Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study

Abstract

Background Recently, the number of laparoscopic procedures for gastric cancer has increased rapidly. Laparoscopic surgery is reported to have many advantages over open gastrectomy with oncologic safety in early gastric cancer. However, there were few reports on long-term outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC). The aim of this study was to investigate long-term survival outcomes after LAG for AGC. Methods The data of 1,485 patients who underwent LAG between April 1998 and December 2005 by ten surgeons at ten hospitals were collected retrospectively. Among them, 239 patients who were diagnosed with AGC on final pathologic examination were enrolled in the present study to investigate long-term clinical outcomes. Results The ratio of male to female patients was 151:88 and the mean age was 57.1 years. One hundred ninetythree subtotal gastrectomies, 41 total gastrectomies, and 5 proximal gastrectomies were performed. D1 ? a, D1 ? b, and D2 lymph node dissections were performed for 14, 62, and 163 cases, respectively. The median follow-up period was 55.4 months. The overall 5-year survival rate of the 239 AGC patients was 78.8% and the disease-specific 5-year survival rate was 85.6%. The 5-year survival rates of the TNM staging system’s (7th ed.) stages were 90.5% (stage Ib, n = 86), 86.4% (stage IIa, n = 53), 78.3% (stage IIb, n = 44), 52.8% (stage IIIa, n = 24), 52.9% (stage IIIb, n = 24), and 37.5% (stage IIIc, n = 8) (p\0.001). Conclusion The long-term survival outcome rates of LAG for AGC in the present study were comparable to those previously reported for open gastrectomy. Based on the present results, a well-designed phase III trial comparing LAG and open gastrectomy for AGC will be needed to affirm the validity of LAG for AGC. Keywords Laparoscopy-assisted gastrectomy Advanced gastric cancer Long-term survival Gastric cancer is one of the life-threatening cancers in the world and is the most prevalent cancer in Korea. The most important treatment for gastric cancer is surgery. The definitive surgery for gastric cancer is subtotal or total gastrectomy with D2 lymph node dissection. However, because the incidence of early gastric cancer has increased due to a national health screening program in Korea and Japan, the concept of minimally invasive surgery such as endoscopic submucosal dissection or laparoscopic gastrectomy was introduced in the field of gastric cancer surgery [1]. Recently, the number of laparoscopic procedures for gastric cancer has increased rapidly [2]. Laparoscopic surgery is reported to have many advantages over open gastrectomy, with oncologic safety in early gastric cancer [3–8]. However, there were few reports on long-term outcomes of laparoscopyassisted gastrectomy (LAG) for advanced gastric cancer (AGC) [9–11]. Therefore, we aimed to investigate the outcome of LAG for AGC. This multicenter retrospective study can be considered a basis for a prospective randomized controlled trial (RCT) of LAG for AGC in the future.