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Three-Port Laparoscopic Exploration is not Sufficient for Patients with T4 Gastric Cancer

  • Huang, Hua (Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center) ;
  • Jin, Jie-Jie (Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center) ;
  • Long, Zi-Wen (Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center) ;
  • Wang, Wei (Department of General Surgery, Affiliated Hospital of Nantong University) ;
  • Cai, Hong (Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center) ;
  • Liu, Xiao-Wen (Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center) ;
  • Yu, Hong-Mei (Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center) ;
  • Zhang, Li-Wen (Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center) ;
  • Wang, Ya-Nong (Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center)
  • Published : 2014.10.23

Abstract

Gastric cancer continues to be a leading cause of cancer death. The majority of patients with gastric adenocarcinoma in China present with advanced disease. Ruling out unresectable cancers from an unnecessary "open" exploration is very important. The aim of this study was to assess the value of five-port anatomical laparoscopic exploration in T4 gastric cancer in comparison with three-port laparoscopic exploration and laparotomy exploration. We conducted a retrospective study on 126 patients with T4 stage scheduled for D2 curative gastrectomy based on computed tomography (CT) staging at Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, from Apr. 2011 to Apr. 2013. Laparotomy exploration (Group I), three-port laparoscopic exploration (Group II) or five-port anatomical laparoscopic exploration (Group III) were performed prior to radical gastrectomy. Accuracy rate for feasibility of D2 curative gastrectomy in laparotomy exploration and five-port anatomical laparoscopic exploration groups was higher than that in the three-port laparoscopic exploration group. Five-port anatomical laparoscopic exploration group had the highest accuracy resection rate (Group I vs Group II vs Group III,92.6% vs78.6% vs 97.7%; p<0.05) and shorter length of hospitalization (Group I vs Group II vs Group III, $9.58{\pm}4.17$ vs $6.13{\pm}2.85$ vs $5.00{\pm}1.81$; p<0.001). Three-port laparoscopic exploration has low accuracy rate for assessing feasibility of D2 curative gastrectomy and five-port anatomical laparoscopic exploration should be performed on patients with T4 gastric cancer.

Keywords

Gastric cancer;T4;anatomical laparoscopic exploration;three port;five port

Acknowledgement

Supported by : Natural Science Foundation of China

References

  1. Bertuccio P, Chatenoud L, Levi F, et al (2009). Recent patterns in gastric cancer: a global overview. Int J Cancer, 125, 666-73. https://doi.org/10.1002/ijc.24290
  2. Brennan MF (2005). Current status of surgery for gastric cancer: a review.Gastric Cancer, 8, 64-70. https://doi.org/10.1007/s10120-005-0319-6
  3. Burbidge S, Mahady K, Naik K (2013).The role of CT and staging laparoscopy in the staging of gastric cancer. Clin Radiol, 68, 251-5. https://doi.org/10.1016/j.crad.2012.07.015
  4. Burke EC, Karpeh MS, Conlon KC, et al (1997). Laparoscopy in the management of gastric adenocarcinoma. Ann Surg, 225, 262-7. https://doi.org/10.1097/00000658-199703000-00004
  5. Jemal A, Siegel R, Xu J, et al (2013).Environmental and lifestyle risk factors of gastric cancer. Arch Iran Med, 16, 358-65.
  6. Cardona K, Zhou Q, Gonen M, et al (2013). Role of repeat staging laparoscopy in locoregionally advanced gastric or gastroesophageal cancer after neoadjuvant therapy. Ann Surg Oncol, 20, 548-54. https://doi.org/10.1245/s10434-012-2598-6
  7. Coburn NG, Lourenco LG, Rossi SE, et al (2010). Management of gastric cancer in Ontario. J Surg Oncol, 102, 54-63. https://doi.org/10.1002/jso.21561
  8. D'Ugo DM, Persiani R, Caracciolo F, et al (1997).Selection of locally advanced gastric carcinoma by preoperative staging laparoscopy. Surg Endosc, 11, 1159-62. https://doi.org/10.1007/s004649900560
  9. Kapiev A, Rabin I, Lavy R, et al (2010). The role of diagnostic laparoscopy in the management of patients with gastric cancer. Isr Med Assoc J, 12, 726-8.
  10. Karanicolas PJ, Elkin EB, Jacks LM, et al (2011). Staging laparoscopy in the management of gastric cancer: a population-based analysis. J Am Coll Surg, 213, 644-51. https://doi.org/10.1016/j.jamcollsurg.2011.07.018
  11. Mahadevan D, Sudirman A, Kandasami P, et al (2010). Laparoscopic staging in gastric cancer: An essential step in its management. J Minim Access Surg, 6 , 111-3. https://doi.org/10.4103/0972-9941.72597
  12. Makino T, Fujiwara Y, Takiguchi S,et al (2011). Preoperative T staging of gastric cancer by multi-detector row computed tomography. Surgery, 149, 672-9. https://doi.org/10.1016/j.surg.2010.12.003
  13. Shimizu H, Imamura H, Ohta K, et al (2010). Usefulness of staging laparoscopy for advanced gastric cancer. Surg Today, 40, 119-24. https://doi.org/10.1007/s00595-009-4017-6
  14. Strong VE (2012). Laparoscopic resection for gastric carcinoma: western experience. Surg Oncol Clin N Am, 21, 141-58. https://doi.org/10.1016/j.soc.2011.09.010
  15. Yamagata Y, Amikura K, Kawashima Y, et al (2012). Staging laparoscopy in advanced gastric cancer: usefulness and issues requiring improvement. Hepatogastroenterology, 60, 751-5.
  16. Yano M, Tsujinaka T, Shiozaki H, et al (2000). Appraisal of treatment strategy by staging laparoscopy for locally advanced gastric cancer. World J Surg, 24, 1130-5. https://doi.org/10.1007/s002680010183
  17. Zhang XM, Wang Z, Liang JW, et al (2014). Analysis of laparoscopy-assisted gastric cancer operations performed by inexperienced junior surgeons. Asian Pac J Cancer Prev, 15, 5077-81. https://doi.org/10.7314/APJCP.2014.15.12.5077

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