Short-term outcomes of laparoscopy-assisted gastrectomy with D2 lymph node dissection for gastric cancer: Experience from a single institution in central Vietnam

Abstract Introduction: Laparoscopic-assisted gastrectomy (LAG) has become more popular and extensively developed for gastric cancer. However, LAG with D2 lymph node (LN) dissection has not been widely deployed because it is a complex technique and should be performed by experienced laparoscopic surgeons. This study aimed to confirm the feasibility and outcomes of the LAG with D2 dissection for gastric cancer. Patients and Methods: The prospective intervention study included 72 patients with gastric cancer and underwent LAG with D2 LN dissection between April 2017 and October 2021. All patients were operated by the same surgeon who had experience with laparoscopy. LAG with conventional D2 lymphadenectomy is based on the Japanese gastric cancer treatment guidelines 2014 (ver. 4). Results: The LAG includes 31 (43.1%) total gastrectomies and 41 (56.9%) distal gastrectomies. Conversion to open laparotomy was required in one patient (1.4%). The mean number of harvested lymph nodes was 20.4 ± 9.1 (range 4 - 47). In 75.0% of the procedures, at least 15 lymph nodes were resected. The mean number of positive lymph nodes was 4.2 ± 5.7 (range 0 - 21), and 16.2 ± 9.3 negative lymph nodes (range 0 - 47). The mean operative time was 231.8 ± 38.1 minutes (range 170 - 350). The mean time to first flatus was 3.5 ± 1.0 days (range 2 - 7). The mean postoperative hospital stay was 10.8 ± 4.0 days (range 7 - 30). The complications within 30 postoperative days occurred in 12 patients (16.7%). Conclusions: Laparoscopy-assisted gastrectomy with D2 LN dissection was safe and feasible with favorable short-term oncological outcomes. However,this technique must be realized by experienced surgeons in specialized centers. Keywords: Gastric cancer, Laparoscopy-assisted gastrectomy, D2 dissection, Vietnam