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Die Chirurgie

Erschienen in:

27.11.2020 | Lymphadenektomie | Leitthema

Evidenz in der minimal-invasiven onkologischen Chirurgie des Magens

verfasst von: Prof. Dr. Kaja Ludwig, Christian Barz, Uwe Scharlau

Erschienen in: Die Chirurgie | Ausgabe 4/2021

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Zusammenfassung

Hintergrund

Ziel dieser Studie war es, in einem systematischen Review die aktuelle Evidenz zur laparoskopischen und robotischen distalen und totalen Gastrektomie im Vergleich zur offenen Chirurgie darzustellen.

Materialien und Methoden

Nach einer Suche auf EMBASE und PubMed wurden 197 qualitätsrelevante randomisierte (RCT) und nichtrandomisierte (Non-RCT) Studien identifiziert. Es erfolgte die Evaluierung für Früh- (EGC) und fortgeschrittene Karzinome (AGC).

Ergebnisse und Diskussion

Für EGC und laparoskopische distale Resektionen (LDG) und totale Gastrektomien (LTG) wurden insgesamt 10 RCT und 6 Non-RCT mit insgesamt 4329 Patienten (laparoskopische 2010 vs. offen 2319) identifiziert. Bei einem hohen Evidenzniveau (1+, 1++) ergaben sich keine signifikanten Unterschiede in Bezug auf Durchführbarkeit, intraoperatives Outcome und onkologische Qualität, Letalität und langfristiges onkologisches Outcome im Vergleich zur offenen Gastrektomie (OG). Patienten nach LDG und LTG zeigten eine signifikant schnellere frühpostoperative Erholung mit einer geringeren Gesamtmorbidität. Im Gegensatz dazu war die Operationszeit im Vergleich zu ODG und OTG signifikant länger. Bei distalen AGC und LDG konnten über 6 RCT mit insgesamt 2806 Patienten (LDG 1410 vs. ODG 1369) vergleichbare Ergebnisse auf einem ebenfalls hohen Evidenzniveau (1++) festgestellt werden. Die Evidenz für LTG bei AGC ist niedriger (2−, 2+). Derzeit sind 6 Non-RCT mit insgesamt 1090 Patienten (LTG 539 vs. OTG 551) verfügbar, die zwar vergleichbare Ergebnisse zur LDG aufweisen, jedoch durch hochwertige RCT abzusichern wären. Die robotische Gastrektomie (RG) wird derzeit evaluiert. Nach ersten Studien scheint eine RG bei EGC gleichwertig zur LDG zu sein, allerdings ist die Evidenz derzeit gering (3 bis 2−).

Allemani C, Matsuda T, Di Carlo V et al (2018) Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37.513.025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 391:1023–1075PubMedPubMedCentral

An JY, Heo G‑U, Cheong J‑H et al (2010) Assessment of open versus laparoscopy-assisted gastrectomy in lymph node-positive early gastric cancer: a retrospective cohort analysis. J Surg Oncol 102:77–81PubMed

Best LMJ, Mughal M, Gurusamy KS (2016) Laparoscopic versus open gastrectomy for gastric cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011389.pub2CrossRefPubMedPubMedCentral

Bo T, Peiwu Y, Feng Q et al (2013) Laparoscopy-assisted vs. open total gastrectomy for advanced gastric cancer: long-term outcomes and technical aspects of a case-control study. J Gastrointest Surg 17:1202–1208PubMed

Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424PubMed

Brenkman HJF, Gisbertz SS, Slaman AE et al (2017) Postoperative outcomes of minimally invasive gastrectomy versus open gastrectomy during the early introduction of minimally invasive gastrectomy in the Netherlands: a population-based cohort study. Ann Surg 266:831–838PubMed

Cai J, Wei D, Gao CF et al (2011) A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig Surg 28:331–337PubMed

Chen XZ, Wang SY, Wang YS et al (2017) Comparisons of short-term and survival outcomes of laparoscopy-assisted versus open total gastrectomy for gastric cancer patients. Oncotarget 8:52366–52380PubMedPubMedCentral

Chouillard E, Gumbs AA, Meyer F et al (2010) Laparoscopic versus open gastrectomy for adenocarcinoma: a prospective comparative analysis. Minerva Chir 65:243–250PubMed

10.

