Araştırma Makalesi
Yıl 2019,
Cilt: 44 Sayı: 4, 1347 - 1356, 29.12.2019
Öz
Amaç: Bu çalışmada bir üniversite kliniğinde gerçekleştirilen laparoskopik gastrektomilerin erken dönem sonuçlarının paylaşılması amaçlanmıştır.
Gereç ve Yöntem: Eylül 2015- Eylül 2018 tarihleri arasında yapılan laparoskopik gastrektomiler total ve distal olmak üzere iki gruba ayrılmış, teknik, patolojik sonuç ve erken postoperatif komplikasyonlar açısından incelenmiştir.
Bulgular: Çalışmaya 11’i erkek, 7’si kadın olmak üzere 18 hasta dahil edilmiştir. Yaş ortalaması 57,4 olup, ortalama BMI 26,3 idi. 13 hastada cerrahi ilk planda tutulmuş sadece beş hastaya neoadjuvan tedavi protokolü uygulanmıştır. Total gastrektomi 14 hastada, distal gastrektomi 4 hastada tercih edilen ameliyat yöntemidir. Tüm hastalara tümör yerleşimine göre standart D2 lenf disseksiyonu uygulandı ve Total gastrektomi grubunda Ortalama 33,2 distal gastrektomi grubunda 32 lenf nodu disseke edildi. Ortalama oral başlama süresi ve Total gastrektomi grubunda 6,4 gün distal gastrektomi grubunda 2,5 gün idi. Duodenal güdük kaçağı 4 hastada, özefagojejunostomi kaçağı 2 hastada tespit edilirken 1 hastada da dren yerinde kanama görüldü.
Sonuç: Laparoskopik gastrektomi ve lenfatik disseksiyonun yeterliliğini gösteren birçok çalışma bulunmaktadır. Ancak öğrenim süreci uzun, teknik zorlukları fazla olan bu ameliyatlarda deneyim ve tecrübe arttıkça ameliyat sürenin kısalacağını ve komplikasyon oranının azalacağını düşünmekteyiz.
Anahtar Kelimeler
Kaynakça
- 1-Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011; 61:69.
- 2-Türkiye'de Kanser İstatistikleri. Available at: https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/istatistik/Turkiye_Kanser_Istatistikleri_2015.pdf
- 3- Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopyassisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4:146–148.
- 4- 7. H. Hayashi, T. Ochiai, H. Shimada, and Y. Gunji, “Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy withextraperigastric lymph node dissection for early gastric cancer,” Surgical Endoscopy, vol. 19, no. 9, pp. 1172–1176, 2005.
- 5. C. G. Huscher, A. Mingoli, G. Sgarzini et al., “Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: _ve-year results of arandomized prospective trial,” Annals of Surgery, vol. 241, no. 2, pp. 232–237, 2005.
- 6. S. Kitano, N. Shiraishi, K. Fujii, K. Yasuda, M. Inomata, and Y. Adachi, “A randomized controlled trial comparing open vs laparoscopyassisted distal gastrectomy for the treatment of early gastric cancer: an interim report,” Surgery, vol. 131, Supplement 1, pp. S306–S311, 2002.
- 7- Hur, H., Lee, H. Y., Lee, H. J., Kim, M. C., Hyung, W. J., Park, Y. K., ... & Han, S. U. (2015). Efficacy of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer: the protocol of the KLASS-02 multicenter randomized controlled clinical trial. BMC cancer, 15(1), 355.
- 8- He, H., Li, H., Su, X., Li, Z., Yu, P., Huang, H., ... & Yu, J. (2018). Study on safety of laparoscopic total gastrectomy for clinical stage I gastric cancer: the protocol of the CLASS02–01 multicenter randomized controlled clinical trial. BMC cancer, 18(1), 944.
- 9- Etoh, T., Shiroshita, H., Shiraishi, N., Kitano, S., & Inomata, M. (2016). Ongoing clinical studies of minimally invasive surgery for gastric cancer in Japan. Translational gastroenterology and hepatology,
- 10-Kim HH, Hyung WJ, Cho GS et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg, 251(3), 417-420 (2010).
- 11-. W. Kim, H. H. Kim, S. U. Han et al., “Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01),” Annals of Surgery, vol. 263, no. 1, pp. 28–35, 2016.
- 12 Y. Hu, C. Huang, Y. Sun et al., “Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial,” Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 34, no. 12, pp.1350–1357, 2016.
- 13-Park YK, Yoon HM, Kim YW et al. Laparoscopy-Assisted versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: Results from a Randomized Phase II Multicenter Clinical Trial (COACT 1001). Ann Surg, (2017).
