Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery

BACKGROUND: Laparoscopy-assisted approaches have become popular for dissecting early-stage gastric cancer in Japan, but the outcomes after 5 years of followup have not been reported. STUDY DESIGN: Between January 1998 and March 2002, 94 patients with histologically proved early-stage gastric carcinoma participated in clinical studies and underwent gastrectomy with regional lymphadenectomy to evaluate feasibility and safety of the laparoscopy-assisted approach. Outcomes and pattern of disease failure during followup up to 5 years were evaluated in all patients. Multivariable analysis was performed to identify relevant prognostic factors. RESULTS: Conversion to open procedures occurred in three patients. Median blood loss was 90 mL (interquartile range, 160 mL), and duration of operation was 230 minutes (interquartile range, 60 minutes). Operative morbidity and mortality were 22.3% and 0%, respectively. Nine patients died during the course of followup, for an overall 5-year survival rate of 90%. Two patients died of recurrent disease, and 2 other patients have been diagnosed with recurrences, for a 5-year recurrence-free survival of 95.6%. Three patients with recurrent cancer, including 1 with port-site recurrence, had stage IA disease (pT1pN0) at operation. Diabetes mellitus as a comorbidity was prominent as a prognostic factor. CONCLUSIONS: Outcomes of patients with a preoperative diagnosis of early-stage cancer were excellent when treated with a laparoscopy-assisted approach, although rare patterns of disease failure were observed.