Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival
Background The purpose of this study is to assess outcomes and 5-year survival after subtotal gastrectomy (SG) for early and advanced distal adenocarcinoma with D2 dissection performed by minimally invasive surgery (MIS). Methods From June 2000 to October 2009 a total of 70 patients with adenocarcin...
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| Veröffentlicht in: | Surgical endoscopy 2010-10, Vol.24 (10), p.2594-2602 |
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| description | Background
The purpose of this study is to assess outcomes and 5-year survival after subtotal gastrectomy (SG) for early and advanced distal adenocarcinoma with D2 dissection performed by minimally invasive surgery (MIS).
Methods
From June 2000 to October 2009 a total of 70 patients with adenocarcinoma of the lower third of the stomach underwent SG with D2 nodal clearance by MIS. This series enrolled 37 patients with early gastric cancer (EGC) and 33 with advanced gastric cancer (AGC). SG was attempted by conventional laparoscopy (CL) in 52 cases and by robot-assisted (RA) technique in 18. Clinical and histopathologic results with 5-year survival were analyzed.
Results
No intraoperative complication was registered. Conversion to laparotomy was required in five patients. Overall, the mean operating time for SG was 254 min (range = 145–460) and estimated mean blood loss was 146 ml (range = 45–250). Postoperative complications occurred in seven patients, including two duodenal leakages none of which required laparotomy. There were two postoperative deaths, one caused by hepatic failure and one by hemorrhagic stroke. Preoperative understaging occurred in ten cases (three were AGC). On average, 30 ± 8 lymph nodes were collected. The distance of proximal resection margin was 6.6 cm (range = 4–8.5 cm). Short-term results were equal with those of laparoscopic and RA gastrectomy. The mean hospital stay of all patients was 10 days (range = 7–24). The mean follow-up span was 53 months (range = 3–112). Relapse of disease occurred in 12 patients, 10 of whom died from the disease and their mean survival was 25 months (range = 12–38). The overall 3-year survival was 85% for CL gastrectomy and 78% for RA gastrectomy, but this difference was not significant with the log rank test (
p
> 0.05). The overall 5-year survival was 81% (97% for EGC and 67% for AGC).
Conclusion
D2 subtotal gastrectomy performed by MIS is reproducible and safe. The long-term outcomes and 5-year survival are acceptable. Extended lymphadenectomy was carried out for both EGC and AGC so as to ensure adequate nodal clearance and compensate preoperative underestimation. |
| doi_str_mv | 10.1007/s00464-010-1014-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_755404860</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>755404860</sourcerecordid><originalsourceid>FETCH-LOGICAL-c400t-451fe5b1ea374a7bb9857c7c478ae47bd92faddc21bfe79695bee668369535bc3</originalsourceid><addsrcrecordid>eNp1kU2L1TAUhoMoznX0B7iRIIirak6aNK27YfyEARfqupyk6dwMbTIm6ZX-Bv-0qffqgOAqX895ziEvIU-BvQLG1OvEmGhExYBVwEBUcI_sQNS84hza-2THuppVXHXijDxK6YYVvAP5kJxxJkA0Ld-Rn18WnUPGiV5jytGaHOaV_nB5T99yOriUypULnuqVzs67Gadppc4fMLmDpWmJ1zaudAxxgzcPDtYHg9E4H2akYaR5X8DiRbN_Q6NNy5QTRT9QWa0W4yY5uANOj8mDEadkn5zWc_Lt_buvlx-rq88fPl1eXFVGMJYrIWG0UoPFWglUWnetVEYZoVq0Qumh4yMOg-GgR6u6ppPa2qZp67KrpTb1OXl59N7G8H2xKfezS8ZOE3obltQrKQUTbcMK-fwf8iYs0ZfhNqhrZMdlgeAImRhSinbsb2P5p7j2wPotp_6YU89-n0H0UGqencSLnu3wt-JPMAV4cQIwGZzGiN64dMfVAqCBTcSPXCpPvmRxN-H_u_8Ce2OsyQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>755965925</pqid></control><display><type>article</type><title>Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Pugliese, Raffaele ; Maggioni, Dario ; Sansonna, Fabio ; Costanzi, Andrea ; Ferrari, Giovanni Carlo ; Di Lernia, Stefano ; Magistro, Carmelo ; De Martini, Paolo ; Pugliese, Francesco</creator><creatorcontrib>Pugliese, Raffaele ; Maggioni, Dario ; Sansonna, Fabio ; Costanzi, Andrea ; Ferrari, Giovanni Carlo ; Di Lernia, Stefano ; Magistro, Carmelo ; De Martini, Paolo ; Pugliese, Francesco</creatorcontrib><description>Background
The purpose of this study is to assess outcomes and 5-year survival after subtotal gastrectomy (SG) for early and advanced distal adenocarcinoma with D2 dissection performed by minimally invasive surgery (MIS).
