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


Background : While laparoscopy for benign diseases provides clear advantages over traditional surgery, the benefits of laparoscopic gastric resection for malignant diseases are less clear. The objectives of this study were to compare prospectively the clinical outcomes between completely laparoscopic and open total and partial gastrectomies for malignant diseases and to assess whether laparoscopic gastrectomies obtain adequate margins and follow oncologic principles.

Methods : Between April 1995 and March 2004, a prospective comparative study was performed comparing eight patients underwent laparoscopic total gastrectomy with eleven patients underwent open total gastrectomy and 16 patients underwent laparoscopic partial gastrectomy with 17 patients underwent open partial gastrectomy. Stage, extent of lymphadenectomy and long term follow-up were examined. The intraoperative and postoperative details of the two groups were compared.

Results : The laparoscopic group patients had less intraoperative complications while the operative time was similar to the open group. Both ambulation and hospital stay were significantly shorter in the laparoscopic groups than in the open groups. The short term morbidity was lower in the laparoscopic groups and there were no cases of death, while one case of postoperative death occurred after an open total gastrectomy. There was no need to convert to open surgery. The number of lymph nodes obtained in the laparoscopic and open procedures was not significantly different. In addition, all resected margins were tumor free in the laparoscopic group, while, tumor involvement was presented in the margin of one specimen in the open group.

Conclusions : The totally laparoscopic approach to total and partial gastrectomies had good results and was proven to be a feasible and safe procedure. In addition, the laparoscopic procedures are superior to open surgeries in terms of faster postoperative recovery, shorter hospital stay and cosmetic outcomes. Totally laparoscopic approach for early and advanced gastric cancer can obtain adequate margins and follow oncologic principles.

Keywords : Laparoscopic gastrectomy- open gastrectomy- Early gastric cancer- Advanced gastric cancer

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