Skip to main content

Advertisement

Log in

A prospective randomized clinical trial comparing D2 dissection in laparoscopic and open gastrectomy for gastric cancer

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Laparoscopic surgery is an acceptable alternative to open surgery in colorectal cancer treatment. However, in gastric cancer, there is not much scientific evidence. Here, we proposed a prospective randomized clinical trial to evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. From October 2010 to September 2012, 300 patients with gastric cancer were randomized to undergo either laparoscopy-assisted gastrectomy (LAG) or conventional open gastrectomy (OG) with D2 dissection. Clinicopathological parameters, recovery and complications were compared between these two groups. Thirty cases were excluded because of refusing to be involved in the trial, having peritoneal seeding metastasis or LAG conversed to OG, and finally 270 cases were analyzed (128 in LAG and 142 in OG). No significant differences were observed in gender, age, body mass index, stages and types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)] (P > 0.05). The number of harvested lymph nodes (HLNs) was similar (29.3 ± 11.8 in LAG vs. 30.1 ± 11.4 in OG, P = 0.574). And in the same type of radical resection, no significant difference was found in the number of HLNs between the two groups (PG + D2, P = 0.770; DG + D2, P = 0.500; TG + D2, P = 0.993). The morbidity of the LAG group (21.8 %) was also comparable to the OG group (19.0 %, P = 0.560). However, the LAG group had significantly less blood loss and faster recovery, and a longer operation time (P < 0.05). Laparoscopic D2 dissection is feasible, safe and capable of fulfilling oncologic criteria for the treatment of gastric cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  PubMed  Google Scholar 

  2. Lin Y, Ueda J, Kikuchi S, Totsuka Y, Wei WQ, Qiao YL, Inoue M. Comparative epidemiology of gastric cancer between Japan and China. World J Gastroenterol. 2011;17:4421–8.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Dikken JL, van de Velde CJ, Coit DG, Shah MA, Verheij M, Cats A. Treatment of resectable gastric cancer. Ther Adv Gastroenterol. 2012;5:49–69.

    Article  CAS  Google Scholar 

  4. Takahashi T, Saikawa Y, Kitagawa Y. Gastric cancer: current status of diagnosis and treatment. Cancers (Basel). 2013;5:48–63.

    Article  Google Scholar 

  5. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.

    CAS  PubMed  Google Scholar 

  6. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:S306–11.

    Article  PubMed  Google Scholar 

  7. Fujii K, Sonoda K, Izumi K, Shiraishi N, Adachi Y, Kitano S. T lymphocyte subsets and Th1/Th2 balance after laparoscopy-assisted distal gastrectomy. Surg Endosc. 2003;17:1440–4.

    Article  CAS  PubMed  Google Scholar 

  8. 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;19:168–73.

    Article  PubMed  Google Scholar 

  9. Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc. 2005;19:1172–6.

    Article  CAS  PubMed  Google Scholar 

  10. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.

    Article  PubMed  Google Scholar 

  11. Kim YW, Yoon HM, Yun YH, Nam BH, Eom BW, Baik YH, Lee SE, Lee Y, Kim YA, Park JY, Ryu KW. Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc. 2013;27:4267–76.

    Article  PubMed  Google Scholar 

  12. Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Watanabe M, Okutomi T, Wang G, Bax L. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc. 2013;27:1695–705.

    Article  PubMed  Google Scholar 

  13. Takiguchi S, Fujiwara Y, Yamasaki M, Miyata H, Nakajima K, Sekimoto M, Mori M, Doki Y. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study. World J Surg. 2013;37:2379–86.

    Article  PubMed  Google Scholar 

  14. Du J, Zheng J, Li Y, Li J, Ji G, Dong G, Yang Z, Wang W, Gao Z. Laparoscopy-assisted total gastrectomy with extended lymph node resection for advanced gastric cancer—reports of 82 cases. Hepatogastroenterology. 2010;57:1589–94.

    PubMed  Google Scholar 

  15. Huang JL, Wei HB, Zheng ZH, Wei B, Chen TF, Huang Y, Guo WP, Hu B. Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer. Dig Surg. 2010;27:291–6.