Cianchi F, Qirici E, Trallori G et al (2013) Totally laparoscopic versus open gastrectomy for gastric cancer: a matched cohort study. J Laparoendosc Adv Surg Tech A 23:117–122PubMed

11.

Cui M, Li Z, Xing J et al (2015) A prospective randomized clinical trial comparing D2 dissection in laparoscopic and open gastrectomy for gastric cancer. Med Oncol 32:241PubMed

12.

Du J, Zheng J, Li Y et al (2010) Laparoscopy-assisted total gastrectomy with extended lymph node resection for advanced gastric cancer—reports of 82 cases. Hepatogastroenterology 57:1589–1594PubMed

13.

Dulucq JL, Wintringer P, Stabilini C et al (2005) Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study. Surg Endosc 19:933–938PubMed

14.

Fang C, Hua J, Li J et al (2014) Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymphadenectomy for advanced gastric cancer. Am J Surg 208:391–396PubMed

15.

Gao Y, Xi H, Qiao Z et al (2019) Comparison of robotic- and laparoscopic-assisted gastrectomy in advanced gastric cancer: updated short- and long-term results. Surg Endosc 33:528–534PubMed

16.

Guzman EA, Pigazzi A, Lee B et al (2009) Totally laparoscopic gastric resection with extended lymphadenectomy for gastric adenocarcinoma. Ann Surg Oncol 16:2218–2223PubMed

17.

Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176PubMed

18.

Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedPubMedCentral

19.

Hiki N, Katai H, Mizusawa J et al (2018) Long-term outcomes of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG0703). Gastric Cancer 21:155–161PubMed

20.

Hu Y, Huang C, Sun Y et al (2016) Morbidity and mortality of Laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357PubMed

21.

Huscher CGS, Mingoli A, Sgarzini G et al (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237PubMedPubMedCentral

22.

Hyung WJ, Yang HK, Han SU et al (2019) A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer 22:214–222PubMed

23.

Hyung WJ, Yang HK, Park YK et al (2020) Long-term outcomes of laparoscopic distal gastrectomy for locally advanced gastric cancer: the KLASS-02-RCT randomized clinical trial. J Clin Oncol. https://doi.org/10.1200/JCO.20.01210CrossRefPubMed

24.

Inaki N, Etoh T, Ohyama T et al (2015) A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741PubMed

25.

Inokuchi M, Otsuki S, Fujimori Y et al (2015) Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy. World J Gastroenterol 21:9656–9665PubMedPubMedCentral

26.

Jeong O, Jung MR, Kim GY et al (2013) Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case-control study using propensity score matching method. J Am Coll Surg 216:184–191PubMed

27.

Katai H, Mizusawa J, Katayama H et al (2017) Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer 20:699–708PubMed

28.

Kawamura H, Yokota R, Homma S, Kondo Y (2009) Comparison of invasiveness between laparoscopy-assisted total gastrectomy and open total gastrectomy. World J Surg 33:2389–2395PubMed

29.

Kelly KJ, Selby L, Chou JF et al (2015) Laparoscopic versus open gastrectomy for gastric adenocarcinoma in the West: a case-control study. Ann Surg Oncol 22:3590–3596PubMedPubMedCentral

30.

Kim HH, Han SU, Kim MC et al (2013) Prospective randomized controlled trial (phase III) to comparing laparoscopic distal gastrectomy with open distal gastrectomy for gastric adenocarcinoma (KLASS 01). J Korean Surg Soc 84:123–130PubMedPubMedCentral

31.

Kim HH, Han SU, Kim MC et al (2019) Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric gancer: the KLASS-01 randomized clinical trial. JAMA Oncol 5:506–513PubMedPubMedCentral

32.

Kim MG, Kim BS, Kim TH et al (2011) The effects of laparoscopic assisted total gastrectomy on surgical outcomes in the treatment of gastric cancer. J Korean Surg Soc 80:245–250PubMedPubMedCentral

33.

Kim W, Kim HH, Han SU et al (2016) 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). Ann Surg 263:28–35PubMed

34.

Kim YW, Baik YH, Yun YH et al (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727PubMed

35.

Kim YW, Yoon HM, Yun YH et al (2013) Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc 27:4267–4276PubMed

36.

Kinoshita T, Uyama I, Terashima M et al (2019) Long-term outcomes of laparoscopic versus open surgery for clinical stage II/III gastric cancer: a multicenter cohort study in Japan (LOC‑A Study). Ann Surg 269:887–894PubMed

37.

Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMed

38.

Kitano S, Shiraishi N, Fujii K et al (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311PubMed

39.

Kodera Y, Yoshida K, Kumamaru H et al (2019) Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer 22:202–213PubMed

40.

Lee HJ, Hyung WJ, Yang HK et al (2019) Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 270:983–991PubMed

41.

Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173PubMed

42.

Lee JH, Nam BH, Ryu KW et al (2015) Comparison of outcomes after laparoscopy-assisted and open total gastrectomy for early gastric cancer. Br J Surg 102:1500–1505PubMed

43.

Li Z, Li J, Li B et al (2018) Robotic versus laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis. Cancer Manag Res 10:705–714PubMedPubMedCentral

44.

Liao G, Wang Z, Zhang W et al (2020) Comparison of the short-term outcomes between totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy for gastric cancer: a meta-analysis. Medicine 99:e19225. https://doi.org/10.1097/MD.0000000000019225CrossRefPubMedPubMedCentral

45.

Liu F, Huang C, Xu Z et al (2020) Morbidity and mortality of laparoscopic vs open total gastrectomy for clinical stage I gastric cancer: the CLASS02 multicenter randomized clinical trial. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2020.3152CrossRefPubMedPubMedCentral

46.

Liu HB, Wang WJ, Li HT et al (2018) Robotic versus conventional laparoscopic gastrectomy for gastric cancer: a retrospective cohort study. Int J Surg 55:15–23PubMed

47.

Lu Y, Jiang B, Liu T (2016) Laparoscopic versus open total gastrectomy for advanced proximal gastric carcinoma: a matched pair analysis. J BUON 21:903–908PubMed

48.

Ludwig K, Möller D, Bernhardt J (2018) Chirurgische Strategie bei Frühkarzinomen des Magens. Chirurg 89:347–357PubMed

49.

Ludwig K, Schneider-Koriath S, Scharlau U et al (2018) Laparoskopische vs. konventionell-offene D2-Gastrektomie bei Magenkarzinom: eine Matched-Pair-Analyse. Zentralbl Chir 143(2):145–154PubMed

50.

Mamidanna R, Almoudaris AM, Bottle A et al (2013) National outcomes and uptake of laparoscopic gastrectomy for cancer in England. Surg Endosc 27:3348–3358PubMed

51.

Mochiki E, Toyomasu Y, Ogata K et al (2008) Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc 22:1997–2002PubMed

52.

Möhler M, Al-Batran SE, Andus T et al (2019) S3-Leitlinie Diagnostik und Therapie der Adenokarzinome des Magens und ösophagogastralen Übergangs. Version 2.0, AWMF 032/009OL. www.awmf.org/leitlinien/detail/II/032-009OL.html. Zugegriffen: 10. Sept. 2020

53.

Moisan F, Norero E, Slako M et al (2012) Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study. Surg Endosc 26:661–672PubMed

54.

Mönig S, Ott K, Gockel I et al (2020) S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und ösophagogastralen Übergangs. Version 2.0. Chirurg 91:37–40PubMed

55.

OCEBM Levels of Evidence—Centre for Evidence-Based Medicine (CEBM), University of Oxford OCEBM Levels of Evidence—Centre for Evidence-Based Medicine (CEBM), University of Oxford. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence. Zugegriffen: 30. Sept. 2020

56.

Orsenigo E, Di Palo S, Tamburini A, Staudacher C (2011) Laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a monoinstitutional Western center experience. Surg Endosc 25:140–145PubMed

57.

Parisi A, Reim D, Borghi F et al (2017) Minimally invasive surgery for gastric cancer: a comparison between robotic, laparoscopic and open surgery. World J Gastroenterol 23:2376–2384PubMedPubMedCentral

58.

Park YK, Yoon HM, Kim YW et al (2018) Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer: results from a randomized phase II multicenter clinical trial (COACT 1001). Ann Surg 267:638–645PubMed

59.

Pugliese R, Maggioni D, Sansonna F et al (2007) Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21:21–27PubMed

60.

Raakow J, Denecke C, Chopra S et al (2020) Laparoskopische versus offene Gastrektomie bei fortgeschrittenem Magenkarzinom. Chirurg 91:252–261PubMed

61.

