Confronto tra gastrectomia laparoscopica e laparotomica per carcinoma gastrico: esperienza monocentrica

Background: Laparoscopic-assisted gastric surgery has become an option for the treatment of gastric cancer. In this study we describe our experience with laparoscopic-assisted gastrectomy (LAG) for gastric cancer (GC). Methods: Between January 2000 and September 2008, 115 patients with GC underwent LAG (total gastrectomy: n=19; distal gastrectomy: n=96) at our hospital. These patients were compared with 220 patients who had GC and underwent conventional open gastrectomy (OG) (open total gastrectomy: n=78; open distal gastrectomy: n=142) during the same period. Results: There was no differences between the two groups regarding the operation time (161±126 minutes and 212 ±152 in OG and LAG group, respectively; p=ns). Estimated blood loss in the LAG group was significantly less than in the OG group. The mortality rate was similar. The morbidity rate was were higher in the LAG than in the OG group. The distance of the proximal resection margin showed a significant difference between the two groups (LAG 3.8 cm versus OG 3 cm). The mean number of nodes resected with LAG was 31 +/- 15, and that with OG was 26 +/- 13 (p = 0.008). There was no significant differences in overall survival between the two groups. The mean follow-up for the LAG group was 31 months and 40 months in OG. Conclusions: LAG with extended lymphadenectomy for GC is a feasible and safe procedure with a radical oncologic resectio

Significato prognostico dell’interessamento dei margini di resezione dopo gastrectomia per carcinoma: esperienza monocentrica

Curative gastrectomy represents the treatment of choice for gastric cancer. A variety of clinicopathologic features, such as resection line involvement (RLI) has been suggested as prognostic indicators for gastric cancer. The aim of this study was to investigate whether microscopic positive margins are detrimental to the outcome of gastric cancer patients treated with gastrectomy. Methods: Among 1087 consecutive patients who had undergone gastrectomy with curative intent for gastric cancer between January 1990 and December 2008, 116 patients (10,7%) had positive resection margins on final histology. Results: Among these 116 patients, 48 had proximal and distal involved margins, 33 had proximal involved margins, and 35 had distal involved margins. No one patient had reoperation. The mean distance between proximal gastric margin and the neoplasia was 4±3,8 (min 0, max 21) and from the distal margin and the neoplasia 4±3.9 (min 0, max 24). The negative margin group had a significantly longer median survival time (P <0.00001). When both groups of patients were stratified according to nodal stage, a positive resection margin determined a worse prognosis only in patients with node-positive disease (mean survival time: 63 months vs. 21 months, P = 0.0001). In early gastric cancer (EGC) the resection margin involvement did not influenced survival. On the contrary, in more advanced diseases the positive margins is a negative prognostic factor for survival. Conclusions: A positive gastric or oesophageal margin is an independent poor prognostic factor for long-term survival in stomach cancer in advanced disease or node positive patients