    Article  PubMed  Google Scholar 

  16. Cui M, Xing JD, Yang W, Ma YY, Yao ZD, Zhang N, Su XQ. D2 dissection in laparoscopic and open gastrectomy for gastric cancer. World J Gastroenterol. 2012;18:833–9.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Qiu JF, Yang B, Fang L, Li YP, Shi YJ, Yu XC, Zhang MC. Safety and efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer in the elderly. Int J Clin Exp Med. 2014;7:3562–7.

    PubMed Central  PubMed  Google Scholar 

  18. Fang C, Hua J, Li J, Zhen J, Wang F, Zhao Q, Shuang J, Du J. Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymphadenectomy for advanced gastric cancer. Am J Surg. 2014;208:391–6.

    Article  PubMed  Google Scholar 

  19. Lee JH, Lee CM, Son SY, Ahn SH, Park DJ, Kim HH. Laparoscopic versus open gastrectomy for gastric cancer: long-term oncologic results. Surgery. 2014;155:154–64.

    Article  PubMed  Google Scholar 

  20. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY. Long-term results of laparoscopic gastrectomy for gastric cancer: large-scale case-control and case-matched Korean multicenter study. J Clin Oncol. 2014;32:627–33.

    Article  PubMed  Google Scholar 

  21. Association Japanese Gastric Cancer. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1(10–24):20.

    Google Scholar 

  22. Degiuli M, Sasako M, Ponti A, Calvo F. Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J Cancer. 2004;90:1727–32.

    CAS  PubMed Central  PubMed  Google Scholar 

  23. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.

    Article  PubMed  Google Scholar 

  24. Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C. Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg. 2007;194:839–44.

    Article  PubMed  Google Scholar 

  25. Pugliese R, Maggioni D, Sansonna F, Ferrari GC, Forgione A, Costanzi A, Magistro C, Pauna J, Di Lernia S, Citterio D, Brambilla C. Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures. Eur J Surg Oncol. 2009;35:281–8.

    Article  CAS  PubMed  Google Scholar 

  26. Lee SR, Kim HO, Son BH, Shin JH, Yoo CH. Laparoscopic-assisted total gastrectomy versus open total gastrectomy for upper and middle gastric cancer in short-term and long-term outcomes. Surg Laparosc Endosc Percutan Tech. 2014;24:277–82.

    Article  PubMed  Google Scholar 

  27. Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC. Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006;202:874–80.

    Article  PubMed  Google Scholar 

  28. Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, Jung EJ, Joo YT, Jeong CY, Ha WS. Risk of recurrence after laparoscopy-assisted radical gastrectomy for gastric cancer performed by a single surgeon. Surg Endosc. 2011;25:872–8.

    Article  PubMed  Google Scholar 

  29. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Cai J, Wei D, Gao CF, Zhang CS, Zhang H, Zhao T. A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig Surg. 2011;28:331–7.

    Article  CAS  PubMed  Google Scholar 

  31. Li HT, Han XP, Su L, Zhu WK, Xu W, Li K, Zhao QC, Yang H, Liu HB. Short-term efficacy of laparoscopy-assisted vs open radical gastrectomy in gastric cancer. World J Gastrointest Surg. 2014;6:59–64.

    PubMed Central  PubMed  Google Scholar 

  32. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized trial (KLASS Trial). Ann Surg. 2010;251:417–20.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by the National Natural Science Foundation of China (Nos. 81272766, 81450028), the National High Technology Research and Development Program of China (863 Program, No. 2014AA020603), Clinical Characteristics and Application Research of Capital (Beijing Municipal Science and Technology Commission, No. Z121107001012130), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (No. XM201309), Peking University (PKU) 985 Special Funding for Collaborative Research with PKU Hospitals (To Xiangqian Su and Fan Bai), Seeding Grant for Medicine and Life Sciences of Peking University (2014-MB-04), Science Foundation of Peking University Cancer Hospital and Institute (No. 2014-14).

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Jiafu Ji or Xiangqian Su.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The studies have been approved by the research ethics committee of Peking University Cancer Hospital and Institute, Beijing, China (Approved No. 2012071710) and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Ming Cui and Ziyu Li have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cui, M., Li, Z., Xing, J. et al. A prospective randomized clinical trial comparing D2 dissection in laparoscopic and open gastrectomy for gastric cancer. Med Oncol 32, 241 (2015). https://doi.org/10.1007/s12032-015-0680-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-015-0680-1

Keywords

Navigation