Methods
From June 2000 to October 2009 a total of 70 patients with adenocarcinoma of the lower third of the stomach underwent SG with D2 nodal clearance by MIS. This series enrolled 37 patients with early gastric cancer (EGC) and 33 with advanced gastric cancer (AGC). SG was attempted by conventional laparoscopy (CL) in 52 cases and by robot-assisted (RA) technique in 18. Clinical and histopathologic results with 5-year survival were analyzed.
Results
No intraoperative complication was registered. Conversion to laparotomy was required in five patients. Overall, the mean operating time for SG was 254 min (range = 145–460) and estimated mean blood loss was 146 ml (range = 45–250). Postoperative complications occurred in seven patients, including two duodenal leakages none of which required laparotomy. There were two postoperative deaths, one caused by hepatic failure and one by hemorrhagic stroke. Preoperative understaging occurred in ten cases (three were AGC). On average, 30 ± 8 lymph nodes were collected. The distance of proximal resection margin was 6.6 cm (range = 4–8.5 cm). Short-term results were equal with those of laparoscopic and RA gastrectomy. The mean hospital stay of all patients was 10 days (range = 7–24). The mean follow-up span was 53 months (range = 3–112). Relapse of disease occurred in 12 patients, 10 of whom died from the disease and their mean survival was 25 months (range = 12–38). The overall 3-year survival was 85% for CL gastrectomy and 78% for RA gastrectomy, but this difference was not significant with the log rank test (
p
> 0.05). The overall 5-year survival was 81% (97% for EGC and 67% for AGC).
Conclusion
D2 subtotal gastrectomy performed by MIS is reproducible and safe. The long-term outcomes and 5-year survival are acceptable. Extended lymphadenectomy was carried out for both EGC and AGC so as to ensure adequate nodal clearance and compensate preoperative underestimation.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-010-1014-1</identifier><identifier>PMID: 20414682</identifier><identifier>CODEN: SUREEX</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdomen ; Abdominal Surgery ; Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Adult ; Aged ; Aged, 80 and over ; Anesthesiology ; Biological and medical sciences ; Biopsy ; Digestive system. Abdomen ; Dissection ; Endoscopy ; Female ; Gastrectomy - methods ; Gastric cancer ; Gastroenterology ; Gastroenterology. Liver. Pancreas. Abdomen ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Hospitals ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Laparoscopy ; Laparotomy ; Lymph Node Excision ; Lymphatic system ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Metastasis ; Middle Aged ; Proctology ; Robotics ; Robots ; Stomach Neoplasms - mortality ; Stomach Neoplasms - pathology ; Stomach Neoplasms - surgery ; Stomach, duodenum, intestine, rectum, anus ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Survival Rate ; Tumors ; Ultrasonic imaging</subject><ispartof>Surgical endoscopy, 2010-10, Vol.24 (10), p.2594-2602</ispartof><rights>Springer Science+Business Media, LLC 2010</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-451fe5b1ea374a7bb9857c7c478ae47bd92faddc21bfe79695bee668369535bc3</citedby><cites>FETCH-LOGICAL-c400t-451fe5b1ea374a7bb9857c7c478ae47bd92faddc21bfe79695bee668369535bc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-010-1014-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-010-1014-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23411611$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20414682$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pugliese, Raffaele</creatorcontrib><creatorcontrib>Maggioni, Dario</creatorcontrib><creatorcontrib>Sansonna, Fabio</creatorcontrib><creatorcontrib>Costanzi, Andrea</creatorcontrib><creatorcontrib>Ferrari, Giovanni Carlo</creatorcontrib><creatorcontrib>Di Lernia, Stefano</creatorcontrib><creatorcontrib>Magistro, Carmelo</creatorcontrib><creatorcontrib>De Martini, Paolo</creatorcontrib><creatorcontrib>Pugliese, Francesco</creatorcontrib><title>Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
The purpose of this study is to assess outcomes and 5-year survival after subtotal gastrectomy (SG) for early and advanced distal adenocarcinoma with D2 dissection performed by minimally invasive surgery (MIS).
