Current status of minimal access surgery for gastric cancer

Shehzad, K, Mohiuddin, K, Nizami, S, Sharma, H, Khan, IM, Memon, B and Memon, MA (2007) Current status of minimal access surgery for gastric cancer. Surgical Oncology-oxford, 16 2: 85-98. doi:10.1016/j.suronc.2007.04.012


Author Shehzad, K
Mohiuddin, K
Nizami, S
Sharma, H
Khan, IM
Memon, B
Memon, MA
Title Current status of minimal access surgery for gastric cancer
Journal name Surgical Oncology-oxford   Check publisher's open access policy
ISSN 0960-7404
Publication date 2007
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.suronc.2007.04.012
Volume 16
Issue 2
Start page 85
End page 98
Total pages 14
Place of publication Oxford
Publisher Elsevier Sci Ltd
Language eng
Abstract Background: The aim was to conduct a systematic review of the literature on the subject of laparoscopic gastrectomy (LG) and determine the relative merits of laparoscopic (LG) and open gastrectomy (OG) for gastric carcinoma. Material and methods: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified individual retrospective and prospective series on LG (proximal, distal and total). Furthermore, all clinical trials that compared LG and OG published in the English language between January 1990 and the end of December 2006 were also identified. A large number of outcome variables were analysed for individual series and comparative trials between LG and OG and results discussed and tabulated. Results: The majority of the literature is published from Japan showing both oncological adequacy and safety of LG. The majority of early series and comparative studies have utilized laparoscopic resection for early and distal gastric cancer. However, with increasing advanced laparoscopic experience, advancement in digital technology and improvement in instrumentation, more advanced gastric cancers and more extensive procedures such as laparoscopic-assisted total gastrectomy and laparoscopy-assisted D2 dissection are becoming more common. To date lymph node harvesting, resection margins and complication rates seem to be equivalent to open procedures. Furthermore, the earlier fears of port-site metastases have not been borne out. Conclusions: The available data suggests that LG seems to be associated with quicker return of gastrointestinal function, faster ambulation, earlier discharge from hospital, and comparable complications and recurrence rate to OG. However, the operating time for LG remains significantly longer compared to its open counterpart, although with experience it is achieving parity with OG. However, the majority of the comparative trials (if not all) probably do not have the power to detect differences in the outcome. As far as the RCT's (LG vs. OG) are concerned, the numbers of patients in such trials are small and the majority of patients were operated upon for early distal gastric cancer and, therefore, any meaningful conclusions regarding the advantages or disadvantages of LG for both the ECGs and extensive and advanced gastric tumours are difficult to justify. (c) 2007 Elsevier Ltd. AR rights reserved.
Keyword Oncology
Surgery
gastrectomy
laparoscopic method
comparative studies
patient's outcome
intraoperative complications
postoperative complications
hospitalization
human
Assisted Distal Gastrectomy
Lymph-node Dissection
Billroth-i Gastrectomy
Pylorus-preserving Gastrectomy
5 Years Experience
Laparoscopic Surgery
Invasive Treatment
Comparing Open
Metastasis
Management
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes This document is a journal review.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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Created: Mon, 18 Feb 2008, 15:14:43 EST