Laparoscopic assisted distal gastrectomy for early gastric cancer

Is it an alternative to the open approach?

Danny Yakoub, Thanos Athanasiou, Paris Tekkis, George B. Hanna

Research output: Contribution to journalReview article

80 Citations (Scopus)

Abstract

Objective: This study aims to compare short term outcomes and oncological value of laparoscopy assisted (LADG) and open distal gastrectomy (ODG) in the treatment of early gastric cancer. Methods: Meta-analysis of 12 studies, including three randomized controlled trials, published between 2000 and 2007, comparing laparoscopy assisted and open distal gastrectomy in 951 patients with early gastric cancer, was done. Outcomes of interest were operative data, lymph node clearance, postoperative recovery complications. Results: Overall morbidity rate was significantly less with LADG (10.5% versus 20.1%, P = 0.003, OR 0.52, CI 0.34-0.8). A mean of 4.61 less number of lymph nodes dissected than ODG (CI -5.96, -3.26 P < 0.001) when all studies are included. There was no difference between the two groups in number of lymph nodes dissected when less than D2 lymphadenectomy was done (2.44 nodes less in LADG group, CI -5.52, 0.63; P = 0.12). LADG patients had less operative blood loss (mean of 151 ml, P < 0.001), less time to walking, oral intake and flatus. LADG patients had less length of hospital stay (5.7 days, P < 0.001), postoperative fever and pain. ODG group showed significantly less operative time. There was no significant difference between the two groups in the incidence of anastomotic complications and wound infection. Conclusion: LADG is a safe technical alternative to ODG for early gastric cancer with a lower overall complication rate and enhanced postoperative recovery. Endorsing LADG as a better alternative to ODG requires data on long term survival, quality of life and cost effectiveness.

Original languageEnglish (US)
Pages (from-to)322-333
Number of pages12
JournalSurgical Oncology
Volume18
Issue number4
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

Fingerprint

Gastrectomy
Stomach Neoplasms
Lymph Nodes
Laparoscopy
Length of Stay
Flatulence
Wound Infection
Operative Time
Postoperative Pain
Lymph Node Excision
Walking
Cost-Benefit Analysis
Meta-Analysis
Fever
Randomized Controlled Trials
Quality of Life
Morbidity
Survival
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Laparoscopic assisted distal gastrectomy for early gastric cancer : Is it an alternative to the open approach? / Yakoub, Danny; Athanasiou, Thanos; Tekkis, Paris; Hanna, George B.

In: Surgical Oncology, Vol. 18, No. 4, 01.12.2009, p. 322-333.

Research output: Contribution to journalReview article

Yakoub, Danny ; Athanasiou, Thanos ; Tekkis, Paris ; Hanna, George B. / Laparoscopic assisted distal gastrectomy for early gastric cancer : Is it an alternative to the open approach?. In: Surgical Oncology. 2009 ; Vol. 18, No. 4. pp. 322-333.
@article{7229d340b8cc4b868e9a69d7db6f4961,
title = "Laparoscopic assisted distal gastrectomy for early gastric cancer: Is it an alternative to the open approach?",
abstract = "Objective: This study aims to compare short term outcomes and oncological value of laparoscopy assisted (LADG) and open distal gastrectomy (ODG) in the treatment of early gastric cancer. Methods: Meta-analysis of 12 studies, including three randomized controlled trials, published between 2000 and 2007, comparing laparoscopy assisted and open distal gastrectomy in 951 patients with early gastric cancer, was done. Outcomes of interest were operative data, lymph node clearance, postoperative recovery complications. Results: Overall morbidity rate was significantly less with LADG (10.5{\%} versus 20.1{\%}, P = 0.003, OR 0.52, CI 0.34-0.8). A mean of 4.61 less number of lymph nodes dissected than ODG (CI -5.96, -3.26 P < 0.001) when all studies are included. There was no difference between the two groups in number of lymph nodes dissected when less than D2 lymphadenectomy was done (2.44 nodes less in LADG group, CI -5.52, 0.63; P = 0.12). LADG patients had less operative blood loss (mean of 151 ml, P < 0.001), less time to walking, oral intake and flatus. LADG patients had less length of hospital stay (5.7 days, P < 0.001), postoperative fever and pain. ODG group showed significantly less operative time. There was no significant difference between the two groups in the incidence of anastomotic complications and wound infection. Conclusion: LADG is a safe technical alternative to ODG for early gastric cancer with a lower overall complication rate and enhanced postoperative recovery. Endorsing LADG as a better alternative to ODG requires data on long term survival, quality of life and cost effectiveness.",
author = "Danny Yakoub and Thanos Athanasiou and Paris Tekkis and Hanna, {George B.}",
year = "2009",
month = "12",
day = "1",
doi = "10.1016/j.suronc.2008.08.006",
language = "English (US)",
volume = "18",
pages = "322--333",
journal = "Surgical Oncology",
issn = "0960-7404",
publisher = "Elsevier BV",
number = "4",

