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Minimally invasive surgery for serosa-positive gastric cancer (pT4a) in patients with preoperative diagnosis of cancer without serosal invasion

Authors
 T. Son  ;  W. J. Hyung  ;  J. H. Lee  ;  Y. M. Kim  ;  S. H. Noh 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.28(3) : 866-874, 2014 
Journal Title
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 
ISSN
 0930-2794 
Issue Date
2014
MeSH
Adenocarcinoma/diagnosis ; Adenocarcinoma/mortality ; Adenocarcinoma/surgery* ; Disease-Free Survival ; Female ; Follow-Up Studies ; Gastrectomy/methods* ; Humans ; Japan/epidemiology ; Laparoscopy ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/methods* ; Neoplasm Invasiveness ; Neoplasm Staging/methods* ; Preoperative Period ; Retrospective Studies ; Risk Factors ; Serous Membrane/pathology* ; Stomach Neoplasms/diagnosis ; Stomach Neoplasms/mortality ; Stomach Neoplasms/surgery* ; Survival Rate/trends ; Tomography, X-Ray Computed
Keywords
Minimally invasive surgery ; Advanced gastric cancer ; Recurrence ; Serosal invasion ; Stomach
Abstract
BACKGROUND: Although surgeons normally use minimally invasive surgery (MIS) for patients with early gastric cancer, in Korea and Japan the procedure is also indicated for serosa-negative tumors. Serosal invasion is regarded to be a potential risk factor for peritoneal dissemination as a result of the effect of pneumoperitoneum and tumor manipulation during the operation. We compared operative outcomes between MIS and conventional open surgery for serosa-involved advanced gastric cancer patients who had a preoperative diagnosis of cancer without serosal invasion. METHODS: A total of 61 patients (39 patients treated by MIS and 22 by open surgery) treated between 2003 and 2009 who were first diagnosed preoperatively as serosa negative on the basis of computed tomography, endoscopy, and endoscopic ultrasound but then diagnosed as serosa positive upon final pathology were studied. We retrospectively compared recurrence and survival between the two treatment groups. RESULTS: Clinicopathologic characteristics, clinical stage, extent of surgery, and short-term operative outcome did not differ between the groups. 5-year overall survival (73.5 vs. 67.5 %, p = 0.518, respectively) and disease-free survival (67.8 vs. 54.2 %, p = 0.296, respectively) were comparable between the MIS and open surgery groups. There were recurrences in 12 patients in the MIS group and 11 patients in the open surgery group, with a median follow-up period of 64 months. Recurrence patterns did not differ between the groups; moreover, MIS did not increase peritoneal recurrences compared to open surgery (42.0 vs. 54.5 %, p = 0.537, respectively). In multivariate analyses, the type of surgery was not an independent prognostic factor. CONCLUSIONS: Similar survival and recurrence patterns were observed in advanced gastric cancer patients preoperatively diagnosed as serosa negative who were treated either by MIS or open surgery. MIS may be safely applied in patients with serosa-positive tumors.
Full Text
http://link.springer.com/article/10.1007%2Fs00464-013-3236-5
DOI
10.1007/s00464-013-3236-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yoo Min(김유민)
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Son, Tae Il(손태일) ORCID logo https://orcid.org/0000-0002-0327-5224
Lee, Joong Ho(이중호)
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98250
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