Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection following standardization--a preliminary study.

Tokunaga, Masanori; Hiki, Naoki; Fukunaga, Tetsu; Nohara, Kyoko; Katayama, Hiroshi; Akashi, Yoshimasa; Ohyama, Shigekazu; Yamaguchi, Toshiharu

BACKGROUND Laparoscopy-assisted distal gastrectomy (LADG) with standard D2 dissection is a complex procedure usually performed only by experienced surgeons, and the feasibility of this procedure still remains unclear. METHOD Patients who underwent LADG at the Cancer Institute Hospital between April 2006 and October 2008 were recruited for this study. Early surgical outcomes were compared between patients who underwent complete D2 dissection (complete D2 group; n = 42) and those who underwent D1 + beta dissection (D1 + beta group; n = 179) to determine the feasibility of laparoscopic D2 lymph node dissection. RESULTS In complete D2 group, the operation time was longer (253 +/- 10 vs 224 +/- 4 min; P = 0.005), and the number of retrieved lymph nodes was larger (41 +/- 2 vs 35 +/- 1; P = 0.002) compared with those in D1 + beta group. The other early surgical outcomes monitored for the two groups were not different between groups. CONCLUSIONS LADG with complete D2 lymph node dissection can be performed safely if the procedure is standardized and an experienced laparoscopic surgeon performs the surgery. To be accepted as a standard treatment for advanced gastric cancer, well-designed prospective trial is necessary.