Ramagem CAG, Linhares M, Lacerda CF et al (2015) Comparison of laparoscopic total gastrectomy and laparotomic total gastrectomy for gastric cancer. Arq Bras Cir Dig 28:65–69PubMedPubMedCentral

62.

Sakamoto T, Fujiogi M, Matsui H et al (2020) Short-term outcomes of laparoscopic and open total gastrectomy for gastric cancer: a nationwide retrospective cohort analysis. Ann Surg Oncol 27:518–526PubMed

63.

Sakuramoto S, Yamashita K, Kikuchi S et al (2013) Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc 27:1695–1705PubMed

64.

Sarela AI (2009) Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins. Surg Endosc 23:153–160PubMed

65.

Scatizzi M, Kröning KC, Lenzi E et al (2011) Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a case-control study. Updates Surg 63:17–23PubMed

66.

Shinohara T, Satoh S, Kanaya S et al (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27:286–294PubMed

67.

Shu B, Lei S, Li F et al (2016) Laparoscopic total gastrectomy compared with open resection for gastric carcinoma: a case-matched study with long-term follow-up. J BUON 21:101–107PubMed

68.

Siani LM, Ferranti F, De Carlo A, Quintiliani A (2012) Completely laparoscopic versus open total gastrectomy in stage I–III/C gastric cancer: safety, efficacy and five-year oncologic outcome. Minerva Chir 67:319–326PubMed

69.

Sica GS, Iaculli E, Biancone L et al (2011) Comparative study of laparoscopic vs open gastrectomy in gastric cancer management. World J Gastroenterol 17:4602–4606PubMedPubMedCentral

70.

Son T, Lee JH, Kim YM et al (2014) Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc 28:2606–2615PubMed

71.

Strong VE, Song KY, Park CH et al (2010) Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg 251:640–646PubMed

72.

Takiguchi S, Fujiwara Y, Yamasaki M et al (2013) Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study. World J Surg 37:2379–2386PubMed

73.

Topal B, Leys E, Ectors N et al (2008) Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 22:980–984PubMed

74.

Usui S, Yoshida T, Ito K et al (2005) Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy. Surg Laparosc Endosc Percutan Tech 15:309–314PubMed

75.

Wang Z, Xing J, Cai J et al (2019) Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial. Surg Endosc 33:33–45PubMed

76.

Wu H, Li W, Chen G et al (2016) Outcome of laparoscopic total gastrectomy for gastric carcinoma. J BUON 21:603–608PubMed

77.

Yamashita K, Sakuramoto S, Kikuchi S et al (2016) Laparoscopic versus open distal gastrectomy for early gastric cancer in Japan: long-term clinical outcomes of a randomized clinical trial. Surg Today 46:741–749PubMed

78.

Yoon HM, Kim YW, Lee JH et al (2012) Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc 26:1377–1381PubMed

79.

Yoshida K, Honda M, Kumamaru H et al (2017) Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: aretrospective cohort study based on nationwide registry database in Japan. Ann Gastroenterol Surg 2:55–64PubMedPubMedCentral

80.

Yu J, Huang C, Sun Y et al (2019) Effect of laparoscopic vs open distal gastrectomy on 3‑year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial. JAMA 321:1983–1992PubMedPubMedCentral

81.

Zeng YK, Yang ZL, Peng JS et al (2012) Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256:39–52PubMed

82.

Zheng XY, Pan Y, Chen K et al (2018) Comparison of intracorporeal and extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a meta-analysis based on short-term outcomes. Chin Med J 131:713–720PubMedPubMedCentral

83.

Ziyu L, Shan F, Ying XJ et al (2019) Assessment of laparoscopic distal gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer. A randomized clinical trial. JAMA Surg 154:1093–1101

Titel: Evidenz in der minimal-invasiven onkologischen Chirurgie des Magens
verfasst von: Prof. Dr. Kaja Ludwig
Christian Barz
Uwe Scharlau
Publikationsdatum: 27.11.2020
Verlag: Springer Medizin
Schlagwörter: Lymphadenektomie
Gastrektomie
Gastrektomie
Magenkarzinom
Magenkarzinom
Erschienen in: Die Chirurgie / Ausgabe 4/2021
Print ISSN: 2731-6971
Elektronische ISSN: 2731-698X
DOI: https://doi.org/10.1007/s00104-020-01315-3

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Zusammenfassung

Hintergrund

Materialien und Methoden

Ergebnisse und Diskussion

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