}

TY - JOUR

T1 - Laparoscopic assisted distal gastrectomy for early gastric cancer

T2 - Is it an alternative to the open approach?

AU - Yakoub, Danny

AU - Athanasiou, Thanos

AU - Tekkis, Paris

AU - Hanna, George B.

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Objective: This study aims to compare short term outcomes and oncological value of laparoscopy assisted (LADG) and open distal gastrectomy (ODG) in the treatment of early gastric cancer. Methods: Meta-analysis of 12 studies, including three randomized controlled trials, published between 2000 and 2007, comparing laparoscopy assisted and open distal gastrectomy in 951 patients with early gastric cancer, was done. Outcomes of interest were operative data, lymph node clearance, postoperative recovery complications. Results: Overall morbidity rate was significantly less with LADG (10.5% versus 20.1%, P = 0.003, OR 0.52, CI 0.34-0.8). A mean of 4.61 less number of lymph nodes dissected than ODG (CI -5.96, -3.26 P < 0.001) when all studies are included. There was no difference between the two groups in number of lymph nodes dissected when less than D2 lymphadenectomy was done (2.44 nodes less in LADG group, CI -5.52, 0.63; P = 0.12). LADG patients had less operative blood loss (mean of 151 ml, P < 0.001), less time to walking, oral intake and flatus. LADG patients had less length of hospital stay (5.7 days, P < 0.001), postoperative fever and pain. ODG group showed significantly less operative time. There was no significant difference between the two groups in the incidence of anastomotic complications and wound infection. Conclusion: LADG is a safe technical alternative to ODG for early gastric cancer with a lower overall complication rate and enhanced postoperative recovery. Endorsing LADG as a better alternative to ODG requires data on long term survival, quality of life and cost effectiveness.

AB - Objective: This study aims to compare short term outcomes and oncological value of laparoscopy assisted (LADG) and open distal gastrectomy (ODG) in the treatment of early gastric cancer. Methods: Meta-analysis of 12 studies, including three randomized controlled trials, published between 2000 and 2007, comparing laparoscopy assisted and open distal gastrectomy in 951 patients with early gastric cancer, was done. Outcomes of interest were operative data, lymph node clearance, postoperative recovery complications. Results: Overall morbidity rate was significantly less with LADG (10.5% versus 20.1%, P = 0.003, OR 0.52, CI 0.34-0.8). A mean of 4.61 less number of lymph nodes dissected than ODG (CI -5.96, -3.26 P < 0.001) when all studies are included. There was no difference between the two groups in number of lymph nodes dissected when less than D2 lymphadenectomy was done (2.44 nodes less in LADG group, CI -5.52, 0.63; P = 0.12). LADG patients had less operative blood loss (mean of 151 ml, P < 0.001), less time to walking, oral intake and flatus. LADG patients had less length of hospital stay (5.7 days, P < 0.001), postoperative fever and pain. ODG group showed significantly less operative time. There was no significant difference between the two groups in the incidence of anastomotic complications and wound infection. Conclusion: LADG is a safe technical alternative to ODG for early gastric cancer with a lower overall complication rate and enhanced postoperative recovery. Endorsing LADG as a better alternative to ODG requires data on long term survival, quality of life and cost effectiveness.

UR - http://www.scopus.com/inward/record.url?scp=70350567933&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70350567933&partnerID=8YFLogxK

U2 - 10.1016/j.suronc.2008.08.006

DO - 10.1016/j.suronc.2008.08.006

M3 - Review article

VL - 18

SP - 322

EP - 333

JO - Surgical Oncology

JF - Surgical Oncology

SN - 0960-7404

IS - 4

ER -