This study aimed to compare the long-term outcomes of laparoscopic and open distal gastrectomy for advanced gastric cancer. Between January 2007 and December 2014, patients with advanced gastric cancer underwent distal gastrectomy by laparoscopic or open approach were identified. Patients in both groups were selected after being matched by age, gender, American Society of Anesthesiologists (ASA) class and clinical TNM stage using propensity score method, to create two comparable groups: laparoscopy and open groups, and prognosis were compared between these two groups. After the patients were matched, 86 patients in each group were selected for analysis. There were no significant differences in the clinicopathological features between the two groups. There were significant differences between the laparoscopy and open groups in terms of blood loss, duration of surgery, and hospital stay. The 5-year overall survival rate was 59% in laparoscopy group, and 56% in open group (P=0.523). The 5-year disease-free survival rate was 52% and 46%, respectively (P=0.362). According to the univariate and multivariate analysis, this type of surgical approach was not a prognostic factor for long-term outcomes. The current results indicated that laparoscopic distal gastrectomy is associated with similar overall survival and disease-free survival for advanced gastric cancer.

Long-term follow-up after laparoscopic versus open distal gastrectomy for advanced gastric cancer

Current status of surgical treatment of gastric cancer in the era of minimally invasive surgery in China: Opportunity and challenge.

Purpose
This study was designed to formulate a model that efficiently predicts splenic hilar lymph node metastasis (SHLNM) in patients with proximal gastric cancer and to assess indications for laparoscopic spleen-preserving no.10 lymph node dissection (LSPNo.10LND) based on this model.

/pdf/a-346-case-analysis-for-laparoscopic-spleen-preserving-no-10-507eg33fou.pdf

A 346 case analysis for laparoscopic spleen-preserving no.10 lymph node dissection for proximal gastric cancer: a single center study.

Large tumor size is a poor prognostic factor of gastric cancer with signet ring cell: Results from the surveillance, epidemiology, and end results database.

AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery (SpA) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy (LTGSPL).

METHODS: The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups (concentrated group vs distributed group) according to the distance between the splenic artery’s furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups.

RESULTS: There were 205 patients with a concentrated type (64.7%) and 112 patients with a distributed type (35.3%) SpA. There were 22 patients (6.9%) with a single branch of the splenic lobar vessels, 250 (78.9%) with 2 branches, 43 (13.6%) with 3 branches, and 2 patients (0.6%) with multiple branches. Eighty seven patients (27.4%) had type I splenic artery trunk, 211 (66.6%) had type II, 13 (4.1%) had type III, and 6 (1.9%) had type IV. The mean splenic hilar lymphadenectomy time (23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy (14.78 ± 11.09 vs 17.37 ± 10.62 mL; P = 0.044), and number of vascular clamps used at the splenic hilum (9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups (P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups (P > 0.05).

CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type SpA may be optimal patients for training new surgeons.

Anatomy and influence of the splenic artery in laparoscopic spleen-preserving splenic lymphadenectomy

Background/aims To explore the impact of tumor size on outcomes in patients with pT2-3N0M0 stage. Methodology ROC curve analysis was used to determine the appropriate cut-off value for tumor size in 115 patients of pT2-3N0M0 stage gastric cancer. Based on this cut-off value, patients were divided into two groups. The five-year overall survival (OS) rates in the two groups were compared according to the independent prognostic factors. Results Using this cut-off value of 3.7cm, 62 patients had large-sized tumors (LSTs, tumor size >3.7cm) and 53 had small-sized tumors (SSTs, tumor size Conclusions Tumor size is a prognostic factor in patients with pT2-3N0M0 stage. Especially for pT2N0M0 stage gastric cancer and pT2-3N0M0 stage gastric cancer with undifferentiated type tumors, the prognosis was poorer in patients with tumor size >3.7cm than that in patients with tumor size

Tumor size as a prognostic factor in patients with node-negative gastric cancer invading the muscularis propria and subserosa (pT2-3N0M0 stage).

