized controlled trials and high-quality
- nonrandomized studies. Ann Surg 2012; 255:446-456.
- Kim YW, Baik YH, Yun YH, et al. Improved quality of life
- outcomes after laparoscopy-assisted distal gastrectomy for
- early gastric cancer: results of a prospective randomized
- clinical trial. Ann Surg 2008; 248:721-727.
- Lee JH, Han HS, Lee JH. A prospective randomized study
- comparing open vs laparoscopy-assisted distal gastrectomy
- in early gastric cancer: early results. Surg Endosc 2005;
- :168-173.
- Ahn HS, Lee HJ, Yoo MW, et al. Changes in clinicopathological
- features and survival after gastrectomy for gastric
- cancer over a 20-year period. Br J Surg 2011;98:255-260.
- Suzuki H, Gotoda T, Sasako M, et al. Detection of early gastric
- cancer: misunderstanding the role of mass screening.
- Gastric Cancer 2006;9:315-319.
- Yalcin S, Gumus M, Kilickap S, et al. End-of-study results
- of Turkish gastric cancer patients from the global REGATE
- study. J BUON 2014; 19:377-387.
- Association JGC. Japanese gastric cancer treatment guidelines
- (ver. 3). Gastric Cancer 2011;14:113-123.
- Jeong O, Ryu SY, Zhao X-F, et al. Short-term surgical outcomes
- and operative risks of laparoscopic total gastrectomy
- (LTG) for gastric carcinoma: experience at a large-volume
- center. Surg Endosc 2012;26:3418-3425.
- Xiong J-J, Nunes QM, Huang W, et al. Laparoscopic vs
- open total gastrectomy for gastric cancer: a meta-analysis.
- World J Gastroenterol 2013;19:8114-8132.
- Bonenkamp JJ, Hermans J, Sasako M, et al. Extended
- lymph-node dissection for gastric cancer. N Engl J Med
- ;340:908-914.
- Danielson H, Kokkola A, Kiviluoto T, et al. Clinical outcome
- after D1 vs D2-3 gastrectomy for treatment of gastric
- cancer. Scand J Surg 2007;96:35-40.
- Maruyama K, Gunvén P, Okabayashi K, et al. Lymph node
- metastases of gastric cancer. General pattern in 1931 patients.
- Ann Surg 1989;210:596-602.
- Noguchi Y, Imada T, Matsumoto A, et al. Radical surgery
- for gastric cancer. A review of the Japanese experience.
- Cancer 1989;64:2053-2062.
- Cuschieri A, Weeden S, Fielding J, et al. Patient survival
- after D1 and D2 resections for gastric cancer: long-term
- R. Aktimur et al. Initial experience with laparoscopic gastrectomy 17
- Dicle Tıp Derg / Dicle Med J www.diclemedj.org Cilt / Vol 42, No 1, 12-17
- results of the MRC randomized surgical trial. Surgical Cooperative
- Group. Br J Cancer 1999;79:1522-1530.
- Wang J, Dang P, Raut CP, et al. Comparison of a lymph
- node ratio-based staging system with the 7th AJCC system
- for gastric cancer: analysis of 18,043 patients from the
- SEER database. Ann Surg 2012;255:478-485.
- Wang W, Zhang X, Shen C, et al. Laparoscopic versus open
- total gastrectomy for gastric cancer: an updated meta-analysis.
- PLoS One 2014; 9:e88753.
- Poller DN. Method of specimen fixation and pathological
- dissection of colorectal cancer influences retrieval of
- lymph nodes and tumour nodal stage. Eur J Surg Oncol
- ;26:758-762.
- Dulucq J-L, Wintringer P, Stabilini C, et al. Laparoscopic
- and open gastric resections for malignant lesions: a prospective
- comparative study. Surg Endosc 2005;19:933-938.
- Du J, Zheng J, Li Y, et al. Laparoscopy-assisted total gastrectomy
- with extended lymph node resection for advanced
- gastric cancer--reports of 82 cases. Hepatogastroenterology
- ;57:1589-1594.
- Kim HS, Kim BS, Lee IS, et al. Comparison of totally
- laparoscopic total gastrectomy and open total gastrectomy
- for gastric cancer. J Laparoendosc Adv Surg Tech A
- ;23:323-331.
- Hallet J, Labidi S, Bouchard-Fortier A, et al. Oncologic
- specimen from laparoscopic assisted gastrectomy for gastric
- adenocarcinoma is comparable to D1-open surgery: the
- experience of a Canadian centre. Can J Surg 2013;56:249-
- -
- Huang K-H, Lan Y-T, Fang W-L, et al. Initial experience of
- robotic gastrectomy and comparison with open and laparoscopic
- gastrectomy for gastric cancer. J Gastrointest Surg
- ;16:1303-1310.
- Ye L-y, Liu D-r, Li C, et al. Systematic review of laparoscopy-assisted
- versus open gastrectomy for advanced gastric
- cancer. J Zhejiang Univ Sci B 2013;14:468-478.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Mayıs 2015 |
| Gönderilme Tarihi | 9 Mayıs 2015 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 42 Sayı: 1 |