Short Term Efficacy of Laparoscopy Assisted vs Open Gastrectomy with D2 Lymph Node Dissection for Advanced Gastric Cancer

INTRODUCTION: The most effective curative treatment for gastric cancer other than early stage is radical gastrectomy with D2 lymph node dissection. Laparoscopy assisted gastrectomy is one of the technique alternatives on this issue. Although the advantages of laparoscopic surgery as a minimal invasive procedure is well known, it should be evaluated for the reach of radical oncological principles and the results should be revealed.
METHODS: The early results of patients with clinical stage IIA and over gastric carcinoma that had been operated with laparoscopy assisted (19 patients) and open surgery (23 patients) were evaluated.
RESULTS: In laparoscopy assisted group, both the bleeding and the need for analgesics in postoperative period were significantly less (166.9±66.5ml vs 264.3±91.3ml, 6.4±1.5 vs 9.04±1.7, times respectively) but the time needed to complete surgery was longer (183± 31.1 min vs 155± 29.5 min). There was no difference in the numbers of lymph nodes removed and surgical resection margins. The pulmonary complications were more frequent in open surgery group.
DISCUSSION AND CONCLUSION: Laparoscopy assisted radical gastrectomy with D2 lymph node dissection is an effective and safe surgical technique for gastric cancers other than early stage. It is thought to have some superiorities in early postoperative healing.

Ýleri evre mide kanserinde laparoskopi yardýmlý ve açýk gastrektomi ile birlikte uygulanan D2 diseksiyonun erken dönem etkinliði

GÝRÝÞ ve AMAÇ: Erken evre dýþýndaki mide kanserinin en etkili küratif tedavisi radikal gastrektomi ile birlikte D2 diseksiyon uygulanmasýdýr. Bu konuda bir diðer teknik alternatif ise laparoskopi yardýmlý gastrektomidir. Her ne kadar minimal ivaziv iþlem olarak laparoskopik cerrahinin avantajlarý iyi bilinse de, bu iþlem radikal onkolojik prensiplere ulaþabilmesi ve sonuçlarýn ortaya konmasý açýsýndan deðerlendirilmelidir.
YÖNTEM ve GEREÇLER: Evre IIA ve üzeri mide kanserli hastalarda laparoskopi yardýmlý (19 hasta) ve açýk cerrahinin (23 hasta) erken sonuçlarý deðerlendirilmiþtir.
BULGULAR: Laparoskopi yardýmlý grupta, hem kanama hem de postoperatif dönmede analjezik ihtiyacý belirgin olarak daha az iken (sýrasýyla, 166.9±66.5mL’ye karþýlýk 264.3±91.3 mL, 6.4±1.5’ye karþýlýk 9.04±1.7 kez), ameliyat süresi daha uzun olarak bulundu (183± 31.1 dakikaya karþýlýk 155± 29.5 dakika). Cerrahi sýnýrlar ve çýkarýlan lenf nodu sayýsý açýsýndan fark yoktu. Açýk cerrahi grubunda akciðer komplikasyonlarý daha sýktý.
TARTIÞMA ve SONUÇ: Laparoskopi yardýmlý radikal gastrektomi ile birlikte D2 diseksiyon erken evre dýþý mide kanserlerinde de etkin ve güvenilir bir cerrahi uygulamadýr. Erken postoperatif iyileþme döneminde bazý üstünlükleri olduðu düþünülmüþtür.