Short-term Outcome of Laparoscopic vs Open Gastrectomy for Gastric Cancer: A Randomized Controlled Trial
Mostafa M Sayed, Mohamed G Taher, Salah I Mohamed, Mostafa A Hamad
Gastrectomy, Gastric cancer, Laparoscopic surgery
Citation Information :
Sayed MM, Taher MG, Mohamed SI, Hamad MA. Short-term Outcome of Laparoscopic vs Open Gastrectomy for Gastric Cancer: A Randomized Controlled Trial. World J Lap Surg 2021; 14 (2):106-110.
Background: Gastric cancer (GC) is a crucial cause of morbidity and mortality worldwide. In Egypt, GC ranked as the 12th most common cancer. During the last two decades, laparoscopic gastrectomy (LG) has proved to be popular and effective. This study aims to compare the short-term outcomes of LG vs open gastrectomy (OG) in resectable GC patients.
Patients and methods: This is a randomized controlled trial, where patients presented to Assiut university hospital with resectable GC, in the period from January 2017 to December 2019, were randomly allocated to OG (group A) or LG (group B).
Results: During the study period, 46 patients were randomized: 23 patients for OG and 23 for LG. Advanced cases after exploration were excluded from both the groups ended up with a total of 36 patients (20 for OG and 16 for LG). The mean follow-up time was 5 months ranging from 40 days to 10 months. There were no statistically significant differences between the two groups in the baseline clinicopathological data. The mean operative time was longer in LG (260.6 ± 46.7 vs 191.0 ± 24.7 minutes in OG) with a p-value <0.001. The postoperative hospital stay was more in OG compared to LG (8.0 ± 4.1 vs 6.9 ± 2.6 days, p-value = 0.361). Postoperative complications were more among OG (4/20) compared to (2/16) in LG (p-value = 0.549). Just one mortality was reported in the OG.
Conclusion: For GC cases, LG shows comparable outcomes to OG in short-term results, and it is a promising minimally invasive surgery in such cases.
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394–424. DOI: 10.3322/caac.21492.
Ibrahim AS, Khaled HM, Mikhail NN, et al. Cancer incidence in Egypt: results of the national population-based cancer registry program. J Cancer Epidemiol 2014;2014(January):1–18. DOI: 10.1155/2014/437971.
Kodera Y, Sano T. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017;20(1):1–19. DOI: 10.1007/s10120-016-0622-4.
Lee HJ, Yang HK. Laparoscopic gastrectomy for gastric cancer. Dig Surg 2013;30(2):132–141. DOI: 10.1159/000350884.
Son T, Hyung WJ. Laparoscopic gastric cancer surgery: current evidence and future perspectives. World J Gastroenterol 2016;22(2):727. DOI: 10.3748/wjg.v22.i2.727.
Gurusamy KS. Laparoscopic versus open gastrectomy for gastric cancer. In: Gurusamy KS, editor. Cochrane Database Syst Rev 2014;2014(11). DOI: 10.1002/14651858.CD011389.
Orditura M, Galizia G, Sforza V, et al. Treatment of gastric cancer. World J Gastroenterol 2014;20(7):1635–1649. DOI: 10.3748/wjg.v20.i7.1635.
Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 2005;11(47):7508–7511. DOI: 10.3748/wjg.v11.i47.7508.
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(1):26–33. DOI: 10.5230/jgc.2013.13.1.26.
Marchesi F, De Sario G, Cecchini S, et al. Laparoscopic subtotal gastrectomy for the treatment of advanced gastric cancer: a comparison with open procedure at the beginning of the learning curve. Acta Biomed 2017;88(3):302–309. DOI: 10.23750/ABM.V88I3.6541.
Gong Y, Wang B, Wang H. A propensity score-matching analysis comparing the oncological outcomes of laparoscopic and open gastrectomy in patients with gastric carcinoma. J BUON 2017;22(1):134–140. PMID: 28365946
Beyer K, Baukloh AK, Kamphues C, et al. Laparoscopic versus open gastrectomy for locally advanced gastric cancer: a systematic review and meta-analysis of randomized controlled studies. World J Surg Oncol 2019;17(1):68. DOI: 10.1186/s12957-019-1600-1.
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(7):627–633. DOI: 10.1200/JCO.2013.48.8551.
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(12):1350–1357. DOI: 10.1200/JCO.2015.63.7215.
Mitrousias AS, Makris MC, Zani Z, et al. Laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer: a systematic review. J BUON 2019;24(3):872–882. PMID: 31424636
Lan X, Xi H, Zhang K, et al. Comparison of complications following open, laparoscopic and robotic gastrectomy. Zhonghua Wei Chang Wai Ke Za Zhi 2017;20(2):184–189. DOI: 10.3760/CMA.J.ISSN.1671-0274.2017.02.014
Hummel R, Bausch D. Anastomotic leakage after upper gastrointestinal surgery: surgical treatment. Visc Med 2017;33(3):207–211. DOI: 10.1159/000470884.
Tanizawa Y, Bando E, Kawamura T, et al. Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer. Gastric Cancer 2010;13(1):50–57. DOI: 10.1007/s10120-009-0535-6.
Lee CM, Park JH, Choi CI, et al. A multi-center prospective randomized controlled trial (phase III) comparing the quality of life between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy for gastric Cancer (study protocol). BMC Cancer 2019;19(1):206. DOI: 10.1186/s12885-019-5396-8.