Optimal Management of Gastric Cancer. Laparoscopic Versus Open Gastrectomy 2014
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LETTER TO THE EDITOR Optimal Management of Gastric Cancer: Laparoscopic Versus Open Gastrectomy To the Editor: W ith interest, we read the original article on optimal management of gastric cancer, entailing results from an international RAND/UCLA expert panel, published in Annals of Surgery. 1 First, an extensive study of literature about gastric can- cer, considering preoperative workup, multi- disciplinary care, treatment decision-making, surgical considerations, and provider consid- erations was conducted. Afterwards, results were anonymously graded by an expert panel on appropriateness and necessity. Regarding laparoscopic versus open gastrectomy, the au- thors conclude that short-term data are en- couraging for a laparoscopic approach, but further research in larger randomized con- trolled trials (RCTs) is required, in accordance with the NCCN guidelines. 2 We do agree with the conclusion by the authors that further re- search is necessary; however, we would like to elaborate. Several studies have assessed a laparo- scopic versus an open approach in treatment of gastric cancer. 3,4 However, as stated by the authors, most RCTs have focused on early gastric cancer. Most of these studies were con- ducted in Asian countries, where incidence of Disclosure: No funding was received for this work, and the authors declare no conflicts of interest. Copyright C 2014 by Lippincott Williams & Wilkins ISSN: 0003-4932/14/00000-0001 DOI: 10.1097/SLA.0000000000000694 gastric cancer is higher. The screening pro- gram in Japan, which started in 1983, has enabled early detection and treatment of gas- tric carcinomas in these countries. 5 As such, tumor stages are lower at the time of diag- nosis when compared with Western coun- tries. Therefore, it is difficult to translate these results to a population where no screening exists. 6 Only a few Western studies were con- ducted that compare laparoscopic and open approaches for gastric cancer. An important previous finding is that laparoscopic gastrec- tomy showed similar results to open gastrec- tomy with regard to quality of oncological resection, as measured by the number of re- trieved lymph nodes and 5-year survival, 7 whereas patient recovery was faster and ad- mission duration shorter. 8,9 However, these studies were underpowered and do not take into account neoadjuvant therapy and long- term follow-up. A prospective trial concerning this sub- ject is underway from our institution (www .stomach-trial.com). In the meanwhile, our meta-analysis has shown that minimally in- vasive gastrectomy is a safe and feasible al- ternative to the open procedure. 10 Jennifer Straatman, MD Miguel A. Cuesta, MD, PhD Donald L. van der Peet, MD, PhD VU Medical Centre Department of Gastrointestinal Surgery De Boelelaan, Amsterdam, The Netherlands [email protected] REFERENCES 1. Coburn N, Seevaratnam R, Paszat L, et al. Optimal management of gastriccancer: results from an in- ternational RAND/UCLA expert panel. Ann Surg. 2014;259:102–108. 2. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology—Gastric Cancer Version 2.2011. Fort Washington, PA: NCCN; 2011. 3. Kim HS, Kim BS, Lee IS, et al. Comparison of totally laparoscopic total gastrectomy and open to- tal gastrectomy for gastric cancer. J Laparoendosc Adv S. 2013;23:1–9. 4. Jeong O, Jung MR, Kim GW, et al. Comparison of short-term surgical outcomes between laparo- scopic and open total gastrectomy for gastric car- cinoma: case-control study using propensity score matching method. J Am Coll Sur. 2013;216:184– 191. 5. Hanisch E, Ziogas D. Laparoscopic gastrectomy for organ-confined cancer: a reality in the West? Surg Endosc. 2009;23:1924–1926. 6. Strong VE, Devaud N, Karpeh M. The role of laparoscopy for gastric cancer in the West. Gastric Cancer. 2009;12:127–131. 7. Huscher CG, Mingoli A, Sgarzini G, et al. Laparo- scopic versus open subtotal gastrectomy for distal gastric cancer: five year results of a randomized prospective trial. Ann Surg. 2005;241:232–237. 8. Azagra JS, Ibanez-Aguirre JF, Goergen M, et al. Long-term results of laparoscopic extended surgery in advanced gastric cancer: a series of 101 patients. Hepatogastroenterology. 2006;53: 304–308. 9. Cianchi F, Qirici E, Trallori G, et al. Totally laparo- scopic versus open gastrectomy for gastric cancer: a matched cohort study. J Laparoendosc Adv Surg Tech A. 2013;23:117–122. 10. Mart´ ınez-Ramos D, Miralles-Tena JM, Cuesta MA, et al. Laparoscopy versus open surgery for advanced and resectable gastric cancer: a meta- analysis. Rev Esp Enferm Dig. 2011;103:133–141. Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Annals of Surgery Volume 00, Number 00, 2014 www.annalsofsurgery.com | 1
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Optimal Management of Gastric Cancer. Laparoscopic Versus Open Gastrectomy 2014
Transcript of Optimal Management of Gastric Cancer. Laparoscopic Versus Open Gastrectomy 2014
LETTER TO THE EDITOR
Optimal Managementof Gastric Cancer:
Laparoscopic VersusOpen Gastrectomy
To the Editor:
W ith interest, we read the originalarticle on optimal management of
gastric cancer, entailing results from aninternational RAND/UCLA expert panel,published in Annals of Surgery.1 First, anextensive study of literature about gastric can-cer, considering preoperative workup, multi-disciplinary care, treatment decision-making,surgical considerations, and provider consid-erations was conducted. Afterwards, resultswere anonymously graded by an expert panelon appropriateness and necessity. Regardinglaparoscopic versus open gastrectomy, the au-thors conclude that short-term data are en-couraging for a laparoscopic approach, butfurther research in larger randomized con-trolled trials (RCTs) is required, in accordancewith the NCCN guidelines.2 We do agree withthe conclusion by the authors that further re-search is necessary; however, we would liketo elaborate.
