Short-term outcomes of D2 lymphadenectomy plus complete mesogastric excision for gastric cancer: a propensity score matching analysis
Tóm tắt
Our previous study has demonstrated the surgical advantages of D2 lymphadenectomy plus complete mesogastric excision (D2 + CME) in gastric cancer surgery. To further verify the safety of D2 + CME procedure, we conducted this large-scale, observational cohort study and applied propensity score matching (PSM) approach to compare D2 + CME with conventional D2 in terms of short-term outcomes in gastric cancer patients. Data on 855 patients from Tongji Hospital who underwent laparoscopic-assisted distal gastrectomy (LADG) with R0 resection (496 in the conventional D2 cohort and 359 in the D2 + CME cohort) between Dec 12, 2013 and Dec 28, 2017 were retrieved from prospectively maintained clinical database. After PSM analysis at a 1:1 ratio, each cohort included 219-matched patients. Short-term outcomes, including surgical results, morbidity, and mortality within 30 days after the operation, were collected and analyzed. In this large-scale, observational cohort study based on PSM analysis, the D2 + CME procedure showed less intra-laparoscopic blood loss, more lymph node harvest, and faster postoperative flatus than the conventional D2 procedure. However, both the overall and severe postoperative adverse events (Clavien–Dindo classification grade ≥ III a) seemed comparable between two cohorts. The present study showed that D2 + CME was associated with better short-term outcomes than conventional D2 dissection for patients with resectable gastric cancer.
Tài liệu tham khảo
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108. https://doi.org/10.3322/caac.21262
Sasako M, Saka M, Fukagawa T, Katai H, Sano T (2007) Surgical treatment of advanced gastric cancer: Japanese perspective. Dig Surg 24(2):101–107. https://doi.org/10.1159/000101896
Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123. https://doi.org/10.1007/s10120-011-0042-4
Giacopuzzi S, Bencivenga M, Cipollari C, Weindelmayer J, de Manzoni G (2017) Lymphadenectomy: how to do it? Transl Gastroenterol Hepatol 2:28. https://doi.org/10.21037/tgh.2017.03.09
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg 69(10):613–616. https://doi.org/10.1002/bjs.1800691019
Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482. https://doi.org/10.1016/s0140-6736(86)91510-2
Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis 11(4):354–365. https://doi.org/10.1111/j.1463-1318.2008.01735.x
West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28(2):272–278. https://doi.org/10.1200/JCO.2009.24.1448
Siani LM, Garulli G (2017) The importance of the mesofascial interface in complete mesocolic excision. Surgeon 15(4):240–249. https://doi.org/10.1016/j.surge.2016.10.006
Kim NK, Kim YW, Han YD et al (2016) Complete mesocolic excision and central vascular ligation for colon cancer: principle, anatomy, surgical technique, and outcomes. Surg Oncol 25(3):252–262. https://doi.org/10.1016/j.suronc.2016.05.009
Xie D, Osaiweran H, Liu L et al (2013) Mesogastrium: a fifth route of metastasis in gastric cancer? Med Hypotheses 80(4):498–500. https://doi.org/10.1016/j.mehy.2012.12.020
Xie D, Liu L, Osaiweran H et al (2015) Detection and characterization of metastatic cancer cells in the mesogastrium of gastric cancer patients [published correction appears in PLoS One. 2016;11(1):e0148681]. PLoS ONE 10(11):e0142970. https://doi.org/10.1371/journal.pone.0142970
Xie D, Gao C, Lu A et al (2015) Proximal segmentation of the dorsal mesogastrium reveals new anatomical implications for laparoscopic surgery. Sci Rep 5:16287. https://doi.org/10.1038/srep16287
Xie D, Yu C, Liu L et al (2016) Short-term outcomes of laparoscopic D2 lymphadenectomy with complete mesogastrium excision for advanced gastric cancer. Surg Endosc 30(11):5138–5139. https://doi.org/10.1007/s00464-016-4847-4