- 14- Lu, J., Huang, C. M., Zheng, C. H., Li, P., Xie, J. W., Wang, J. B., ... & Lin, M. (2015). Short-and long-term outcomes after laparoscopic versus open total gastrectomy for elderly gastric cancer patients: a propensity score-matched analysis. Journal of gastrointestinal surgery, 19(11), 1949-1957.
- 15-Jeong O, Ryu SY, Zhao XF, Jung MR, Kim KY, Park YK. Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma:experience at a large-volume center. Surg Endosc, 26(12), 3418-3425 (2012).
- 16-Lee, J., & Kim, W. (2013). Clinical experience of 528 laparoscopic gastrectomies on gastric cancer in a single institution. Surgery, 153(5), 611-618.
- 17-Lee, S. W., Nomura, E., Bouras, G., Tokuhara, T., Tsunemi, S., & Tanigawa, N. (2010). Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. Journal of the American College of Surgeons, 211(1), 33-40.
- 18-Li G, Hu Y, Liu H. Current status of randomized con¬trolled trials for laparoscopic gastric surgery for gastric cancer in China. Asian J Endosc Surg. 2015;8:263-7..
- 19-Karaköse, O., Karagül, S., & Aslan, M. Laparoscopic surgery for gastric tumor: a single-center experience. Laparoscopic Endoscopic Surgical Science (LESS), 25(2), 43-46.
- 20-Haverkamp, L., Ruurda, J. P., Offerhaus, G. J. A., Weijs, T. J., Van Der Sluis, P. C., & Van Hillegersberg, R. (2016). Laparoscopic gastrectomy in Western European patients with advanced gastric cancer. European Journal of Surgical Oncology (EJSO), 42(1), 110-115.
- 21-Bjelović, M., Veselinović, M., Gunjić, D., Babić, T., & Nikolić, L. (2018). Short-term outcomes of laparoscopic radical gastrectomy for advanced gastric neoplasms: single center experience. Srp Arh Celok Lek, 146(1-2), 31-5.
- 22-Bahri Çakabay ve ett all Laparoscopic Gastrectomy in Stomach Cancer:a Single-Center Experience Endoskopik Laparoskopik & Minimal ‹nvaziv Cerrahi Dergisi 2011; 18(4)
- 23-Li, Z., Bai, B., Zhao, Y., Yu, D., Lian, B., Liu, Y., & Zhao, Q. (2018). Severity of complications and long-term survival after laparoscopic total gastrectomy with D2 lymph node dissection for advanced gastric cancer: A propensity score-matched, case–control study. International Journal of Surgery, 54, 62-69
- 24-Fecso, A. B., Bhatti, J. A., Stotland, P. K., Quereshy, F. A., & Grantcharov, T. P. (2018). Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery. Annals of surgery.
- 25-Pisarska, M., Pędziwiatr, M., Major, P., Kisielewski, M., Migaczewski, M., Rubinkiewicz, M., ... & Budzyński, A. (2017). Laparoscopic gastrectomy with enhanced recovery after surgery protocol: single-center experience. Medical science monitor: international medical journal of experimental and clinical research, 23, 1421.
- 26- Ye, L. Y., Liu, D. R., Li, C., Li, X. W., Huang, L. N., Ye, S., ... & Chen, L. (2013). Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer. Journal of Zhejiang University SCIENCE B, 14(6), 468-478
- 27-Kim, H. L., Puymon, M. R., Qin, M., Guru, K., & Mohler, J. L. (2013). NCCN Clinical practice guidelines in oncology™.
- 28-Smyth, E. C., Verheij, M., Allum, W., Cunningham, D., Cervantes, A., & Arnold, D. (2016). Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 27(suppl_5), v38-v49.
- 29-Siewert, J. R., Böttcher, K., Stein, H. J., & Roder, J. D. (1998). Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Annals of surgery, 228(4), 449.
- 30- Japanese Gastric Cancer Association. “Japanese gastric cancer treatment guidelines 2014 (ver. 4)” Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association vol. 20,1 (2016): 1-19.
- 31-Cai, J., Wei, D., Gao, C.F., Zhang, C.S., Zhang, H., Zhao, T., 2011. A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig. Surg., 28(5-6):331-337. [doi:10.1159/000330782]
- 32-Norero, E., Funke, R., Garcia, C., Fernandez, J. I., Lanzarini, E., Rodriguez, J., ... & Gonzalez, P. (2018). National Trend in Laparoscopic Gastrectomy for Gastric Cancer: Analysis of the National Register in Chile. Digestive surgery.
- 33-Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery, 240(2), 205
- 34- Usui, S., Yoshida, T., Ito, K., Hiranuma, S., Kudo, S. E., & Iwai, T. (2005). Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 15(6), 309-314.
