Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy.
OBJECTIVE
Only a few surgeons with much experience of laparoscopic surgery perform laparoscopy-assisted total gastrectomy (LATG), because of its technical difficulty and concern about subsequent complications. The aim of this study was to evaluate the technical feasibility and safety of LATG as compared with laparoscopy-assisted distal gastrectomy (LADG) in gastric cancer.


METHODS
From January 2002 to December 2007, LADG was performed in 473 patients and LATG in 67 patients at the Korean National Cancer Center. Surgical procedures and short-term surgical outcomes of LATG were analyzed.


RESULTS
D2 lymph node dissection was performed in 35 LATG (52.2%) cases and in 274 LADG (57.9%) cases (P = 0.378). Mean blood losses during operation were 156.8 +/- 158.0 ml and 190.7 +/- 176.2 ml, respectively (P = 0.114). The open conversion rate for LATG was higher than LADG without significance (4.3% vs. 1.7%, P = 0.153). Complications occurred in 18 LATG cases (26.9%) and 38 LADG cases (8.0%) (P < 0.001). The most common postoperative complication of LATG was anastomotic stricture after esophagojejunostomy.


CONCLUSIONS
LATG is a technically feasible procedure as compared with LADG. However, its postoperative complication rate is higher than that of LADG, especially that of anastomotic stricture. A more effective anastomotic method during LATG is required to prevent stricture.
Lee
Sang Eok
SE
Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Gyeonggi-do, South Korea.
Ryu
Keun Won
KW
Nam
Byung Ho
BH
Lee
Jun Ho
JH
Kim
Young-Woo
YW
Yu
Jun Sik
JS
Cho
Soo Jeong
SJ
Lee
Jong Yeul
JY
Kim
Chan Gyoo
CG
Choi
Il Ju
IJ
Kook
Myeong Cherl
MC
Park
Sook Ryun
SR
Kim
Min Ju
MJ
Lee
Jong Seok
JS
D000230:Adenocarcinoma / Q000601:surgery; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D016063:Blood Loss, Surgical; D004940:Esophageal Stenosis / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*