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Original Article
Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2
Kyung Won Seo1, Kae Won Park2, Ki Young Yoon1
Kosin Medical Journal 2013;28(1):27-33.
DOI: https://doi.org/10.7180/kmj.2013.28.1.27
Published online: January 19, 2013

1Department of Surgery, College of Medicine, Kosin University, Busan, Korea

2Postgraduate school, College of Medicine, Kosin University, Busan, Korea

Corresponding author: Ki Young YOON, Department of Surgery, College of Medicine, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan, 602-703, Republic of Korea TEL: +82-51-990-6462 FAX: +82-51-246-6093 E-mail: yoonkiyoung@naver.com
• Received: August 14, 2012   • Accepted: January 28, 2013

Copyright © 2013 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Objectives
    Laparoscopy-assisted distal gastrectomy (LADG) is a common surgical procedure that has recently been accepted as safe and feasible for the treatment of early gastric cancer. There have been many efforts to expand the indications of LADG to include the treatment of advanced gastric cancer. The aim of this study was to determine the usefulness of noncompliance rate as an indicator for D2 lymph node dissection (LND) validation in LADG.
  • Methods
    The subjects were 48 patients who underwent distal gastrectomy with D2 LND at Kosin University Gospel Hospital from October to December 2010. Of them, 28 underwent LADG and 20 underwent open distal gastrectomy (ODG). We compared several factors including noncompliance rate to validate D2 LND.
  • Results
    There were no significant differences in clinicopathologic factors except for BMI and tumor depth between the two groups. The average number of retrieved lymph nodes was significantly greater in the ODG group (45.9 ± 2.9) than in the LADG group (35.5 ± 2.0). The noncompliance rate was 43% in the LADG group and 40% in the ODG group with no significant difference.
  • Conclusions
    In terms of no difference of noncompliance rate, LADG with D2 lymph node dissection is a safe, feasible and oncologicallycamparable with open gastrectomy. A large scaled prospective randomized trial should be needed to confirm the benefit of LADG.
  • Keywords: Advanced gastric cancer; Gastric neoplasms; Laparoscopy-assisted distal gastrectomy; Noncompliance rate
Table 1.
Patient clinicopathologic characteristics
Variables LADG (n = 28) ODG (n = 20) P
Sex M 21 15 1.000
F 7 5
BMI 23.7 ± 0.49 22.0 ± 0.45 0.019
T stage T1 26 8 0.001
T2 1 2
T3 1 5
T4 0 5
N stage N0 27 12 0.015
N1 1 4
N2 0 2
N3 0 2
Anastomosis Billroth I 23 16 0.856
Billroth II 5 4

Mean ± SEM.

Table 2.
Patient surgical outcomes
Variables LADG (n = 28) ODG (n = 20) P
Estimated blood loss 117.8 ± 18.2 230.0 ± 27.2 0.002
Op. time (min.) 199.6 ± 11.4 190.7 ± 7.7 0.521
Retrieved LN 35.5 ± 2.0 45.9 ± 2.9 0.006
Noncompliance rate 0.43 0.4 0.847
Hospital stay (days) 7.2 8.4 0.678
First flatus (days) 2.7 3.3 0.785
Starting semi-liquid diet 3 3 1
  • 1.Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y. Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years' experience. Surg Laparosc Endosc Percutan Tech 2002;12:204–7.ArticlePubMed
  • 2.Hur H, Jeon HM, Kim W. Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years' experience. J Surg Oncol 2008;98:515–9.ArticlePubMed
  • 3.Lee J, Kim W. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol 2009;100:693–8.ArticlePubMed
  • 4.Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH. Laparo-scopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 2009;23:1252–8.ArticlePubMed
  • 5.Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10–24.ArticlePubMedPDF
  • 6.Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004;22:2069–77.ArticlePubMed
  • 7.Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999;79:1522–30.ArticlePubMedPMC
  • 8.Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer 2002;5:1–5.Article
  • 9.Huang JL, Wei HB, Zheng ZH, Wei B, Chen TF, Huang Y, et al. Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer. Dig Surg 2010;27:291–6.ArticlePubMed
  • 10.Tokunaga M, Hiki N, Fukunaga T, Nohara K, Katayama H, Akashi Y, et al. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection following standardization--a preliminary study. J Gastrointest Surg 2009;13:1058–63.ArticlePubMed
  • 11.Lee JH, Kim YW, Ryu KW, Lee JR, Kim CG, Choi IJ, et al. A phase-II clinical trial of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients. Ann Surg Oncol 2007;14:3148–53.ArticlePubMed
  • 12.Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 2010;13:238–44.ArticlePubMed
  • 13.COACT. Feasibility Study of Laparoscopy-assisted D2 Distal Gastrectomy to Treat Advanced Gastric Cancer (COACT_1001). 2010;[updated 2010-06-16]; Available from:.http://www.clinicaltrial.gov/ct2/show/NCT01088204?term=COACT&rank=3.
  • 14.KLASS. Standardization of D2 Lymphadenectomy and Surgical Quality Control: KLASS-02-QC. 2011;[updated January 25, 2011]; Available from:.http://www.clinicaltrial.gov/ct2/show/NCT01283893?term=KLASS&rank=2.

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        Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2
        Kosin Med J. 2013;28(1):27-33.   Published online January 19, 2013
        DOI: https://doi.org/10.7180/kmj.2013.28.1.27
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      Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2
      Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2

      Patient clinicopathologic characteristics

      Variables LADG (n = 28) ODG (n = 20) P
      Sex M 21 15 1.000
      F 7 5
      BMI 23.7 ± 0.49 22.0 ± 0.45 0.019
      T stage T1 26 8 0.001
      T2 1 2
      T3 1 5
      T4 0 5
      N stage N0 27 12 0.015
      N1 1 4
      N2 0 2
      N3 0 2
      Anastomosis Billroth I 23 16 0.856
      Billroth II 5 4

      Patient surgical outcomes

      Variables LADG (n = 28) ODG (n = 20) P
      Estimated blood loss 117.8 ± 18.2 230.0 ± 27.2 0.002
      Op. time (min.) 199.6 ± 11.4 190.7 ± 7.7 0.521
      Retrieved LN 35.5 ± 2.0 45.9 ± 2.9 0.006
      Noncompliance rate 0.43 0.4 0.847
      Hospital stay (days) 7.2 8.4 0.678
      First flatus (days) 2.7 3.3 0.785
      Starting semi-liquid diet 3 3 1
      Table 1. Patient clinicopathologic characteristics

      Mean ± SEM.

      Table 2. Patient surgical outcomes

      Table 1.

      Table 2.

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