Laparoscopic Surgery for Gastric Cancer - How to Avoid Undesired Complications

Abstract

Aim: Gastric cancer is the second most common cause of death among all malignancies. Only 50% of the patients are eligible for radical treatment with curative intent. Open gastrectomy with lymphadenectomy has been a preferred surgical method worldwide for a long time. However, this procedure is associated with clinically significant postoperative stress, high morbidity rate (9.1-46.0%) and longer hospital stay. Several meta-analyses have shown better short-term results after laparoscopic gastrectomy compared to an open procedure, with similar oncological outcomes. Patients with resectable gastric cancer were included in this study.Materials and Methods: This study was a non-randomized prospective trial. Patients with histologically proven, surgically resectable gastric cancer (T1-4a,N1- 3b, M0) and European Oncology Study Group performance status 0,1,2 were eligible to participate in this study. The primary endpoints were operative time and morbidity rate. The second factors were length of hospital stay and cost-effectiveness. Additionally, we focused on the standardized operative technique. For the period March 1, 2014-December 30, 2015, 32 patients underwent laparoscopic gastric resection for gastric cancer. We performed 14 total D2 gastrectomies with intracorporal esophagojejunal anastomosis and 18 subtotal gastrectomies with gastrojejonoanastomosis. We also performed 42 open gastrectomies (28 total and 14 subtotal one) during this period. Results: The mean duration of the laparoscopic procedure was 210 min. versus 150 min in open group. There was 1 conversion due to a mesenterial lipoma as a reason for a short jejunal lооp. The mean hospital stay was 5.6 days in the laparoscopic group and 9.4 days in the open group. Two postoperative complications (7.1%) after a laparoscopic procedure (internal pancreatic fistula, leakage of oesophagojejunal anastomosis ) were reported. Three postoperative complications (7.1%) after an open surgery (duodenal stump leakage, external pancreatic fistula with bleeding, leakage from oesophagojejunal anastomosis) were found. All of the patients with postoperative complications had an advanced-stage gastric cancer (T3-4aN1- 3bM0).Conclusion: The implementation of laparoscopy in the clinical practice in patients with gastric cancer can result in improved post-operative care quality, shortening of the hospital stay, and quicker return to normal activity. We did not find significant differences in the morbidity rate between laparoscopic and open-operated patients. Perhaps, we have not analyzed the enire learning curve of the laparoscopic gastric surgery.