Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2

Kyung Won Seo; Kae Won Park; Ki Young Yoon

doi:10.7180/kmj.2013.28.1.27

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Seo, Park, and Yoon: Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2

Original Article

Kosin Medical Journal 2013;28(1):27-33.

Published online: 19 January 2013

DOI: https://doi.org/10.7180/kmj.2013.28.1.27

Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2

Kyung Won Seo¹, Kae Won Park², Ki Young Yoon¹

¹Department of Surgery, College of Medicine, Kosin University, Busan, Korea

²Postgraduate school, College of Medicine, Kosin University, Busan, Korea

Corresponding author: Ki Young YOON, Department of Surgery, College of Medicine, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan, 602-703, Republic of Korea TEL: +82-51-990-6462 FAX: +82-51-246-6093 E-mail: yoonkiyoung@naver.com

Received 14 August 201222 December 2012 Accepted 28 January 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Laparoscopy-assisted distal gastrectomy (LADG) is a common surgical procedure that has recently been accepted as safe and feasible for the treatment of early gastric cancer. There have been many efforts to expand the indications of LADG to include the treatment of advanced gastric cancer. The aim of this study was to determine the usefulness of noncompliance rate as an indicator for D2 lymph node dissection (LND) validation in LADG.

Methods

The subjects were 48 patients who underwent distal gastrectomy with D2 LND at Kosin University Gospel Hospital from October to December 2010. Of them, 28 underwent LADG and 20 underwent open distal gastrectomy (ODG). We compared several factors including noncompliance rate to validate D2 LND.

Results

There were no significant differences in clinicopathologic factors except for BMI and tumor depth between the two groups. The average number of retrieved lymph nodes was significantly greater in the ODG group (45.9 ± 2.9) than in the LADG group (35.5 ± 2.0). The noncompliance rate was 43% in the LADG group and 40% in the ODG group with no significant difference.

Conclusions

In terms of no difference of noncompliance rate, LADG with D2 lymph node dissection is a safe, feasible and oncologicallycamparable with open gastrectomy. A large scaled prospective randomized trial should be needed to confirm the benefit of LADG.

Keywords: Advanced gastric cancer, Gastric neoplasms, Laparoscopy-assisted distal gastrectomy, Noncompliance rate

REFERENCES

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Table 1.

Patient clinicopathologic characteristics

Variables		LADG (n = 28)	ODG (n = 20)	P
Sex	M	21	15	1.000
	F	7	5
BMI		23.7 ± 0.49	22.0 ± 0.45	0.019
T stage	T1	26	8	0.001
	T2	1	2
	T3	1	5
	T4	0	5
N stage	N0	27	12	0.015
	N1	1	4
	N2	0	2
	N3	0	2
Anastomosis	Billroth I	23	16	0.856
	Billroth II	5	4

Mean ± SEM.

Table 2.

Patient surgical outcomes

Variables	LADG (n = 28)	ODG (n = 20)	P
Estimated blood loss	117.8 ± 18.2	230.0 ± 27.2	0.002
Op. time (min.)	199.6 ± 11.4	190.7 ± 7.7	0.521
Retrieved LN	35.5 ± 2.0	45.9 ± 2.9	0.006
Noncompliance rate	0.43	0.4	0.847
Hospital stay (days)	7.2	8.4	0.678
First flatus (days)	2.7	3.3	0.785
Starting semi-liquid diet	3	3	1

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