- 35- Honda, M., Kumamaru, H., Etoh, T., Miyata, H., Yamashita, Y., Yoshida, K., ... & Seto, Y. (2018). Surgical risk and benefits of laparoscopic surgery for elderly patients with gastric cancer: a multicenter prospective cohort study. Gastric Cancer, 1-8.
Yıl 2019,
Cilt: 44 Sayı: 4, 1347 - 1356, 29.12.2019
Öz
Purpose: The aim of this study was to evaluate the early results of laparoscopic gastrectomy performed in a university clinic.
Materials and Methods: Laparoscopic gastrectomy performed between September 2015 and September 2018 were divided into two groups as total and distal, and evaluated in terms of the technical, pathological and early postoperative complications.
Results: Eighteen patients (11 male and 7 female) were included in the study. The mean age was 57.4 and the mean BMI was 26.3. Surgical treatment was prioritised in 13 patients and only five patients underwent neoadjuvant treatment protocols. Total gastrectomy was the preferred surgical method in 14 patients and distal gastrectomy in 4 patients. All patients underwent standard D2 lymph dissection according to tumor localization and 33.2 was the mean number of lymph nodes dissected in the total gastrectomy group; while a mean of 32 lymph nodes were dissected in the distal gastrectomy group. The mean oral start time was 6.4 days in the total gastrectomy group and 2.5 days in the distal gastrectomy group. Duodenal stump leak was detected in 4 patients, esophagojejunostomy leak was detected in 2 patients, while 1 patient had bleeding in the drain location.
Conclusion: There are many studies demonstrating the adequacy of laparoscopic gastrectomy and lymphatic dissection. However, we believe that as the experience increases in these surgeries with many technical difficulties and a long learning duration; the operation time will be shortened and the complication rate will decrease.
Anahtar Kelimeler
Kaynakça
- 1-Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011; 61:69.
- 2-Türkiye'de Kanser İstatistikleri. Available at: https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/istatistik/Turkiye_Kanser_Istatistikleri_2015.pdf
- 3- Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopyassisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4:146–148.
- 4- 7. H. Hayashi, T. Ochiai, H. Shimada, and Y. Gunji, “Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy withextraperigastric lymph node dissection for early gastric cancer,” Surgical Endoscopy, vol. 19, no. 9, pp. 1172–1176, 2005.
- 5. C. G. Huscher, A. Mingoli, G. Sgarzini et al., “Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: _ve-year results of arandomized prospective trial,” Annals of Surgery, vol. 241, no. 2, pp. 232–237, 2005.
- 6. S. Kitano, N. Shiraishi, K. Fujii, K. Yasuda, M. Inomata, and Y. Adachi, “A randomized controlled trial comparing open vs laparoscopyassisted distal gastrectomy for the treatment of early gastric cancer: an interim report,” Surgery, vol. 131, Supplement 1, pp. S306–S311, 2002.
- 7- Hur, H., Lee, H. Y., Lee, H. J., Kim, M. C., Hyung, W. J., Park, Y. K., ... & Han, S. U. (2015). Efficacy of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer: the protocol of the KLASS-02 multicenter randomized controlled clinical trial. BMC cancer, 15(1), 355.
- 8- He, H., Li, H., Su, X., Li, Z., Yu, P., Huang, H., ... & Yu, J. (2018). Study on safety of laparoscopic total gastrectomy for clinical stage I gastric cancer: the protocol of the CLASS02–01 multicenter randomized controlled clinical trial. BMC cancer, 18(1), 944.
- 9- Etoh, T., Shiroshita, H., Shiraishi, N., Kitano, S., & Inomata, M. (2016). Ongoing clinical studies of minimally invasive surgery for gastric cancer in Japan. Translational gastroenterology and hepatology,
- 10-Kim HH, Hyung WJ, Cho GS et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg, 251(3), 417-420 (2010).
- 11-. W. Kim, H. H. Kim, S. U. Han et al., “Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01),” Annals of Surgery, vol. 263, no. 1, pp. 28–35, 2016.
- 12 Y. Hu, C. Huang, Y. Sun et al., “Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial,” Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 34, no. 12, pp.1350–1357, 2016.
- 13-Park YK, Yoon HM, Kim YW et al. Laparoscopy-Assisted versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: Results from a Randomized Phase II Multicenter Clinical Trial (COACT 1001). Ann Surg, (2017).
- 14- Lu, J., Huang, C. M., Zheng, C. H., Li, P., Xie, J. W., Wang, J. B., ... & Lin, M. (2015). Short-and long-term outcomes after laparoscopic versus open total gastrectomy for elderly gastric cancer patients: a propensity score-matched analysis. Journal of gastrointestinal surgery, 19(11), 1949-1957.
- 15-Jeong O, Ryu SY, Zhao XF, Jung MR, Kim KY, Park YK. Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma:experience at a large-volume center. Surg Endosc, 26(12), 3418-3425 (2012).
