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Novel technique safe for total laparoscopic radical BII gastrectomy with lymphadenectomy for early gastric cancer, data suggest

Friday, September 19 2008 | Comments

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What's This? An upper to lower, right to left, clockwise quadrant to quadrant technique appears to allow safe and effective completely laparoscopic Billroth II (BII) subtotal gastrectomy with lymphadenectomy in cases of early gastric cancer, according to the results of a small, prospective study.

Thirty-four consecutive patients (mean age, 56.5 years) were operated on between July 1998 and January 2005 using this technique. For comparison purposes, the investigators used their department's gastric cancer database to identify 34 controls matched for age, sex, and pathologic stage who had gastrectomy using a conventional, open technique. Inclusion criteria were gastric cancer of the distal stomach <5 cm in size without distant metastases or prominent serosal invasion. Fifty-nine percent of the patients were male.

Primary study endpoints were operative time, blood loss, length of stay (LOS), morbidity and mortality, adequacy of lymphadenectomy, and long-term outcome. Patients were followed for at least 2 years.

One patient (2.9%) in the laparoscopic group required conversion to laparotomy owing to inadequate resection margins. Mean operative time was significantly longer for the laparoscopic group as compared with the control group (283 vs 195 minutes; P<.001). However, as compared with the control group, the laparoscopic cohort had significantly less blood loss (74 mL vs 190 mL; P <.001); earlier flatus passage (2.9 vs 4.9 days; P <.01); less need for analgesics for postoperative pain control (3.5 vs 5.8 doses; P<.05); and a shorter LOS (8.5 vs 12.1 days; P<.01).

There were 2 major complications in both groups (5.9%), including anastomotic leaking, intraabdominal abscess, and respiratory failure due to pneumonia. There were 5 minor complications in the laparoscopic group (14.7%) compared with 4 (11.8%) in the control group; these included gastrointestinal bleeding, gastric stasis, wound infection, and duodenal stump leakage.

Three patients in each group (7.5%) experienced late mortality. In the laparoscopic cohort, 1 patient (2.9%) had cerebrovascular hemorrhage and 2 patients (5.9%) had a recurrence of their cancer. In the control group, cancer recurred in 1 patient (2.9%).

"[D]espite a small number of patients, the study reveals that [total laparoscopic BII gastrectomy] with D2 lymphadenectomy is feasible and safe, and that it provides an oncologic resection similar to that of open resection," the researchers concluded. It avoids major incisions, requires less medication for pain control, decreases intraoperative blood loss, and affords more rapid recovery and earlier discharge to home, they stressed. (Lee W-J, et al. Surg Laparosc Endosc Percutan Tech 2008;18:369-374.)

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