Laparoscopic Gastrectomy Lymphadenectomy and Results of Gastric Cancer

 

Ethicon Laparoscopic Trainer

Ethicon Laparoscopic Trainer

Locally Advanced Gastric Cancer

Definition

Locally advanced gastric cancer invades beyond the submucosa, regardless of lymphatic metastases. Ethicon Laparoscopic Trainer.

During their internship in laparoscopic technique, many of them have not received practical training with Ethicon Laparoscopic Trainer .

This type of cancer requires D2 lymphadenectomy. And unlike lymphadenectomy, it requires dissection of the lymphatic groups that are around larger vessels. Such as the hepatic artery, splenic artery, and the portal vein.

In the latest guidelines, the lymphatic group of the splenic hilum eliminates from the definition of D2 dissection. Due to the limitations of laparoscopy regarding the visibility of these lesions, currently, the surgery of choice for patients with locally advanced gastric cancer is open gastrectomy with lymphadenectomy.

Gaining experience with laparoscopic gastrectomy in early gastric cancer, surgeons started with the laparoscopic approach for locally advanced tumors. The presence of more of this staging encouraged surgeons to perform a greater number of laparoscopic gastrectomy in these patients, compared.

Results

A multicenter, prospective, randomized controlled study, called CLASS-01, conducts from 2012 to 2014. 1000 patients with locally advanced gastric cancer randomly assigns to gastrectomy. laparoscopic vs open, both with D2 lymphatic dissection.

Similar results obtain in laparoscopic vs. open gastrectomy in perioperative morbidity (15% vs. 13%, respectively) and perioperative mortality (0.4% vs. 0%, respectively). Also, both achieved D2 lymphadenectomy rates greater than 99%. At 3 years of the study, laparoscopic vs open gastrectomy achieved a survival similar, disease-free survival (77% vs 78% respectively) and similar recurrence rates (19% vs 17% respectively).

The CLASS-01 study demonstrated that when performed by experienced surgeons, laparoscopic distal gastrectomy with D2 lymphadenectomy is safe and effective for locally advanced gastric cancer. However, one-third of the patients were over-staged and had an early pathological stage.

No patient received neoadjuvant therapy, contrary to what usually recommends in Western guidelines. Unlike Western patients, most of these patients require a distal gastrectomy, so it considers as a limitation. The study, a randomized controlled trial, in which 180 patients compares, the technical safety of laparoscopic gastrectomy with D2 dissection demonstrates in the study.

There is currently a phase III study to evaluate long-term results as well. A randomized controlled trial that seeks to compare the effectiveness of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced cancer.

The studies cited above suggest that laparoscopic gastrectomy is safe, feasible and onco-logically validated when performed by experienced surgeons, although long-term data not yet accumulates.

Patient Selection

If you decide to perform a laparoscopic gastrectomy or an open gastrectomy, you must consider some factors that will mentions in detail. Laparoscopic Training simulation with Ethicon Laparoscopic Trainer is a prudent choice.

Surgeon Factors

Laparoscopic gastrectomy is a requesting technique that requires progressed abilities and cooperation. The specialist should have insight with complex and progressed minimally invasive gastrointestinal procedure.

This type of laparoscopic surgery is a complicated procedure, the learning curve associated with mastering performing the operation D2 lymphadenectomy and reconstruction can be quite steep.

Studies from Eastern countries estimated that surgeons would require at least 40 to 60, and possibly more than 90 laparoscopic distal gastrectomy cases, or more than 100 laparoscopic total gastrectomy cases to become competent. In at least one study, performing fewer than 45 cases of laparoscopic total gastrectomy was associated with increased morbidity.

Hospital Factors

If a complication occurs, optimal hospital resources must be available, additional support from critical care intensivists, therapeutic gastroenterologists, and interventional radiologists may be necessary. Expert physiotherapy and nutritional support services are also essential for good results, as many gastric cancer patients come to surgery in frail or debilitated condition.

Patient Factors

Patient-related factors include body habitus, comorbidities, and cancer stage. Patients who have early gastric cancer and those who are free of significant cardiopulmonary comorbidities, obesity, and previous upper abdominal surgery are the best candidates for laparoscopy. Patients with chronic obstructive pulmonary disease (COPD) or heart disease may not tolerate prolonged pneumoperitoneum.

Such patients could benefit from an open approach. Obesity can make laparoscopic gastrectomy with D2 lymphadenectomy technically challenging. Studies from Eastern countries found that laparoscopic gastrectomy in obese patients may require a longer operative time than open gastrectomy, although lymph node dissection, postoperative recovery and complication rate were not different.

Previous abdominal surgery can make laparoscopy technically challenging due to the presence of adhesions or altered anatomy. However, this factor alone should not prevent the laparoscopic approach.

Stage Of the Neoplasm

Patients with early-stage disease without local invasion into surrounding structures or bulky lymphadenopathy are optimal candidates for surgeons to initiate laparoscopic expertise, as are patients with locally advanced cancer who have responded well to neoadjuvant therapy.

Conclusion

In the most recent rules, the lymphatic gathering of the splenic hilum dispenses with from the meaning of D2 analyzation. Because of the limits of laparoscopy in regards to the perceivability of these wounds, as of now, the medical procedure of decision for patients with privately progressed gastric malignant growth is open gastrectomy with lymphadenectomy.

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