- 16-Lee, J., & Kim, W. (2013). Clinical experience of 528 laparoscopic gastrectomies on gastric cancer in a single institution. Surgery, 153(5), 611-618.
- 17-Lee, S. W., Nomura, E., Bouras, G., Tokuhara, T., Tsunemi, S., & Tanigawa, N. (2010). Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. Journal of the American College of Surgeons, 211(1), 33-40.
- 18-Li G, Hu Y, Liu H. Current status of randomized con¬trolled trials for laparoscopic gastric surgery for gastric cancer in China. Asian J Endosc Surg. 2015;8:263-7..
- 19-Karaköse, O., Karagül, S., & Aslan, M. Laparoscopic surgery for gastric tumor: a single-center experience. Laparoscopic Endoscopic Surgical Science (LESS), 25(2), 43-46.
- 20-Haverkamp, L., Ruurda, J. P., Offerhaus, G. J. A., Weijs, T. J., Van Der Sluis, P. C., & Van Hillegersberg, R. (2016). Laparoscopic gastrectomy in Western European patients with advanced gastric cancer. European Journal of Surgical Oncology (EJSO), 42(1), 110-115.
- 21-Bjelović, M., Veselinović, M., Gunjić, D., Babić, T., & Nikolić, L. (2018). Short-term outcomes of laparoscopic radical gastrectomy for advanced gastric neoplasms: single center experience. Srp Arh Celok Lek, 146(1-2), 31-5.
- 22-Bahri Çakabay ve ett all Laparoscopic Gastrectomy in Stomach Cancer:a Single-Center Experience Endoskopik Laparoskopik & Minimal ‹nvaziv Cerrahi Dergisi 2011; 18(4)
- 23-Li, Z., Bai, B., Zhao, Y., Yu, D., Lian, B., Liu, Y., & Zhao, Q. (2018). Severity of complications and long-term survival after laparoscopic total gastrectomy with D2 lymph node dissection for advanced gastric cancer: A propensity score-matched, case–control study. International Journal of Surgery, 54, 62-69
- 24-Fecso, A. B., Bhatti, J. A., Stotland, P. K., Quereshy, F. A., & Grantcharov, T. P. (2018). Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery. Annals of surgery.
- 25-Pisarska, M., Pędziwiatr, M., Major, P., Kisielewski, M., Migaczewski, M., Rubinkiewicz, M., ... & Budzyński, A. (2017). Laparoscopic gastrectomy with enhanced recovery after surgery protocol: single-center experience. Medical science monitor: international medical journal of experimental and clinical research, 23, 1421.
- 26- Ye, L. Y., Liu, D. R., Li, C., Li, X. W., Huang, L. N., Ye, S., ... & Chen, L. (2013). Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer. Journal of Zhejiang University SCIENCE B, 14(6), 468-478
- 27-Kim, H. L., Puymon, M. R., Qin, M., Guru, K., & Mohler, J. L. (2013). NCCN Clinical practice guidelines in oncology™.
- 28-Smyth, E. C., Verheij, M., Allum, W., Cunningham, D., Cervantes, A., & Arnold, D. (2016). Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 27(suppl_5), v38-v49.
- 29-Siewert, J. R., Böttcher, K., Stein, H. J., & Roder, J. D. (1998). Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Annals of surgery, 228(4), 449.
- 30- Japanese Gastric Cancer Association. “Japanese gastric cancer treatment guidelines 2014 (ver. 4)” Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association vol. 20,1 (2016): 1-19.
- 31-Cai, J., Wei, D., Gao, C.F., Zhang, C.S., Zhang, H., Zhao, T., 2011. A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig. Surg., 28(5-6):331-337. [doi:10.1159/000330782]
- 32-Norero, E., Funke, R., Garcia, C., Fernandez, J. I., Lanzarini, E., Rodriguez, J., ... & Gonzalez, P. (2018). National Trend in Laparoscopic Gastrectomy for Gastric Cancer: Analysis of the National Register in Chile. Digestive surgery.
- 33-Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery, 240(2), 205
- 34- Usui, S., Yoshida, T., Ito, K., Hiranuma, S., Kudo, S. E., & Iwai, T. (2005). Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 15(6), 309-314.
- 35- Honda, M., Kumamaru, H., Etoh, T., Miyata, H., Yamashita, Y., Yoshida, K., ... & Seto, Y. (2018). Surgical risk and benefits of laparoscopic surgery for elderly patients with gastric cancer: a multicenter prospective cohort study. Gastric Cancer, 1-8.
Toplam 35 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi, Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Aralık 2019 |
| Kabul Tarihi | 26 Nisan 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 44 Sayı: 4 |
