Laparoscopic surgery produces a similar rate of recurrence-free survival as traditional open surgery in patients with gastric cancer but results in fewer complications and shorter hospital stays, according to the results of a study published in the Annals of Surgical Oncology.
Gastric cancer (or stomach cancer) forms in the tissues and lining of the stomach. The prevalence of gastric cancer has been steadily declining in the United States but is still the leading cause of cancer in Asia, accounting for 18% of cancer deaths in Japan. Gastric cancer is the second leading cause of cancer deaths worldwide.
The primary treatment of gastric cancer is surgical removal of the stomach (gastrectomy) to remove the cancer and prevent a recurrence, as well as removal of the lymph nodes to determine whether the cancer has spread. A subtotal gastrectomy refers to surgery in which only the part of the stomach involved with cancer is removed, while the upper stomach is preserved. This is a less extensive operation and is associated with better nutrition and quality of life than total gastrectomy. Still, a subtotal gastrectomy is an “open” and very invasive surgical procedure and can result in major complications.
Laparoscopic gastrectomy is a minimally invasive surgical procedure during which a surgeon removes the stomach while guided by a laparoscope (a thin, lighted tube with a video camera on its tip), which magnifies images onto large screens in the operating room, thereby allowing the surgeon to perform the surgery while watching his or her movements on the screen. This type of procedure prevents the need for large surgical incisions, and may reduce the risk of infection, healing complications, pain, and blood loss.
Researchers at the Memorial Sloan-Kettering Cancer Center compared the outcomes of 30 patients who underwent traditional “open” gastrectomy to those of 30 patients who underwent laparoscopic gastrectomy. The patients in both groups were matched for age, gender, and stage of cancer. After three years of follow-up, they found that both procedures resulted in similar rates of recurrence-free survival. The laparoscopic procedure took longer to perform, but resulted in shorter hospital stays (five days versus seven days for the open procedure), fewer postoperative complications, and less postoperative pain. The researchers noted that both procedures allowed for adequate removal of lymph nodes.
The researchers concluded that “laparoscopic subtotal gastrectomy for adenocarcinoma is comparable to the open approach” and results in similar outcomes. The advantage of the laparoscopic approach is that it results in shorter hospital stays, decreased need for pain medication, and fewer complications.
 Strong VE, Devaud N, Allen PJ, at al. Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: A case-control study. Annals of Surgical Oncology. Published online April 4, 2009. DOI: 10.1245/s10434-009-0286-8.
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