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Value of extended lymphadenectomy in laparoscopic subtotal gastrectomy for advanced gastric cancer
LETTER
Value of Extended Lymphadenectomy in Laparoscopic Subtotal Gastrectomy for Advanced Gastric Cancer
same analysis Dr Miura did on 20 patients who had a laparoscopic subtotal gastrectomy with a D2 lymphadenectomy, for whom we found such a detailed pathologic report. These patients were compared with 20 patients submitted in the same period to a conventional open subtotal gastrectomy with a D2 dissection. Our results are quite different from those reported by Miura and colleagues. The number of total lymph nodes (laparoscopy-assisted distal gastrectomy [LADG], 54.1 ⫾ 16.5 versus open, 53.8 ⫾ 23.5), perigastric lymph nodes (LADG 36.8 ⫾ 8.9 versus open, 36.2 ⫾ 13.6), and second-tier lymph nodes (LADG, 17.3 ⫾ 7 versus open, 17.6 ⫾ 10.6) was similar after the two procedures. We did not observe any difference among the numbers of open or laparoscopic harvested lymph nodes of groups 4 (open 8.2 ⫾ 3 versus LADG 8.4 ⫾ 4), 6 (open 5.6 ⫾ 2 versus LADG 5.4 ⫾ 2), 9 (open 3.2 ⫾ 1 versus LADG 3.4 ⫾ 1), and 11 (open 3.2 ⫾ 1 versus LADG 3.0 ⫾ 1). In conclusion, we agree with Dr Miura and his colleagues about the feasibility and safety of laparoscopic gastric procedures with extended lymphadenectomy for advanced cancer. As already reported,2 we believe that laparoscopic total or subtotal gastrectomies with D2 dissection have the same oncologic effectiveness of open procedures because they allow the same radical resection (R0) of gastric tumors and the same complete perigastric and second-tier lymph node dissection of open surgery, with a similar longterm survival.
Cristiano Huscher, MD, FACS, FRCS Andrea Mingoli, MD, FACS Giovanna Sgarzini, MD Andrea Sansonetti, MD Francesca Piro, MD Cecilia Ponzano, MD Gioia Brachini, MD Rome, Italy We read with great interest the article by Miura and colleagues1 on their comparison of lymph node retrieval after distal gastrectomy with D1 or D2 lymphadenectomy performed by laparoscopy-assisted (89 patients) or conventional open (342 patients) approaches. All patients had been operated on for a T1 gastric cancer. In their experience, the total number of lymph nodes, perigastric lymph nodes, and second-tier lymph nodes was greater with open surgery than with laparoscopic approach, after both D1 and D2 lymphadenectomy. Particularly, the number of lymph nodes resected by the laparoscopic approach was significantly smaller among stations along the greater curvature (Nos. 4 and 6) and along celiac (No. 9) and splenic (No. 11) arteries. Despite this significant difference in the quality of lymphadenectomy between laparoscopic and open surgery, the authors suggest that laparoscopy-assisted approach is feasible and applicable to more advanced gastric tumor, because of the lower importance recently attributed to the resection of splenic lymph nodes. These results prompted us to review our experience on about 100 laparoscopic gastric procedures for advanced cancer. We could retrospectively perform the
© 2005 by the American College of Surgeons Published by Elsevier Inc.
REFERENCES 1. Miura S, Kodera Y, Fujiwara M, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: A critical reappraisal from the viewpoint of lymph node retrieval. J Am Coll Surg 2004;198:933–938. 2. Huscher CGS, Mingoli A, Sgarzini G, et al. Videolaparoscopic total or subtotal gastrectomy with extended lymph node dissection for gastric cancer: analysis on 44 cases. Am J Surg 2004;188: 728–735.
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ISSN 1072-7515/05/$30.00 doi:10.1016/j.jamcollsurg.2004.10.024
Value of Extended Lymphadenectomy in Laparoscopic Subtotal Gastrectomy for Advanced Gastric Cancer
same analysis Dr Miura did on 20 patients who had a laparoscopic subtotal gastrectomy with a D2 lymphadenectomy, for whom we found such a detailed pathologic report. These patients were compared with 20 patients submitted in the same period to a conventional open subtotal gastrectomy with a D2 dissection. Our results are quite different from those reported by Miura and colleagues. The number of total lymph nodes (laparoscopy-assisted distal gastrectomy [LADG], 54.1 ⫾ 16.5 versus open, 53.8 ⫾ 23.5), perigastric lymph nodes (LADG 36.8 ⫾ 8.9 versus open, 36.2 ⫾ 13.6), and second-tier lymph nodes (LADG, 17.3 ⫾ 7 versus open, 17.6 ⫾ 10.6) was similar after the two procedures. We did not observe any difference among the numbers of open or laparoscopic harvested lymph nodes of groups 4 (open 8.2 ⫾ 3 versus LADG 8.4 ⫾ 4), 6 (open 5.6 ⫾ 2 versus LADG 5.4 ⫾ 2), 9 (open 3.2 ⫾ 1 versus LADG 3.4 ⫾ 1), and 11 (open 3.2 ⫾ 1 versus LADG 3.0 ⫾ 1). In conclusion, we agree with Dr Miura and his colleagues about the feasibility and safety of laparoscopic gastric procedures with extended lymphadenectomy for advanced cancer. As already reported,2 we believe that laparoscopic total or subtotal gastrectomies with D2 dissection have the same oncologic effectiveness of open procedures because they allow the same radical resection (R0) of gastric tumors and the same complete perigastric and second-tier lymph node dissection of open surgery, with a similar longterm survival.
Cristiano Huscher, MD, FACS, FRCS Andrea Mingoli, MD, FACS Giovanna Sgarzini, MD Andrea Sansonetti, MD Francesca Piro, MD Cecilia Ponzano, MD Gioia Brachini, MD Rome, Italy We read with great interest the article by Miura and colleagues1 on their comparison of lymph node retrieval after distal gastrectomy with D1 or D2 lymphadenectomy performed by laparoscopy-assisted (89 patients) or conventional open (342 patients) approaches. All patients had been operated on for a T1 gastric cancer. In their experience, the total number of lymph nodes, perigastric lymph nodes, and second-tier lymph nodes was greater with open surgery than with laparoscopic approach, after both D1 and D2 lymphadenectomy. Particularly, the number of lymph nodes resected by the laparoscopic approach was significantly smaller among stations along the greater curvature (Nos. 4 and 6) and along celiac (No. 9) and splenic (No. 11) arteries. Despite this significant difference in the quality of lymphadenectomy between laparoscopic and open surgery, the authors suggest that laparoscopy-assisted approach is feasible and applicable to more advanced gastric tumor, because of the lower importance recently attributed to the resection of splenic lymph nodes. These results prompted us to review our experience on about 100 laparoscopic gastric procedures for advanced cancer. We could retrospectively perform the
© 2005 by the American College of Surgeons Published by Elsevier Inc.
REFERENCES 1. Miura S, Kodera Y, Fujiwara M, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: A critical reappraisal from the viewpoint of lymph node retrieval. J Am Coll Surg 2004;198:933–938. 2. Huscher CGS, Mingoli A, Sgarzini G, et al. Videolaparoscopic total or subtotal gastrectomy with extended lymph node dissection for gastric cancer: analysis on 44 cases. Am J Surg 2004;188: 728–735.
314
ISSN 1072-7515/05/$30.00 doi:10.1016/j.jamcollsurg.2004.10.024