LATG with extracorporeal esophagojejunostomy: is this minimal invasive surgery for gastric cancer?
BACKGROUND
This retrospective study determined whether extracorporeal esophagojejunostomy after laparoscopy-assisted total gastrectomy (LATG) for gastric cancer can be considered minimally invasive surgery, compared to the conventional open total gastrectomy (OTG).


METHODS
This retrospective study involved 60 patients seen between January 2004 and July 2006. Twenty-seven patients underwent LATG, and 33 patients had OTG. The surgical procedure included the use of five ports with an upper vertical midline incision. In all patients, reconstruction was performed by using a Roux-en-Y esophagojejunostomy through the minilaparotomy site. In all cases, the jejunojejunostomy was performed extracorporeally as the conventional method. In OTG, a Roux-en-Y esophagojejunostomy was performed with an upper midline incision.


RESULTS
The mean number of retrieved lymph nodes was smaller and the mean operating time was longer in the LATG group. The postoperative hospital course was similar in both groups. In the LATG group, the mean length of the minilaparotomy incision was 8.0+/-1.2 cm (maximum length, 11 cm), and a direct relationship was observed between the distance from the xiphoid process to the esophageal hiatus (DisXE) and the minilaparotomy incision length (Spearman's correlation of rank coefficient: 0.386; P=0.046).


CONCLUSIONS
With the concept of minimal invasiveness, if the patient's DisXE exceeds 9 cm, the length of the minilaparotomy incision in laparoscopic surgery could be disadvantageous. Nevertheless, we consider LATG the treatment of choice for early gastric cancer. If the patient's DisXE exceeds 9 cm, we consider intracorporeal anastomosis with the laparoscopic total gastrectomy. The type of esophagojejunostomy may be determined preoperatively by using three-dimensional abdominal computed tomography.
Kim
Sang-Gi
SG
Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Korea.
Lee
Young-Joon
YJ
Ha
Woo-Song
WS
Jung
Eun-Jung
EJ
Ju
Young-Tae
YT
Jeong
Chi-Young
CY
Hong
Soon-Chan
SC
Choi
Sang-Kyung
SK
Park
Soon-Tae
ST
Bae
Kyungsoo
K
D000713:Anastomosis, Roux-en-Y; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*