Methods
From June 2000 to October 2009 a total of 70 patients with adenocarcinoma of the lower third of the stomach underwent SG with D2 nodal clearance by MIS. This series enrolled 37 patients with early gastric cancer (EGC) and 33 with advanced gastric cancer (AGC). SG was attempted by conventional laparoscopy (CL) in 52 cases and by robot-assisted (RA) technique in 18. Clinical and histopathologic results with 5-year survival were analyzed.
Results
No intraoperative complication was registered. Conversion to laparotomy was required in five patients. Overall, the mean operating time for SG was 254 min (range = 145–460) and estimated mean blood loss was 146 ml (range = 45–250). Postoperative complications occurred in seven patients, including two duodenal leakages none of which required laparotomy. There were two postoperative deaths, one caused by hepatic failure and one by hemorrhagic stroke. Preoperative understaging occurred in ten cases (three were AGC). On average, 30 ± 8 lymph nodes were collected. The distance of proximal resection margin was 6.6 cm (range = 4–8.5 cm). Short-term results were equal with those of laparoscopic and RA gastrectomy. The mean hospital stay of all patients was 10 days (range = 7–24). The mean follow-up span was 53 months (range = 3–112). Relapse of disease occurred in 12 patients, 10 of whom died from the disease and their mean survival was 25 months (range = 12–38). The overall 3-year survival was 85% for CL gastrectomy and 78% for RA gastrectomy, but this difference was not significant with the log rank test (
p
> 0.05). The overall 5-year survival was 81% (97% for EGC and 67% for AGC).
Conclusion
D2 subtotal gastrectomy performed by MIS is reproducible and safe. The long-term outcomes and 5-year survival are acceptable. Extended lymphadenectomy was carried out for both EGC and AGC so as to ensure adequate nodal clearance and compensate preoperative underestimation.</description><subject>Abdomen</subject><subject>Abdominal Surgery</subject><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesiology</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Digestive system. Abdomen</subject><subject>Dissection</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gastrectomy - methods</subject><subject>Gastric cancer</subject><subject>Gastroenterology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Laparoscopy</subject><subject>Laparotomy</subject><subject>Lymph Node Excision</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Proctology</subject><subject>Robotics</subject><subject>Robots</subject><subject>Stomach Neoplasms - mortality</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - surgery</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Survival Rate</subject><subject>Tumors</subject><subject>Ultrasonic imaging</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU2L1TAUhoMoznX0B7iRIIirak6aNK27YfyEARfqupyk6dwMbTIm6ZX-Bv-0qffqgOAqX895ziEvIU-BvQLG1OvEmGhExYBVwEBUcI_sQNS84hza-2THuppVXHXijDxK6YYVvAP5kJxxJkA0Ld-Rn18WnUPGiV5jytGaHOaV_nB5T99yOriUypULnuqVzs67Gadppc4fMLmDpWmJ1zaudAxxgzcPDtYHg9E4H2akYaR5X8DiRbN_Q6NNy5QTRT9QWa0W4yY5uANOj8mDEadkn5zWc_Lt_buvlx-rq88fPl1eXFVGMJYrIWG0UoPFWglUWnetVEYZoVq0Qumh4yMOg-GgR6u6ppPa2qZp67KrpTb1OXl59N7G8H2xKfezS8ZOE3obltQrKQUTbcMK-fwf8iYs0ZfhNqhrZMdlgeAImRhSinbsb2P5p7j2wPotp_6YU89-n0H0UGqencSLnu3wt-JPMAV4cQIwGZzGiN64dMfVAqCBTcSPXCpPvmRxN-H_u_8Ce2OsyQ</recordid><startdate>20101001</startdate><enddate>20101001</enddate><creator>Pugliese, Raffaele</creator><creator>Maggioni, Dario</creator><creator>Sansonna, Fabio</creator><creator>Costanzi, Andrea</creator><creator>Ferrari, Giovanni Carlo</creator><creator>Di Lernia, Stefano</creator><creator>Magistro, Carmelo</creator><creator>De Martini, Paolo</creator><creator>Pugliese, Francesco</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20101001</creationdate><title>Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival</title><author>Pugliese, Raffaele ; Maggioni, Dario ; Sansonna, Fabio ; Costanzi, Andrea ; Ferrari, Giovanni Carlo ; Di Lernia, Stefano ; Magistro, Carmelo ; De Martini, Paolo ; Pugliese, Francesco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-451fe5b1ea374a7bb9857c7c478ae47bd92faddc21bfe79695bee668369535bc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Abdomen</topic><topic>Abdominal Surgery</topic><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesiology</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Digestive system. Abdomen</topic><topic>Dissection</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gastrectomy - methods</topic><topic>Gastric cancer</topic><topic>Gastroenterology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Laparoscopy</topic><topic>Laparotomy</topic><topic>Lymph