Laparoscopic gastrectomy for cancer
- Joyce Wong, MD
Joyce Wong, MD
- Assistant Professor of Surgery
- Penn State Milton S. Hershey Medical Center
Gastrectomy for adenocarcinoma via an open abdominal approach (OG) has been performed since the 1920s. Laparoscopic gastrectomy (LG) was first described in Japan in 1994, where a distal gastrectomy with Billroth I gastroduodenostomy reconstruction was performed for an early-stage gastric cancer . Since then, surgical experience with LG has been increasing, particularly in Eastern countries such as Japan, Korea, and China, where gastric adenocarcinoma is more prevalent.
The indications, patient selection, surgical techniques, postoperative care, and outcomes of LG for cancer are discussed in this topic. OG and LG for benign diseases (eg, peptic ulcer) or weight loss are discussed in other topics. (See "Surgical management of peptic ulcer disease" and "Partial gastrectomy and gastrointestinal reconstruction" and "Total gastrectomy and gastrointestinal reconstruction" and "Bariatric procedures for the management of severe obesity: Descriptions" and "Surgical management of invasive gastric cancer".)
EASTERN VERSUS WESTERN EXPERIENCE
Eastern experience — LG is a well-established technique for treating gastric cancer in Eastern countries. According to national surveys, LG accounted for approximately 25 percent of all gastric surgeries performed for cancer in Japan and South Korea as early as 2009 . The efficacy of LG has been demonstrated for both early and locally advanced gastric cancers in Eastern countries.
Early gastric cancer — Early gastric cancer is defined as invasive gastric cancer that invades no more deeply than the submucosa, regardless of lymph node metastasis (T1, any N, M0) (table 1). Early gastric cancer is of particular importance to patients in East Asia, where it accounts for 25 to 50 percent of all gastric cancers diagnosed because of screening programs. (See "Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging".)
An early Japanese study involving 1294 patients undergoing LG (91.5 percent distal gastrectomy) for gastric cancer from 1994 to 2003 showed mortality and morbidity rates of 0 and 14.8 percent and a recurrence rate of 0.6 percent at a median follow-up of three years . The five-year disease-free survival rate was 99.8 percent for stage IA disease, 98.7 percent for stage IB disease, and 85.7 percent for stage II disease.
- Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4:146.
- Son SY, Kim HH. Minimally invasive surgery in gastric cancer. World J Gastroenterol 2014; 20:14132.
- Kitano S, Shiraishi N, Uyama I, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007; 245:68.
- Honda M, Hiki N, Kinoshita T, et al. Long-term Outcomes of Laparoscopic Versus Open Surgery for Clinical Stage I Gastric Cancer: The LOC-1 Study. Ann Surg 2016; 264:214.
- Kim W, Kim HH, Han SU, et al. Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer: Short-term Outcomes From a Multicenter Randomized Controlled Trial (KLASS-01). Ann Surg 2016; 263:28.
- Kim HH, Han SU, Kim MC, et al. Long-term outcomes of laparoscopic distal gastrectomy compared with open distal gastrectomy for clinical stage I gastric adenocarcinoma (KLASS-01): a multi-center prospective randomized controlled trial. J Clin Oncol 2016; 34:(suppl; abstr 4060).
- Katai H, Mizusawa J, Katayama H, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer 2016.
- Li Z, Shan F, Wang Y, et al. Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer after neoadjuvant chemotherapy: safety and short-term oncologic results. Surg Endosc 2016; 30:4265.
- Hu Y, Ying M, Huang C, et al. Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective cohort study from China. Surg Endosc 2014; 28:2048.
- Hu Y, Huang C, Sun Y, et al. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. J Clin Oncol 2016; 34:1350.
- Hur H, Lee HY, Lee HJ, et al. Efficacy of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer: the protocol of the KLASS-02 multicenter randomized controlled clinical trial. BMC Cancer 2015; 15:355.
- Inaki N, Etoh T, Ohyama T, et al. A Multi-institutional, Prospective, Phase II Feasibility Study of Laparoscopy-Assisted Distal Gastrectomy with D2 Lymph Node Dissection for Locally Advanced Gastric Cancer (JLSSG0901). World J Surg 2015; 39:2734.
- Glenn JA, Turaga KK, Gamblin TC, et al. Minimally invasive gastrectomy for cancer: current utilization in US academic medical centers. Surg Endosc 2015; 29:3768.
- Greenleaf EK, Sun SX, Hollenbeak CS, Wong J. Minimally invasive surgery for gastric cancer: the American experience. Gastric Cancer 2017; 20:368.
- Kelly KJ, Selby L, Chou JF, et al. Laparoscopic Versus Open Gastrectomy for Gastric Adenocarcinoma in the West: A Case-Control Study. Ann Surg Oncol 2015; 22:3590.
- Haverkamp L, Brenkman HJ, Seesing MF, et al. Laparoscopic versus open gastrectomy for gastric cancer, a multicenter prospectively randomized controlled trial (LOGICA-trial). BMC Cancer 2015; 15:556.
- Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg 2010; 251:640.
- Strong VE, Song KY, Park CH, et al. Comparison of disease-specific survival in the United States and Korea after resection for early-stage node-negative gastric carcinoma. J Surg Oncol 2013; 107:634.
