BACKGROUND: Surgery in gastric cancer (GC) aims to achieve resection of the primary tumor and its lymphatic drain, with a minimal adverse effect on morbidity and mortality, and the best possible quality of life. METHODS: From June 1993 to May 2008, 113 patients with a preoperative diagnosis of the GC were considered for laparoscopic gastrectomy at our institution. There was a predominance of males and mean age was 60 years. After peritoneal cavity inspection, laparoscopic ultrasound was used to determine the presence of deep liver metastasis. Total gastrectomy and Roux-en-Y reconstruction were performed in upper and middle-third tumors, and subtotal gastrectomy, either with Billroth II or Roux-en-Y reconstruction, in tumors affecting the lower third of the stomach. D2 lymphadenectomy was performed in both cases. RESULTS: There were 21 cases (18.5%) with distant metastases and/or an unresectable tumor due to the invasion of adjacent organs. In these patients the procedure was limited to laparoscopic biopsy in 16 cases and laparoscopic gastrojejunostomy in 5 cases. Laparoscopic gastrectomy was performed in 92 patients with a mean surgical time of 162 minutes and a mortality rate of 5.4%. Conversion was necessary in 7 cases (7.6%). CONCLUSIONS: The benefits and safety of laparoscopic gastrectomy are evident, with similar outcomes to conventional surgery and all the advantages of minimally invasive access. The learning curve is long. Laparoscopic gastrectomy is a safe and effective option for the treatment of GC, avoiding nontherapeutic laparotomy in patients with advanced disease. Comparative prospective studies evaluating the long-term survival of these patients are still necessary.
BACKGROUND: Surgery in gastric cancer (GC) aims to achieve resection of the primary tumor and its lymphatic drain, with a minimal adverse effect on morbidity and mortality, and the best possible quality of life. METHODS: From June 1993 to May 2008, 113 patients with a preoperative diagnosis of the GC were considered for laparoscopic gastrectomy at our institution. There was a predominance of males and mean age was 60 years. After peritoneal cavity inspection, laparoscopic ultrasound was used to determine the presence of deep liver metastasis. Total gastrectomy and Roux-en-Y reconstruction were performed in upper and middle-third tumors, and subtotal gastrectomy, either with Billroth II or Roux-en-Y reconstruction, in tumors affecting the lower third of the stomach. D2 lymphadenectomy was performed in both cases. RESULTS: There were 21 cases (18.5%) with distant metastases and/or an unresectable tumor due to the invasion of adjacent organs. In these patients the procedure was limited to laparoscopic biopsy in 16 cases and laparoscopic gastrojejunostomy in 5 cases. Laparoscopic gastrectomy was performed in 92 patients with a mean surgical time of 162 minutes and a mortality rate of 5.4%. Conversion was necessary in 7 cases (7.6%). CONCLUSIONS: The benefits and safety of laparoscopic gastrectomy are evident, with similar outcomes to conventional surgery and all the advantages of minimally invasive access. The learning curve is long. Laparoscopic gastrectomy is a safe and effective option for the treatment of GC, avoiding nontherapeutic laparotomy in patients with advanced disease. Comparative prospective studies evaluating the long-term survival of these patients are still necessary.
Authors: Paulo Kassab; Wilson Luiz da Costa; Carlos Eduardo Jacob; Roberto de Moraes Cordts; Osvaldo Antônio Prado Castro; Leandro Cardoso Barchi; Ivan Cecconello; Amir Zeide Charruf; Felipe José Fernández Coimbra; Antônio Moris Cury; Alessandro Landskron Diniz; Igor Correia de Farias; Wilson Rodrigues de Freitas; André Luis de Godoy; Elias Jirjoss Ilias; Carlos Alberto Malheiros; Marcus Fernando Kodama Pertille Ramos; Heber Salvador de Castro Ribeiro; André Roncon Dias; Fábio Rodrigues Thuler; Osmar Kenji Yagi; Laércio Gomes Lourenço; Bruno Zilberstein Journal: Transl Gastroenterol Hepatol Date: 2017-05-12
Authors: Mashaal Dhir; Lynette M Smith; Fred Ullrich; Premila D Leiphrakpam; Quan P Ly; Aaron R Sasson; Chandrakanth Are Journal: J Gastrointest Surg Date: 2012-09-05 Impact factor: 3.452