Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: From a viewpoint of pancreas-related complications

• Published in: Surgery 2011, Vol.149 (1), p.15-21
• Main Authors: Obama, Kazutaka, MD, PhD, Okabe, Hiroshi, MD, PhD, Hosogi, Hisahiro, MD, PhD, Tanaka, Eiji, MD, PhD, Itami, Atsushi, MD, PhD, Sakai, Yoshiharu, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Biological and medical sciences; Case-Control Studies; Digestive system. Abdomen; Disease-Free Survival; Endoscopy; Feasibility Studies; Female; Follow-Up Studies; Gastrectomy - adverse effects; Gastrectomy - methods; Gastroscopy - adverse effects; Gastroscopy - methods; General aspects; Hospitals, University; Humans; Investigative techniques, diagnostic techniques (general aspects); Japan; Length of Stay; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Male; Medical sciences; Middle Aged; Neoplasm Staging; Pain, Postoperative - physiopathology; Pancreas; Pancreatic Fistula - etiology; Pancreatic Fistula - physiopathology; Pancreatic Function Tests; Postoperative Care - methods; Postoperative Hemorrhage - physiopathology; Retrospective Studies; Risk Assessment; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2010.04.014

Background There is little evidence for the technical feasibility of laparoscopic gastrectomy (LG) with peripancreatic lymphadenectomy in terms of postoperative complications. To evaluate the technical feasibility of LG with radical lymphadenectomy, we focused on pancreas-related complications in LG and open gastrectomy (OG), and then investigated whether such complications increased in LG. Methods We reviewed the surgical outcomes of 138 consecutive patients with gastric cancer who underwent LG with peripancreatic lymphadenectomy in our hospital between July 2005 and February 2009. As a control group, we used 95 consecutive OG cases with peripancreatic lymphadenectomy without splenectomy or para-aortic lymphadenectomy. LG and OG were compared for clinicopathologic characteristics, operative outcomes, postoperative morbidities and mortalities, and amylase concentration of drainage fluid (d-AMY). Results The overall operative morbidity rates were 15% in the LG and 20% in the OG group. Rates of postoperative pancreatic fistula (POPF), Grade B and C in the International Study Group on Pancreatic Fistula definition, were 7% in the LG group and 2% in the OG group, indicating no statistical difference ( P = .149). There were no in-hospital deaths. The median value of d-AMY in LG was 934.5 IU/L, while that in OG was 349 IU/L; d-AMY after LG was significantly higher than that after OG ( P < .01). Conclusion Considering low morbidity and mortality rates, LG with peripancreatic lymphadenectomy is technically feasible. Although POPF after LG was infrequent, d-AMY level was higher than after OG. We should pay attention to the potential risk of pancreatic leakage when carrying out LG with peripancreatic lymphadenectomy.