Node Excision</topic><topic>Lymphatic system</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Proctology</topic><topic>Robotics</topic><topic>Robots</topic><topic>Stomach Neoplasms - mortality</topic><topic>Stomach Neoplasms - pathology</topic><topic>Stomach Neoplasms - surgery</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Survival Rate</topic><topic>Tumors</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pugliese, Raffaele</creatorcontrib><creatorcontrib>Maggioni, Dario</creatorcontrib><creatorcontrib>Sansonna, Fabio</creatorcontrib><creatorcontrib>Costanzi, Andrea</creatorcontrib><creatorcontrib>Ferrari, Giovanni Carlo</creatorcontrib><creatorcontrib>Di Lernia, Stefano</creatorcontrib><creatorcontrib>Magistro, Carmelo</creatorcontrib><creatorcontrib>De Martini, Paolo</creatorcontrib><creatorcontrib>Pugliese, Francesco</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pugliese, Raffaele</au><au>Maggioni, Dario</au><au>Sansonna, Fabio</au><au>Costanzi, Andrea</au><au>Ferrari, Giovanni Carlo</au><au>Di Lernia, Stefano</au><au>Magistro, Carmelo</au><au>De Martini, Paolo</au><au>Pugliese, Francesco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2010-10-01</date><risdate>2010</risdate><volume>24</volume><issue>10</issue><spage>2594</spage><epage>2602</epage><pages>2594-2602</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><coden>SUREEX</coden><abstract>Background
The purpose of this study is to assess outcomes and 5-year survival after subtotal gastrectomy (SG) for early and advanced distal adenocarcinoma with D2 dissection performed by minimally invasive surgery (MIS).
Methods
From June 2000 to October 2009 a total of 70 patients with adenocarcinoma of the lower third of the stomach underwent SG with D2 nodal clearance by MIS. This series enrolled 37 patients with early gastric cancer (EGC) and 33 with advanced gastric cancer (AGC). SG was attempted by conventional laparoscopy (CL) in 52 cases and by robot-assisted (RA) technique in 18. Clinical and histopathologic results with 5-year survival were analyzed.
Results
No intraoperative complication was registered. Conversion to laparotomy was required in five patients. Overall, the mean operating time for SG was 254 min (range = 145–460) and estimated mean blood loss was 146 ml (range = 45–250). Postoperative complications occurred in seven patients, including two duodenal leakages none of which required laparotomy. There were two postoperative deaths, one caused by hepatic failure and one by hemorrhagic stroke. Preoperative understaging occurred in ten cases (three were AGC). On average, 30 ± 8 lymph nodes were collected. The distance of proximal resection margin was 6.6 cm (range = 4–8.5 cm). Short-term results were equal with those of laparoscopic and RA gastrectomy. The mean hospital stay of all patients was 10 days (range = 7–24). The mean follow-up span was 53 months (range = 3–112). Relapse of disease occurred in 12 patients, 10 of whom died from the disease and their mean survival was 25 months (range = 12–38). The overall 3-year survival was 85% for CL gastrectomy and 78% for RA gastrectomy, but this difference was not significant with the log rank test (
p
> 0.05). The overall 5-year survival was 81% (97% for EGC and 67% for AGC).
Conclusion
D2 subtotal gastrectomy performed by MIS is reproducible and safe. The long-term outcomes and 5-year survival are acceptable. Extended lymphadenectomy was carried out for both EGC and AGC so as to ensure adequate nodal clearance and compensate preoperative underestimation.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>20414682</pmid><doi>10.1007/s00464-010-1014-1</doi><tpages>9</tpages></addata></record> |
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| subjects | Abdomen Abdominal Surgery Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Adult Aged Aged, 80 and over Anesthesiology Biological and medical sciences Biopsy Digestive system. Abdomen Dissection Endoscopy Female Gastrectomy - methods Gastric cancer Gastroenterology Gastroenterology. Liver. Pancreas. Abdomen Gastrointestinal surgery Gynecology Hepatology Hospitals Humans Investigative techniques, diagnostic techniques (general aspects) Laparoscopy Laparotomy Lymph Node Excision Lymphatic system Male Medical sciences Medicine Medicine & Public Health Metastasis Middle Aged Proctology Robotics Robots Stomach Neoplasms - mortality Stomach Neoplasms - pathology Stomach Neoplasms - surgery Stomach, duodenum, intestine, rectum, anus Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Survival Rate Tumors Ultrasonic imaging |
| title | Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival |
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