OBJECTIVETo evaluate the long-term clinical outcomes between laparoscopic and open distal gastrectomy with D2 lymph dissection for advanced gastric cancer.

METHODSClinical data of 377 cases of laparoscopic distal gastrectomy and 301 cases of open distal gastrectomy with D2 lymph dissection at the Southwest Hospital, the Third Military Medical University from January 2004 to June 2010 were retrospectively analyzed. Patients were followed up until September 2015. Surgical outcomes, postoperative complications and long-term survival were compared between the two groups.

RESULTSCompared with conventional open group, laparoscopic group was associated with lower intraoperative blood loss [(125±89) ml vs. (290±161) ml, t=-15.942, P=0.000], shorter time to oral intake [(2.9±0.7) days vs. (4.1±1.6) days, t=-12.120, P=0.000], quicker bowel function retum[(2.7±1.4) days vs. (3.6±1.6) days, t=-7.804, P=0.000], shorter postoperative hospital stay [(7.7±3.6) days vs. (10.1±4.1) days, t=-8.107, P=0.000]. In addition, there were no significant differences in the operative time[(207±57) minutes vs. (202±43) minutes, P>0.05], number of retrieved lymph nodes(33±13 vs. 31±15, P>0.05), resection margin length(P>0.05) between two groups. The postoperative complication morbidity in laparoscopic group was significantly lower than that in open group[7.2%(22/377) vs. 12.6%(38/301), χ(2)=5.762, P=0.016]. Within perioperative period, 7 patients underwent operation again due to complication and 1 case died of peritoneal bleeding in laparoscopic group; 6 patients underwent re-operation and 2 cases died of peritoneal infection with hepatic failure and lung infection with respiratory failure. During the median follow-up of 86 months (range from 3-140 months), relapse occurred in 171(45.4%) patients and 183(48.5%, among them, 156 cases died of primary disease) patients died in laparoscopic group; relapse occurred in 140(46.5%) patients and 151(50.2%, among them, 127 cases died of primary disease) patients died in open group. The difference in overall 5-year survival rate between two groups was not statistically significant (51.5% vs. 49.8%, χ(2)=0.142, P=0.706). No significant difference was seen in 5-year disease-free survival rate (49.1% vs. 47.8%, χ(2)=0.062, P=0.803). Stratified analysis based on TNM stage also showed no significant difference in 5-year overall or disease-free survival rate(both P>0.05).

CONCLUSIONLaparoscopic distal gastrectomy with D2 lymph dissection for advanced gastric cancer has better short-term efficacy and similar long-tern efficacy as compared to open surgery.