Validation of the effectiveness of Gastric Carcinectomy and Laparoscopic Surgery for 10 Years

Endoscopy and laparoscopic surgery are common in earlier stage of Gastric cancer but this is not the case in advanced gastric cancer. There was an opinion that cancer should be removed by laparotomy. However laparoscopic surgery is less complicated than laparotomy and the result of surgery(recurrence rate) is about the same.

The research team of the Korean association of oncologists, which consists of 20 surgeons from 13 medical institutions including Professor Han Sang-wook of Ajou University Hospital and Professor Hyung Woo-jin of Severance Hospital, published the results of a comparative analysis for the safety and effectiveness of laparotomy and laparoscopic surgery in August of the Journal of Clinical Oncology.

The research team randomly selected a total of 1,050 patients , 524 patients who underwent laparoscopic surgery and 525 patients who underwent laparoscopic surgery from November 2011 to April 2015, and finally analyzed 492 patients for laparoscopic surgery, excluding 76 patients according to the exclusion criteria. It did not include the metastasis to another organ.

492 patients who underwent laparoscopic surgery, they did laparoscopic gastrectomy(surgery to connect the remaining stomach and small intestine after the removal of the stomach 2/3)and D2 lymph node resection (surgery to remove the stomach for advanced gastric cancer and remove all lymph nodes around it) As a result, laparoscopic surgery was significantly lower than laparoscopic surgery in both initial complications(laparoscopic surgery vs laparotomy,15.7% vs 23.4%) and late complications(4.7% vs 9.5%)

Especially, laparoscopic surgery was significantly low with 2.0% and 4.4% of intestinal obstruction after surgery due to late complications. If intestinal obstruction occur after surgery, not only will destroy quality of life but also if it is serious, the person can lose their life.

The research team proved that the safety of laparoscopic surgery through mortality after earlier stage of gastric cancer surgery and initial complications in the previous KLASS-01 study and comfirmed that laparoscopic surgery can reduce postoperative complications even for locally advanced gastric cancer.

Moreover, in the case of the 3 years of no recurring rate, which is most worrisome after surgery, laparoscopic surgery was 80.3% and laparotomy was 81.3% , meaningless difference between the two patients groups. Multivariate analysis which corrects the experience of participating surgeons, also found that surgical methods do not affect patients' recurrence rate. In other words, there was no difference in the recurrence rate between laparotomy and laparoscopic surgery.

Han Sang-wook, professor of gastroenterology at Ajou University Hospital and responsible director of this research journal said, " The results of this research are a clinical test of the efficacy of laparoscopic surgery and laparoscopic surgery for gastric cancer by many surgeons in 13 medical institutions over the past 10 years. It is significant that we have established standard guidelines for laparoscopic surgery for gastric cancer worldwide."

In addition, he also said "gastric cancer is the most common cancer among Korean and it is worthwhile to offer safe surgical procedures to many patients suffering from gastric cancer."

Laparoscopic surgery is surgical method of making 4~5 small holes in the stomach and inserting endoscopy and surgical tools through the holes to resect the desired area and the incision site is small because it makes a hole not opening it. It has many advantages such as a small scar, less pain and a quick recovery so it is commonly implemented in many diseases.

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Severance Hospital(연세대학교 의과대학 세브란스병원)
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