Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer.
BACKGROUND
The use of laparoscopic total gastrectomy (LTG) for the treatment of advanced gastric cancer (AGC) has not yet gained widespread acceptance because of difficulties in performing D2 lymphadenectomy. The purpose of this study was to evaluate the safety and effectiveness of LTG with D2 lymphadenectomy in treating AGC.


METHODS
A total of 94 patients who underwent LTG with D2 lymphadenectomy for AGC between January 2005 and October 2011 were included in this study. The patient data were obtained from a prospectively maintained institutional database. Morbidity was stratified by the Clavien-Dindo classification.


RESULTS
Concurrent pancreatectomy or splenectomy was performed on 48 patients. The median operation time was 230 min, and the median number of lymph nodes harvested per patient was 60.5. The TNM stages of the tumor were Ib in 9 patients (9.6 %), IIa in 16 (17 %), IIb in 7 (7.4 %), IIIa in 16 (17 %), IIIb in 17 (18.1 %), IIIc in 25 (26.6 %), and IV in 4 (4.3 %). Major morbidity (≥ grade IIIa) occurred in 9 patients (9.6 %) without postoperative mortality. At last follow-up, tumor recurrence had occurred in 13 patients with a median follow-up time of 12.77 months.


CONCLUSIONS
The acceptable rate of major morbidity in our series suggested that laparoscopic total gastrectomy with D2 lymphadenectomy is applicable to AGC. Long-term follow-up is mandatory to validate long-term outcome.
Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea. leejuhee79@gmail.com
Ju-Hee
JH
Lee
Sang-Hoon
SH
Ahn
Do Joong
DJ
Park
Hyung-Ho
HH
Kim
Hyuk-Joon
HJ
Lee
Han-Kwang
HK
Yang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult