title: Laparoscopically-assisted palliative total gastrectomy in patients with stage IV or metastatic gastric cancer: is it worthwhile?
abstract: OBJECTIVE
  Conventional open total gastrectomy in patients with IV stage or metastatic gastric carcinoma in the middle or upper third of the stomach is under controversy due to its poor prognosis and its surgical complexity. Based on advances in laparoscopic equipment, techniques, and ongoing experience in laparoscopically- assisted D2 total gastrectomy, laparoscopically-assisted noncurative total gastrectomy was performed in patients with stage IV or metastatic gastric carcinoma in the middle or upper third of the stomach who suffered from local gastric bleeding, pain, obstruction symptoms refractory to other therapies at our institution. The purpose of the current study was to determine feasibility of laparoscopically-assisted noncurative total gastrectomy in patients with stage IV disease or metastatic gastric cancer.
  
  
  METHODS
  Between July 2005 and Sep 2007 in our institution, 43 patients with stage IV disease or metastatic gastric carcinoma in the middle or upper third of the stomach who suffered from local gastric bleeding, pain, obstruction refractory to other therapies underwent laparoscopically-assisted noncurative total gastrectomy. Stomach was dissected and the first part of the duodenum was transected laparoscopically. Because of extensive involvement of adjacent tissues, final dissection was performed extracorporeally by a small laparotomy incision under the xyphoid (5-7 cm) for removal of specimen and anastomosis. Clinical data of the procedure was analyzed.
  
  
  RESULTS
  None of 43 patients was converted to laparotomy and no operative mortality was observed. Final dissection of involvement was extracorporeally performed by a small laparotomy incision in 18 patients with extensive involvement of adjacent tissues. Postoperative complication occurred in 4 cases (9%), 1 minor duodenal stump leak, 3 wound infection. The mean operative time was 245 +/- 81 min, operative blood loss was 163 +/- 131 mL. Time of ambulation and first flatus were 2.6 +/- 1.3 and 3.3 +/- 1.0 days after surgery respectively. All patients uneventfully recovered after surgery. Mean hospital stay was 8.8 +/- 3.5 days. All preoperative symptoms resolved. Mean survival time was 8.9 +/- 3.2 months, 5 patients still are alive to present within fellow-up of 6-15 months.
  
  
  CONCLUSIONS
  Laparoscopically-assisted noncurative total gastrectomy in patients with stage IV or metastatic gastric cancer is considered to be a safe and feasible approach. Laparoscopically-assisted palliative total gastrectomy can be performed to obtain better quality of life in patients with gastric cancer who suffered from local gastric bleeding, pain, obstruction symptoms refractory to other therapies.
authors.affiliation: Department of General Surgery, Xijing Hospital, Fourth Military Medical University, No.15 Changle West Road, Xian 710032, People's Republic of China. Dujjp@hotmail.com
authors.forename: Jianjun
authors.initials: J
authors.lastname: Du
authors.forename: Jipeng
authors.initials: J
authors.lastname: Li
authors.forename: Yongqi
authors.initials: Y
authors.lastname: Li
authors.forename: Gang
authors.initials: G
authors.lastname: Ji
authors.forename: Zhi
authors.initials: Z
authors.lastname: Yang
authors.forename: Zhiqing
authors.initials: Z
authors.lastname: Gao
authors.forename: Jianyong
authors.initials: J
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010166:Palliative Care; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors