Mini-invasive surgery for advanced gastric cancer: a literary review and single centre experience

Background: In the last decade the use of laparoscopic gastrectomy has been regarded as an oncologically safe surgical technique for early cancer and thus gaining rapidly popularity over traditional open gastrectomy. However, its use for advanced gastric cancer is still controversial due to concerns regarding the ability to perform an adequate lymph node dissection, especially on less studied Western populations. Aim: To determine whether laparoscopic gastrectomy is non-inferior than open gastrectomy for the treatment of advanced gastric cancer on a select Western population. Methods: After exclusion of patients that did not meet the study’s criteria, a total of 23 patients were assigned to either laparoscopic (15 patients) or open (8 patients) gastrectomy. Three variables were chosen to monitor the success of each procedure: 1) number of lymph nodes harvested; 2) operative time; and 3) length of hospital stay. Each of these variables were compared between both groups in order to determine if there were any differences. Results: The mean number of lymph nodes harvested was 34.0 in the laparoscopic group and 31.0 in the open group, with a p value of 0.603 using the student test and 0.722 using the Mann-Whitney test. The mean operative time (minutes) was 235.9 in the laparoscopic group and 255.4 in the open group, with a p value of 0.255 using the student test and 0.259 using the Mann-Whitney test. The mean length of hospital stay (days) was 7.2 in the laparoscopic group and 11.9 in the open group, with a p value of 0.033 using the student test and 0.031 using the Mann-Whitney test. With the exception of the operative time, these results are consistent with the four studies included in the literary review. Conclusion: The results of this study show that laparoscopic gastrectomy is non-inferior, and possible superior, than open gastrectomy for the treatment of advanced gastric cancer.