- Kim HG, Park JH, Jeong SH, et al. Totally laparoscopic distal gastrectomy after learning curve completion: comparison with laparoscopy-assisted distal gastrectomy. J Gastric Cancer 2013; 13:26.
- Moon JS, Park MS, Kim JH, et al. Lessons learned from a comparative analysis of surgical outcomes of and learning curves for laparoscopy-assisted distal gastrectomy. J Gastric Cancer 2015; 15:29.
- Kim HH, Han SU, Kim MC, et al. Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 2014; 32:627.
- Jung DH, Son SY, Park YS, et al. The learning curve associated with laparoscopic total gastrectomy. Gastric Cancer 2016; 19:264.
- Jeong O, Ryu SY, Choi WY, et al. Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma. Ann Surg Oncol 2014; 21:2994.
- Wang Z, Zhang X, Liang J, et al. Short-term outcomes for laparoscopy-assisted distal gastrectomy for body mass index ≥30 patients with gastric cancer. J Surg Res 2015; 195:83.
- Sugimoto M, Kinoshita T, Shibasaki H, et al. Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer. Surg Endosc 2013; 27:4291.
- Son SY, Jung DH, Lee CM, et al. Laparoscopic gastrectomy versus open gastrectomy for gastric cancer in patients with body mass index of 30 kg/m2 or more. Surg Endosc 2015; 29:2126.
- Nunobe S, Hiki N, Fukunaga T, et al. Previous laparotomy is not a contraindication to laparoscopy-assisted gastrectomy for early gastric cancer. World J Surg 2008; 32:1466.
- Woo Y, Hyung WJ, Kim HI, et al. Minimizing hepatic trauma with a novel liver retraction method: a simple liver suspension using gauze suture. Surg Endosc 2011; 25:3939.
- Saeki H, Oki E, Kawano H, et al. Newly developed liver-retraction method for laparoscopic gastric surgery using a silicone disc: the φ-shaped technique. J Am Coll Surg 2013; 216:e43.
- Abdikarim I, Cao XY, Li SZ, et al. Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas. World J Gastroenterol 2015; 21:13339.
- Wong-Chong N, Kehlet H, Grantcharov TP. Outcomes From an Enhanced Recovery Program for Laparoscopic Gastric Surgery. Surg Laparosc Endosc Percutan Tech 2016; 26:e50.
- Li HZ, Chen JX, Zheng Y, Zhu XN. Laparoscopic-assisted versus open radical gastrectomy for resectable gastric cancer: Systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. J Surg Oncol 2016; 113:756.
- Kim YW, Baik YH, Yun YH, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 2008; 248:721.
- Kim YW, Yoon HM, Yun YH, et al. Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc 2013; 27:4267.
- Coratti A, Fernandes E, Lombardi A, et al. Robot-assisted surgery for gastric carcinoma: Five years follow-up and beyond: A single western center experience and long-term oncological outcomes. Eur J Surg Oncol 2015; 41:1106.
- Nakauchi M, Suda K, Susumu S, et al. Comparison of the long-term outcomes of robotic radical gastrectomy for gastric cancer and conventional laparoscopic approach: a single institutional retrospective cohort study. Surg Endosc 2016; 30:5444.
- Kim HI, Han SU, Yang HK, et al. Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma. Ann Surg 2016; 263:103.
- Park JM, Kim HI, Han SU, et al. Who may benefit from robotic gastrectomy?: A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy. Eur J Surg Oncol 2016; 42:1944.
- Cianchi F, Indennitate G, Trallori G, et al. Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study. BMC Surg 2016; 16:65.
- Hu LD, Li XF, Wang XY, Guo TK. Robotic versus Laparoscopic Gastrectomy for Gastric Carcinoma: a Meta-Analysis of Efficacy and Safety. Asian Pac J Cancer Prev 2016; 17:4327.
- Uedo N, Iishi H, Tatsuta M, et al. Longterm outcomes after endoscopic mucosal resection for early gastric cancer. Gastric Cancer 2006; 9:88.
- Ahn JY, Jung HY, Choi KD, et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 2011; 74:485.
- Shoda K, Ichikawa D, Arita T, et al. Risk Stratification According to the Total Number of Factors That Meet the Indication Criteria for Radical Lymph Node Dissection in Patients with Early Gastric Cancer at Risk for Lymph Node Metastasis. Ann Surg Oncol 2016; 23:792.
- EASTERN VERSUS WESTERN EXPERIENCE
- Eastern experience
- - Early gastric cancer
- - Locally advanced gastric cancer
- Western experience
- East versus West
- PATIENT SELECTION
- Provider factors
- - Surgeon experience
- - Hospital resources
- Patient factors
- - Comorbidities
- - Obesity
- - Previous abdominal surgery
- - Disease extent
- SURGICAL TECHNIQUES
- Laparoscopic total gastrectomy
- Laparoscopic distal gastrectomy
- POSTOPERATIVE CARE
- MINIMALLY INVASIVE ALTERNATIVES
- Robotic surgery
- Endoscopic resection
- SUMMARY AND RECOMMENDATIONS