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Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery

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Affiliated Author(s)
권인규
Alternative Author(s)
Kwon, In Gyu
Journal Title
Surgical Endoscopy
ISSN
0930-2794
Issued Date
2014
Keyword
Minimally invasive surgeryRemnant gastric cancerStomachCompletion total gastrectomy
Abstract
Background Completion total gastrectomy for remnant
gastric cancer (RGC) is technically challenging, especially
using the minimally invasive approach. Only a few small
case series have reported the technical feasibility of completion
total gastrectomy by minimally invasive surgery
(MIS). The aim of this study was to compare the efficacy
and safety of MIS and open surgery for RGC.
Methods We retrospectively analyzed 76 completion
total gastrectomies for RGC between 2005 and 2012.
Indications for MIS were limited to no evidence of serosa
invasion or lymph node metastasis to extraperigastric areas
on preoperative evaluation. We compared patient characteristics,
intraoperative factors, post-operative outcomes,
and survival for the MIS and open surgery groups.
Results Eighteen patients underwent completion total
gastrectomy with MIS (10 laparoscopic, 8 robotic) and 58
patients underwent open surgery. Operation time was
longer in the MIS than the open group (266 vs. 203 min,
P = 0.004), but the groups had similar estimated blood
loss, frequency of unplanned other organ resection, and
number of retrieved lymph nodes. The MIS group had a
significantly earlier initiation of soft diet, shorter hospital
stay, and fewer pain medication injections. Complication
rates, recurrence, and overall 5-year survival were similar
for the two groups. When we compared laparoscopy with
robotic, similar result was shown in all parameters except
operation time.
Conclusions Compared to open surgery, MIS for RGC
demonstrated better short-term outcome and comparable
oncologic results. MIS for RGC is feasible and safe and
maintains advantages of minimal invasiveness. Both laparoscopic
and robotic approaches are reasonable to the
management of RGC.
Keywords Minimally invasive surgery Remnant gastric
cancer Stomach Completion total gastrectomy
Remnant gastric cancer was originally defined as gastric
cancer arising after distal gastrectomy for benign disease
[1, 2]. More recently, remnant gastric cancer has been used
to refer to all cancers arising in the remnant stomach,
regardless of the initial disease or operation [3–5]. As
patients with gastric cancer are now surviving longer
because of early diagnosis and improved prognosis, remnant
gastric cancer after gastrectomy for malignant disease
is becoming more common, especially in Eastern countries
[6–8]. At the same time, remnant gastric cancer is often
diagnosed at a relatively early stage because of regular
patient follow-up after gastrectomy for cancer [9]. Thus, an
increasing number of remnant gastric cancers are detected
at a resectable stage, which can be treated by surgical
resection as a primary gastric cancer. Standard surgery for remnant gastric cancer involves
removing the entire remnant stomach with lymph node
dissection; this is known as a completion total gastrectomy
with lymph node dissection. This procedure is most often
performed as open surgery since minimally invasive surgery
(MIS) is not usually indicated for patients who have
undergone previous major abdominal surgery because of
technical difficulties due to adhesions and anatomical
alterations from the previous surgery. With advances in
laparoscopic techniques and devices, the accumulating
experience of surgeons, and the wider acceptance of MIS
for gastric cancer in general, MIS for remnant gastric
cancer is gaining interest. However, the literature in this
area is sparse, and only a few small case series have
described completion total gastrectomy successfully performed
by the laparoscopic approach [10–12]. There is
only one study with a small number of cases that compared
outcomes after laparoscopic approach for remnant gastric
cancer with open surgery [13]. To the best of our knowledge,
no study has compared MIS with open surgery for the
treatment of remnant gastric cancer, including robotic
surgery.
The aim of this study was to assess the effectiveness and
safety of MIS for remnant gastric cancer. We compared the
short-term and long-term outcomes of minimally invasive
completion total gastrectomy with those of open completion
total gastrectomy to determine whether benefits of
MIS are observed in patients undergoing this technically
complex operation.
Department
Dept. of Surgery (외과학)
Publisher
School of Medicine
Citation
In Gyu Kwon et al. (2014). Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery. Surgical Endoscopy, 28(8), 2452–2458. doi: 10.1007/s00464-014-3496-8
Type
Article
ISSN
0930-2794
DOI
10.1007/s00464-014-3496-8
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/34447
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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