Cao B, Xiao A, Shen J, Xie D, Gong J (2020) An optimal surgical approach for suprapancreatic area dissection in laparoscopic D2 gastrectomy with complete mesogastric excision. J Gastrointest Surg 24(4):916–917. https://doi.org/10.1007/s11605-019-04467-8
Xie D, Wang Y, Shen J, Hu J, Yin P, Gong J (2018) Detection of carcinoembryonic antigen in peritoneal fluid of patients undergoing laparoscopic distal gastrectomy with complete mesogastric excision. Br J Surg 105(11):1471–1479. https://doi.org/10.1002/bjs.10881
Shen J, Cao B, Wang Y et al (2018) Prospective randomized controlled trial to compare laparoscopic distal gastrectomy (D2 lymphadenectomy plus complete mesogastrium excision, D2 + CME) with conventional D2 lymphadenectomy for locally advanced gastric adenocarcinoma: study protocol for a randomized controlled trial. Trials 19(1):432. https://doi.org/10.1186/s13063-018-2790-5
Xie D, Shen J, Liu L et al (2021) Complete mesogastric excision for locally advanced gastric cancer: short-term outcomes of a randomized clinical trial. Cell Rep Med 2(3):100217. https://doi.org/10.1016/j.xcrm.2021.100217
Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of adverse events of surgery with examples of utility in cholecystectomy. Surgery 111(5):518–526
Hu Y, Huang C, Sun Y et al (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34(12):1350–1357. https://doi.org/10.1200/JCO.2015.63.7215
Lee HJ, Hyung WJ, Yang HK et al (2019) Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 270(6):983–991. https://doi.org/10.1097/SLA.0000000000003217
Inaki N, Etoh T, Ohyama T et al (2015) A multi-institutional, prospective, Phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39(11):2734–2741. https://doi.org/10.1007/s00268-015-3160-z
Smith DD, Schwarz RR, Schwarz RE (2005) Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol 23(28):7114–7124. https://doi.org/10.1200/JCO.2005.14.621
Baxter NN, Tuttle TM (2005) Inadequacy of lymph node staging in gastric cancer patients: a population-based study. Ann Surg Oncol 12(12):981–987. https://doi.org/10.1245/ASO.2005.03.008
Li B, Li Y, Wang W et al (2016) Incorporation of N0 stage with insufficient numbers of lymph nodes into N1 stage in the seventh edition of the TNM classification improves prediction of prognosis in gastric cancer: results of a single-institution study of 1258 Chinese patients. Ann Surg Oncol 23(1):142–148. https://doi.org/10.1245/s10434-015-4578-0
Shinohara T, Satoh S, Kanaya S et al (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27(1):286–294. https://doi.org/10.1007/s00464-012-2442-x
Yu J, Hu J, Huang C et al (2013) The impact of age and comorbidity on postoperative adverse events in patients with advanced gastric cancer after laparoscopic D2 gastrectomy: results from the Chinese laparoscropic gastrointestinal surgery study (CLASS) cohort. Eur J Surg Oncol 39(10):1144–1149. https://doi.org/10.1016/j.ejso.2013.06.021
Yu HW, Jung DH, Son SY et al (2013) Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery. J Gastric Cancer 13(3):179–184. https://doi.org/10.5230/jgc.2013.13.3.179
Kim MC, Kim W, Kim HH et al (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol 15(10):2692–2700. https://doi.org/10.1245/s10434-008-0075-z
Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS (2008) The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 248(5):793–799. https://doi.org/10.1097/SLA.0b013e3181887516
Etoh T, Shiraishi N, Tajima M et al (2007) Transient liver dysfunction after laparoscopic gastrectomy for gastric cancer patients. World J Surg 31(5):1115–1120. https://doi.org/10.1007/s00268-007-0237-3
Kim CH, Song KY, Park CH, Seo YJ, Park SM, Kim JJ (2015) A comparison of outcomes of three reconstruction methods after laparoscopic distal gastrectomy. J Gastric Cancer 15(1):46–52. https://doi.org/10.5230/jgc.2015.15.1.46