PROSPECTIVE NON-RANDOMIZED CASE-CONTROL STUDY: IMMEDIATE RESULTS OF RADICAL LAPAROSCOPIC INTERVENTIONS FOR GASTRIC CANCER, THE EXPERIENCE OF A SINGLE CENTER

Abstract

The aim of this study was to define safety and oncological adequacy of radical laparoscopic interventions in gastric cancer (GC) in the conditions of a specialized oncology center.

Materials and methods. The study included 193 (108 men and 85 women) with a histologically verified gastric adenocarcinoma of varying degrees of differentiation or cricoid-cell carcinoma with stage T1b-T4a cN0-N1 according to the UICC / TNM classification (7th edition). The study was prospective. The main group (laparoscopic interventions) included 81 patients: 54 underwent distal subtotal resections of the stomach (DSRS) and 27 underwent gastrectomies (GE); 101 patients (66 DSRSs and 35 GEs) contained the control group (open interventions). Separate group of 11 patients were with a conversion access.

Results. The average duration of the laparoscopic DSRS was 209.6 ± 50.4 minutes, the open DSRS - 168.9 ± 44.1 minutes (p <0.05). The mean duration of laparoscopic GE was 241.7 ± 60.3 min, while the open GE was 185.1 ± 48.9 min (p <0.05). The average volume of intraoperative blood loss for laparoscopic DSRS was 100 ± 65.4 ml, with open DSRS - 217.4 ± 102.5 ml (p <0.05) and for laparoscopic and open GE it was 105.5 ± 45.2 ml and 247.1 ± 87.4 ml, respectively (p <0.05). The average number of removed lymph nodes in laparoscopic DSRS was 24,7 ± 5,1, with open DSRS - 25,4 ± 6,7 (p> 0,05), while in laparoscopic and open GE it was 25,1 ± 6, 4 and 26.8 ± 5.3, respectively (p> 0.05). In all cases of laparoscopic interventions R0 resection was performed. In the structure of postoperative complications the specific gravity of severe complications (IIIb - V degree according to the classification of Clavien-Dindo) in the subgroup of laparoscopic DSRS was 5.6%, in the subgroup of open DSRS - 6% (p> 0.05), and in subgroups of laparoscopic and open GE - 11.1% and 8.6%, respectively (p> 0.05). Postoperative lethality in the group of laparoscopic interventions was 1.2%, in the open surgery group - 2.9% (p> 0.05). The analysis of training curves in the performance of laparoscopic interventions demonstrated that the experience of 30 laparoscopic DSRSs and 15 laparoscopic GEs did not allow promoting an access to the plateau but it demonstrated the trend in reducing the duration of operations when accumulating experience.

Conclusions. Radical laparoscopic operations for stomach cancer are safe and oncologically adequate. The absence of long-term results of treatment dictates the necessity of continuing the study.