Special Issue "New Insights into Gastrectomy for Gastric Cancer"

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Surgical Oncology".

Deadline for manuscript submissions: 15 November 2022 | Viewed by 1312

Special Issue Editor

Dr. Stefano Caruso
E-Mail Website
Guest Editor
Department of General Surgery and Surgical Specialties, Unit of General Surgery, “Santa Maria Annunziata” Hospital, Florence, Italy
Interests: surgical oncology; gastrointestinal surgery; minimally invasive surgery

Special Issue Information

Dear Colleagues,

Radical gastrectomy with adequate lymphadenectomy is currently the recommended surgical procedure for most resectable gastric cancer patients.

Minimally invasive surgery has been increasingly used in the treatment of gastric cancer, demonstrated to be capable of maintaining the typical well-known advantages of laparoscopic technique over open surgery, with non-inferior oncological outcomes. Laparoscopic gastrectomy (LG) has progressively spread worldwide, especially in Eastern countries, where laparoscopic assisted distal gastrectomy has become a standard procedure for early distal tumors. However, LG with D2 node dissection technique for the treatment of advanced gastric cancer did not meet the same spread, mainly due to the poor adaptability of laparoscopic tools to complex maneuvers, such as extended required lymphadenectomy and challenging reconstruction. This gave rise to concerns regarding the oncological adequacy of LG for AGC.

The introduction of robotic gastrectomy has been reported to overcome some intrinsic drawbacks of the conventional LG, and to date seems a promising tool to extend the minimally invasive surgical indications. Evidence from high-quality randomized trials on LG and RG, whose results were eagerly awaited, have recently been published, essentially originating from Eastern Laparoscopic Gastrointestinal Surgery Study Groups (KLASS, CLASS, JCOG trials).

Therefore, the purpose of this Special Issue is to promote contributions on these emerging perspectives, in order to verify if definitive indications could be advisable.

Dr. Stefano Caruso
Guest Editor

Manuscript Submission Information

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Keywords

  • gastric cancer
  • surgical oncology
  • upper gastrointestinal surgery
  • radical gastrectomy
  • open gastrectomy
  • minimally invasive surgery
  • laparoscopic gastrectomy
  • robotic-assisted gastrectomy

Published Papers (1 paper)

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Research

Article
Laparoscopic vs. Open Gastrectomy for Locally Advanced Gastric Cancer: A Propensity Score-Matched Retrospective Case-Control Study
Curr. Oncol. 2022, 29(3), 1840-1865; https://doi.org/10.3390/curroncol29030151 - 09 Mar 2022
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Abstract
Introduction: Minimally invasive surgery has been increasingly used in the treatment of gastric cancer. While laparoscopic gastrectomy has become standard therapy for early-stage gastric cancer, especially in Asian countries, the use of minimally invasive techniques has not attained the same widespread acceptance for [...] Read more.
Introduction: Minimally invasive surgery has been increasingly used in the treatment of gastric cancer. While laparoscopic gastrectomy has become standard therapy for early-stage gastric cancer, especially in Asian countries, the use of minimally invasive techniques has not attained the same widespread acceptance for the treatment of more advanced tumours, principally due to existing concerns about its feasibility and oncological adequacy. We aimed to examine the safety and oncological effectiveness of laparoscopic technique with radical intent for the treatment of patients with locally advanced gastric cancer by comparing short-term surgical and oncologic outcomes of laparoscopic versus open gastrectomy with D2 lymphadenectomy at two Western regional institutions. Methods: The trial was designed as a retrospective comparative matched case-control study for postoperative pathological diagnoses of locally advanced gastric carcinoma. Between January 2015 and September 2021, 120 consecutive patients who underwent curative-intent laparoscopic gastrectomy with D2 lymph node dissection were retrospectively recruited and compared with 120 patients who received open gastrectomy. In order to obtain a comparison that was as homogeneous as possible, the equal control group of pairing (1:1) patients submitted to open gastrectomy who matched those of the laparoscopic group was statistically generated by using a propensity matched score method. The following potential confounder factors were aligned: age, gender, Body Mass Index (BMI), comorbidity, ASA, adjuvant therapy, tumour location, type of gastrectomy, and pT stage. Patient demographics, operative findings, pathologic characteristics, and short-term outcomes were analyzed. Results: In the case-control study, the two groups were clearly comparable with respect to matched variables, as was expected given the intentional primary selective criteria. No statistically significant differences were revealed in overall complications (16.7% vs. 20.8%, p = 0.489), rate of reoperation (3.3% vs. 2.5%, p = 0.714), and mortality (4.2% vs. 3.3%, p = 0.987) within 30 days. Pulmonary infection and wound complications were observed more frequently in the OG group (0.8% vs. 4.2%, p < 0.01, for each of these two categories). Anastomotic and duodenal stump leakage occurred in 5.8% of the patients after laparoscopic gastrectomy and in 3.3% after open procedure (p = 0.072). The laparoscopic approach was associated with a significantly longer operative time (212 vs. 192 min, p < 0.05) but shorter postoperative length of stay (9.1 vs. 11.6 days, p < 0.001). The mean number of resected lymph nodes after D2 dissection (31.4 vs. 33.3, p = 0.134) and clearance of surgical margins (97.5% vs. 95.8%, p = 0.432) were equivalent between the groups. Conclusion: Laparoscopic gastrectomy with D2 nodal dissection appears to be safe and feasible in terms of perioperative morbidity for locally advanced gastric cancer, with comparable oncological equivalency with respect to traditional open surgery. Full article
(This article belongs to the Special Issue New Insights into Gastrectomy for Gastric Cancer)
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