title: The evolution of surgical technique for total gastrectomy over a 12-year period: a single institution's experience.
abstract: Despite the wide acceptance of laparoscopic surgical techniques, its use for gastric cancer has been limited. Laparoscopic total gastrectomy poses many technical challenges when compared with open gastrectomy. Our objective was to evaluate our institutional experience and surgical technique  for total gastrectomy. Through a review of patients undergoing total gastrectomy (1999 to 2011), 50 patients were identified. During the first decade, 25 per cent of total gastrectomies were performed laparoscopically compared with 77 per cent since 2009. Compared with open cases, laparoscopic  cases yielded a significantly higher number of examined lymph nodes (29 vs 19), lower estimated blood loss (200 vs 450 mL), and shorter length of stay (8 vs 14 days). Median operative time, average tumor size, and number of positive lymph nodes were not different. Morbidity  rates were much lower in the laparoscopic series; and 30-day mortality rates were similar in both groups. Laparoscopic total gastrectomy and D2 lymphadenectomy are comparable in safety and have improved efficacy than our open total gastrectomy experience. After initiation of a laparoscopic  total gastrectomy program in 2009, the majority of cases in our institution are now performed by laparoscopic techniques.
authors.affiliation: Department of Oncologic Surgery, City of Hope Comprehensive Cancer Center, Duarte, California 91010, USA.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Arrington
authors.forename: Rebecca
authors.initials: R
authors.lastname: Nelson
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chen
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Ellenhorn
authors.forename: Julio
authors.initials: J
authors.lastname: Garcia-Aguilar
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000639:trends*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult