Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic surgery benefits for benign diseases are established, but its advantages for malignant gastric conditions remain less clear.
• Assessing oncologic principles and margin adequacy is crucial for laparoscopic gastric resections.

Purpose of the Study:

• To prospectively compare clinical outcomes of laparoscopic versus open total and partial gastrectomies for malignant diseases.
• To evaluate the oncologic safety, including margin status and lymphadenectomy, of laparoscopic gastrectomies.

Main Methods:

• A prospective comparative study involving 8 laparoscopic and 11 open total gastrectomies, and 16 laparoscopic and 17 open partial gastrectomies.
• Comparison of intraoperative and postoperative details, including complications, recovery, and oncologic parameters like lymph node retrieval and margin status.

Main Results:

• Laparoscopic gastrectomies showed fewer intraoperative complications and significantly shorter ambulation and hospital stays.
• Short-term morbidity was lower in the laparoscopic group, with no deaths, versus one death in the open group.
• Adequate lymph node retrieval and tumor-free margins were achieved in the laparoscopic group, comparable to open procedures.

Conclusions:

• Totally laparoscopic gastrectomies are feasible, safe, and demonstrate good clinical outcomes for gastric cancer.
• Laparoscopic procedures offer superior postoperative recovery, shorter hospital stays, and better cosmetic results compared to open surgery.
• The laparoscopic approach for gastric cancer effectively obtains adequate margins and adheres to oncologic principles.