BACKGROUND/AIMS Although the XELOX regimen has been recommended as first-line adjuvant chemotherapy for advanced gastric cancer (AGC), its role in a neoadjuvant setting is not well established. Therefore, we aimed to assess the clinical effect of XELOX neoadjuvant chemotherapy on AGC when combined with laparoscopic surgery. METHODOLOGY We compared the effects of perioperative XELOX (neoadjuvant chemotherapy group, NCG) with the effects of adjuvant XELOX (direct surgical group, DSG) in patients with locally AGC. The response to chemotherapy was assessed according to Recist criteria and pathological changes. The Kaplan-Meier log-rank test was used to calculate and compare survival differences. RESULTS Seventy patients were included (neoadjuvant=35). The rate of effective neoadjuvant chemotherapy was 62.9%, and the disease control rate was 91.5%. In the NCG, 32 (94.7%) of the patients underwent laparoscopic-assisted D2 radical gastrectomy. The R0 resection rate was 100%. However, rates were 26 (74.3%) and 85.7% in the DSG, respectively (P<0.05). The 3-year overall survival (OS) in the NCG was 77.1% vs. 62.3% in the DSG (P=0.119). The 3-year disease-free survival (DFS) was 74.3% in the NCG, and the DFS was 59.3% in the DSG (P=0.033). CONCLUSIONS XELOX can enhance the R0 resection rate, increase potential for laparoscopic surgery with rather good safety and improve the 3-year DFS of patients with AGC.

Treatment of locally advanced gastric cancer with the XELOX program of neoadjuvantchemotherapy combined with laparoscopic surgery: the experience in China.

BACKGROUND/AIMS This article discusses the results of study of the impact of tumor size on the lymph node metastasis of early distal gastric cancer (EDGC). The understanding of such impact will provide the basis for the selection of optimal lymph node dissection and scope. METHODOLOGY Between April 1995 and August 2006, 146 patients of EDGC underwent primary surgery and were included in the study. We selected the optimal cut-off point of tumor size via ROC curve. We then investigated the relationship between the tumor size and the lymph node metastasis for each group. RESULTS The optimal cut-off point of the tumor size was 23 mm. Metastasis only occurred in No.1, 3-7 lymph nodes for patients in small-diameter group (SDG) or those in large-diameter group (LDG) with intramucosal carcinoma. For patients in the LDG with submucosal carcinoma, metastasis occurred in No.1, 3-7, 8a, 9 and 12a lymph nodes. CONCLUSIONS For EDGC patients, when tumor was <23 mm or intramucosal cancer was ≥23 mm, metastasis tended to occur only in No.1, 3-7 lymph nodes. But if submucosal cancer was ≥23 mm, metastasis occurred in all of No. 1, 3-7 and No. 8a, 9 and 12a lymph nodes.

The effect of tumor size on lymph node metastasis in patients with early distal gastric cancer.

BACKGROUND/AIMS To evaluate the feasibility and safety of laparoscopic spleen-preserving splenic hilar lymph node dissection for advanced upper gastric cancer in patients with high body mass index. METHODOLOGY Outcomes were retrospectively analyzed in 140 patients with AUGC who underwent laparoscopic spleen-preserving splenic hilar LN dissection between January 2010 and December 2012, including those with high (≥ 23 kg/m) and normal (< 23 kg/m2) BMI. RESULTS Except for BMI, the clinicopathologic characteristics of patients with high and normal BMI were similar. The number of retrieved No. 10 LNs per patient was significantly lower in the high than in the normal BMI group. There were no significant between group differences in operation time, blood loss, postoperative hospital stay and complications. Subgroup analysis showed that the numbers of No. 10 LNs retrieved per patient were lower in males with high than normal BMI and in patients after the initial learning curve of 40 patients with high than normal BMI. CONCLUSIONS Laparoscopic spleen-preserving splenic hilar LN dissection is feasible and safe in patients with high BMI, although even experienced laparoscopic surgeons should take special care in these patients, especially in men.

Laparoscopic Spleen-Preserving Splenic Hilar Lymph Node Dissection for Advanced Upper Gastric Cancer in Patients with High Body Mass Index.

Background/Aims: To investigate the learning curve of laparoscopy spleen-preserving splenic hilar lymph node dissection for advanced upper gastric cancer (AUGC). Methodology: A retrospective analysis of clinical data of 100 cases of spleen-preserving splenic hilar lymph node dissection for AUGC, completed by the same group of physicians with extensive laparoscopic gastric cancer surgical experience. The patients were divided into five groups (A, B, C, D and E) in accordance with their surgical priorities. Results: The five groups of patients were comparable in age, gender, body mass index, spleen lobe artery count, histological type and invasion department. The surgical time for Group A and Group B was longer than Group C, Group D and Group E. The amount of bleeding for Group A and Group B was significantly larger than Group C, Group D and Group E. Laparotomy rate, the number of splenic hilar lymph node dissection, incidence of complications, recovery time of bowel function, days for postoperative hospital stay were not statistically different among the five groups. Conclusions: On the basis of skilled surgical techniques for laparoscopic gastric cancer, the learning curve for laparoscopy spleen-preserving splenic hilar lymph node dissection for upper advanced gastric cancer was roughly 40 cases.

Learning curve of laparoscopy spleen-preserving splenic hilar lymph node dissection for advanced upper gastric cancer.

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