Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy.
BACKGROUND
Laparoscopy-assisted total gastrectomy (LATG) is not widely used for the treatment of gastric cancer located in the upper or middle third of the stomach. To assess the safety and usefulness of LATG, we compared the outcomes of LATG with those of open total gastrectomy (OTG).


METHODS
From July 2004 to July 2007, we performed pancreas- and spleen-preserving total gastrectomy with D1 + beta or D2 lymph-node dissection and Roux-en-Y reconstruction in 74 patients with cancer located in the upper or middle third of the stomach. Of these patients, 30 underwent LATG (LATG group) and 44 underwent OTG (OTG group). Short-term outcomes were compared between the groups.


RESULTS
Operation time was significantly longer in the LATG group than in the OTG group (313 min vs. 218 min, p < 0.001). Blood loss (134 g vs. 407 g, p < 0.001) and the rate of the use of analgesics (6.8 times vs. 11.8 times, p < 0.05) were significantly lower, and postoperative hospital stay was significantly shorter in the LATG group than in the OTG group (13.5 days vs. 18.2 days, p < 0.05). The LATG group had better hematologic and serum chemical profiles, including white-cell counts, C-reactive protein levels, total protein levels, and albumin levels, as well as lower rate of postoperative body-weight loss. The number of dissected lymph nodes (43.2 vs. 51.2, p = 0.098) and the rate of postoperative complications (20.0% vs. 27.3%, p = 0.287) were similar in the groups. However, major complications such as anastomotic leakage, abdominal abscess, and pancreatic leakage occurred in six patients (13.6%) in the OTG group, but in none of the patients in the LATG group.


CONCLUSIONS
LATG is associated with less severe complications and better postoperative quality of life than OTG. We believe that LATG is a safe, useful, and less invasive alternative for the treatment of gastric cancer located in the upper or middle third of the stomach.
Sakuramoto
Shinichi
S
Department of Surgery, Kitasato University School of Medicine, 2-1-1 Asamizodai, Sagamihara, Kanagawa, 228-8520, Japan. sakura@med.kitasato-u.ac.jp
Kikuchi
Shiro
S
Futawatari
Nobue
N
Katada
Natsuya
N
Moriya
Hiromitsu
H
Hirai
Kazuya
K
Yamashita
Keishi
K
Watanabe
Masahiko
M
D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D010179:Pancreas; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013154:Spleen; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome