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WJOLS
10.5005/jp-journals-10033-1194
Laparoscopy: A Procedure no less than Laparotomy for Lymph Node Dissection in Total Gastrectomy for Gastric Carcinoma
ORIGINAL ARTICLE
Laparoscopy: A Procedure no less than Laparotomy for
Lymph Node Dissection in Total Gastrectomy for

Gastric Carcinoma

T Anil Kumar, Manoj Gowda, Manash Ranjan Sahoo

ABSTRACT established, but the same rigorous approach to other cancers
has yet to be reported. Gastric cancer is the fourth most
Aim: To show that laparoscopic lymph node dissection and
harvesting is equal to laparotomic lymph node dissection in common cancer and the second leading cause of cancer-
patients undergoing total gastrectomy for gastric carcinoma. related deaths worldwide. In the Far East countries such
1,2
Materials and methods: Retrospective data was collected from as China, 3 Korea 4 and Japan, 5 gastric cancer is the most
36 patients who underwent total gastrectomy for carcinoma prevalent malignancy, and the leading cause of cancer-
stomach. Fifteen patients underwent open total gastrectomy related deaths. Since the first report of laparoscopic gastrec-
(OG) and other 21 laparoscopic assisted total gastrectomy 6
(LAG) over a period of 4 years from March 2009 to June 2012. tomy in 1992, laparoscopy-assisted gastrectomy (LAG) has
In the laparoscopic group, dissection of lymph nodes and been carried out not only in distal gastrectomy, but also in
division of ligaments and omentum was done laparoscopically proximal gastrectomy and total gastrectomy. 7-9 Several
using harmonic scalpel. Both groups were compared for randomized control trials (RCTs) have shown that LAG can
operative blood loss, operative time, blood transfusion, 10-15
morbidity, mortality, the number of harvested lymph nodes be performed in early gastric cancer (EGC). Radical
(HLNs) with emphasis on harvested lymph nodes. surgical resection of the stomach and regional lymph nodes
Results: There were no significant differences in morbidity or dissection is still the mainstream of the treatment of AGC.
mortality in both groups. Tumor free margins were obtained in However, LAG for the treatment of advanced gastric cancer
all cases. Compared with OG group, the LAG group had (AGC) has remained controversial, mainly due to a lack of
significantly less blood loss, but a longer operation time. The
evidence from large-scale studies demonstrating that
mean harvested lymph nodes (HLN’s) is 24.7 in LAG group as
compared 23.3 in OG group. laparoscopic D2 dissection, the standard lymphadenectomy
for AGC, is equivalent to open surgery. Recently, some
Conclusion: Laparoscopic dissection and harvested lymph
nodes is equivalent to OG with no other significant differences studies have evaluated the outcome of D2 lymph node
except for decreased blood loss and increased operative time. dissection in LAG and open surgery for gastric cancer. 16-19
Thus, this procedure can achieve the same result as OG.
In this study, we evaluated operative blood loss, operative
Keywords: Open gastrectomy, Laparoscopic-assisted time, blood transfusion, morbidity, mortality, the number
gastrectomy, Gastric cancer, Harvested lymph nodes. of harvested lymph nodes (HLNs) with emphasis on HLNs
How to cite this article: Kumar TA, Gowda M, Sahoo MR. between LAG and OG.
Laparoscopy: A Procedure no less than Laparotomy for Lymph
Node Dissection in Total Gastrectomy for Gastric Carcinoma.
MATERIALS AND METHODS
World J Lap Surg 2013;6(3):111-115.
Retrospective data was collected from 36 patients who
Source of support: Nil
underwent total gastrectomy for carcinoma stomach over a
Conflict of interest: None
period of 4 years from March 2009 to June 2012 in the
Department of Surgery SCB Medical College, Cuttack,
INTRODUCTION
India. The exclusion criteria included: (1) invasion of
While laparoscopic approaches are used for many abdominal adjacent structures; (2) distant metastases; and (3) associated
procedures and allow for faster recovery of bowel function, comorbid conditions making unfit to undergo surgery.
better immunologic response and overall accelerated Routine blood examination, chest X-ray, contrast-enhanced
recovery for the patient, the use of laparoscopy for cancer computed tomographic scan of the abdomen and pelvis and
surgery is still a matter of debate. For patients with cancer, endoscopy were performed before operation. Biopsy
questions remain about the immunologic implications of revealed adenocarcinoma in all cases. The study population
laparoscopic surgery, the adequacy and standardization of thus included 20 cases that successfully underwent radical
laparoscopic techniques, the risk for disease recurrence, and gastrectomy with D2 dissection. Twenty-one cases
the impact on survival. The safety and efficacy of underwent LAG and other 15 OG. Mean period of follow-up
laparoscopic surgery for colorectal cancer has certainly been was 8 months.
World Journal of Laparoscopic Surgery, September-December 2013;6(3):111-115 111