Short-term Outcomes in D2 Dissection in Laparoscopic versus Open Gastrectomy for Gastric Cancer
Ali Zedan, Haisam A. Samy, Tark Salah, Marwa T. Hussien
Ahead of print,
Article DOI: 10.21614/sgo-25-5-295
Background: Surgical resection with en-bloc lymphadenectomy is the hallmark of curative therapy for gastric cancer patients. The favoured surgical technique worldwide has been open gastrectomy for a long time. This procedure however, is connected to significant morbidity. Compared to open procedures, multiple meta-analyses have demonstrated a benefit in the short-term results of laparoscopic gastrectomy.

Objective: Comparison of the short-term advantages of radical gastrectomy with dissection D2 (laparoscopic and open in gastric cancer patients).

Methods: This study was a retrospective analysis of 42 patients who underwent either open radical gastrectomy (ORG) (24 patients)or laparoscopic radical gastrectomy (LRG) (18 patients) with D2 lymphadenectomy. The interventions took place at the South Egypt Cancer Institute, Assuit University, Department of Surgical Oncology between September 2017 and September 2020. Through a statistically generated selection of all gastrectomies conducted over the same duration, controls were matched for stage, age and gender, comparison patient demographics, stage of tumor-node-metastasis (TNM), histologic characteristics, tumor position, retrieval of lymph nodes, margins, and intraoperative factors, postoperative morbidity and mortality.

Results: Less intraoperative blood loss (625.94+-166.60 mL vs 1096.38+-326.76 mL, P<0.0001), the median laparoscopic approach operating time was 307 minutes (range 230- 363 minutes) compared to the median 265 minutes (range 219-310 minutes) in the open group (p 0.01).
Radical resection types [total radical gastrectomy, radical proximal gastrectomy, radical distal gastrectomy] (P=0.590). The degree of dissection of the lymph node and the number of lymph nodes retrieved did not vary among the two groups [32.06+-8.612 vs 30.29+-7), (P=0.451)]. After laparoscopic gastrectomy, the hospital stay duration was nine days (range 7-13 days) compared to 12 days (range 9-17 days) in the open group (p = 0.01). Tumor free margins were obtained in all cases.
Postoperative recovery shows that postoperative pain was significantly lower in laparoscopic patients with a median period of 3 days (range 2-5 days) compared to 5 days (range 2-8 days) in the open group, as calculated by the number of days of IV narcotics use (p 0.01). Shorter time to mobilization [2(1-3) vs 3 (1-4) d, P <<0.001], intestinal opening time [3(2-4) d vs 4(3-6) d, P < 0.001)] and normal diet time are shorter [3(2-4) d vs 4(3-5)d, P < 0.001)]. No substantial variations were observed among the two groups in overall morbidity (29.1% in LAG vs 27.7% in OG, P = 0.480). For each group, mortality and readmission rates were similar among the two groups, one case p= 1.0.

Conclusion: Compared with the ORG procedure, LARG provided patients with many improved short-term advantages, such as less intraoperative blood loss, shorter hospitalization period, shorter mobilization time, and shorter intestinal opening time.
Additionally, shorter time to resume oral intake, and decreased narcotics. LARG is safer, more efficient and less invasive in treating gastric cancer, with better short-term effectiveness relative to ORG, with equivalent margin status and adequate lymph node retrieval.

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