title: Safe implementation of laparoscopic gastrectomy in a community-based general surgery practice.
abstract: BACKGROUND
  This study reviewed a 3-year experience with the implementation of laparoscopic gastrectomy at a community hospital.
  
  
  METHODS
  A retrospective chart review identified all patients that underwent laparoscopic gastrectomy between January 2004 and March 2007. Patient demographics, tumor characteristics, length of stay, operative time, and short-term outcomes (postoperative complications and death) were examined.
  
  
  RESULTS
  A total of 49 patients were identified; 25 (51%) were male. Median age was 68 years (range 31-90 years). Thirty-five (71%) and seven (14%) patients presented with adenocarcinoma and gastrointestinal stromal tumor (GIST), respectively. Median operative time was 169 min (range 23-387 min). Conversion to open laparotomy was necessary in six cases (12%). Median length of stay was 5 days (range 0-48 days). There were four (8.2%) postoperative deaths, and eight major complications, which included: myocardial infarction, pulmonary embolism, duodenal stump leak, bleeding, dehiscence, anastomotic leak, and obstruction. Of patients undergoing laparoscopic gastrectomy with curative intent, 36/38 (95%) underwent R0 resection. Median number of lymph nodes that were pathologically evaluated was 11 (range 1-27).
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to report on the implementation of laparoscopic gastrectomy in a community hospital setting. Laparoscopic gastrectomy can be performed safely in a community hospital setting with operative times and length of stay that are comparable to open cases. Our short-term outcomes are comparable with existing studies from academic/university centers.
authors.affiliation: Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Stotland
authors.forename: Shea
authors.initials: S
authors.lastname: Chia
authors.forename: Jamie
authors.initials: J
authors.lastname: Cyriac
authors.forename: John A
authors.initials: JA
authors.lastname: Hagen
authors.forename: Lazar V
authors.initials: LV
authors.lastname: Klein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery*; D013502:General Surgery / Q000458:organization & administration*; D006764:Hospitals, Community; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*