Several studies have assessed a laparo-scopic versus an open approach in treatmentof gastric cancer.3,4 However, as stated by theauthors, most RCTs have focused on earlygastric cancer. Most of these studies were con-ducted in Asian countries, where incidence of
Disclosure: No funding was received for this work, andthe authors declare no conflicts of interest.
Copyright C© 2014 by Lippincott Williams & WilkinsISSN: 0003-4932/14/00000-0001DOI: 10.1097/SLA.0000000000000694
gastric cancer is higher. The screening pro-gram in Japan, which started in 1983, hasenabled early detection and treatment of gas-tric carcinomas in these countries.5 As such,tumor stages are lower at the time of diag-nosis when compared with Western coun-tries. Therefore, it is difficult to translate theseresults to a population where no screeningexists.6
Only a few Western studies were con-ducted that compare laparoscopic and openapproaches for gastric cancer. An importantprevious finding is that laparoscopic gastrec-tomy showed similar results to open gastrec-tomy with regard to quality of oncologicalresection, as measured by the number of re-trieved lymph nodes and 5-year survival,7
whereas patient recovery was faster and ad-mission duration shorter.8,9 However, thesestudies were underpowered and do not takeinto account neoadjuvant therapy and long-term follow-up.
A prospective trial concerning this sub-ject is underway from our institution (www.stomach-trial.com). In the meanwhile, ourmeta-analysis has shown that minimally in-vasive gastrectomy is a safe and feasible al-ternative to the open procedure.10
Jennifer Straatman, MDMiguel A. Cuesta, MD, PhD
Donald L. van der Peet, MD, PhDVU Medical Centre
Department of Gastrointestinal SurgeryDe Boelelaan, Amsterdam, The Netherlands
REFERENCES1. Coburn N, Seevaratnam R, Paszat L, et al. Optimal
management of gastriccancer: results from an in-ternational RAND/UCLA expert panel. Ann Surg.2014;259:102–108.
2. National Comprehensive Cancer Network(NCCN). NCCN Clinical Practice Guidelines inOncology—Gastric Cancer Version 2.2011. FortWashington, PA: NCCN; 2011.
3. Kim HS, Kim BS, Lee IS, et al. Comparison oftotally laparoscopic total gastrectomy and open to-tal gastrectomy for gastric cancer. J LaparoendoscAdv S. 2013;23:1–9.
4. Jeong O, Jung MR, Kim GW, et al. Comparisonof short-term surgical outcomes between laparo-scopic and open total gastrectomy for gastric car-cinoma: case-control study using propensity scorematching method. J Am Coll Sur. 2013;216:184–191.
5. Hanisch E, Ziogas D. Laparoscopic gastrectomyfor organ-confined cancer: a reality in the West?Surg Endosc. 2009;23:1924–1926.
6. Strong VE, Devaud N, Karpeh M. The role oflaparoscopy for gastric cancer in the West. GastricCancer. 2009;12:127–131.
7. Huscher CG, Mingoli A, Sgarzini G, et al. Laparo-scopic versus open subtotal gastrectomy for distalgastric cancer: five year results of a randomizedprospective trial. Ann Surg. 2005;241:232–237.
8. Azagra JS, Ibanez-Aguirre JF, Goergen M,et al. Long-term results of laparoscopic extendedsurgery in advanced gastric cancer: a series of101 patients. Hepatogastroenterology. 2006;53:304–308.
9. Cianchi F, Qirici E, Trallori G, et al. Totally laparo-scopic versus open gastrectomy for gastric cancer:a matched cohort study. J Laparoendosc Adv SurgTech A. 2013;23:117–122.
10. Martı́nez-Ramos D, Miralles-Tena JM, CuestaMA, et al. Laparoscopy versus open surgery foradvanced and resectable gastric cancer: a meta-analysis. Rev Esp Enferm Dig. 2011;103:133–141.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Annals of Surgery � Volume 00, Number 00, 2014 www.annalsofsurgery.com | 1
