title: Comparison of short- and long-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in gastric cancer patients.
abstract: BACKGROUND
  Laparoscopy-assisted total gastrectomy (LATG) has been used more frequently despite the associated technical difficulty and concerns over oncological safety. This study was undertaken to compare the short- and long-term surgical outcomes following either LATG or open total gastrectomy (OTG) for gastric cancer.
  
  
  METHODS
  A total of 120 LATG and 228 OTG were retrospectively matched with respect to sex, age (±5 years), and pathological tumor-node-metastasis stage for comparison of the clinical outcomes.
  
  
  RESULTS
  The total complication rate among 120 LATG and 228 OTG was 18.3 % (22/120) and 16.2 % (37/228), respectively. The most common complication after LATG was anastomotic-related complication (6.7 %); five anastomotic leakages (4.2 %) and three anastomotic strictures were reported (2.5 %). That after OTG was wound complication (3.5 %), including seroma or infection. Matched patients analysis: Time to first gas passing and time to the resumption of a soft diet were significantly shorter in the LATG group than in the OTG group. The postoperative hospital stay of LATG was shorter in the LATG group (9.3 ± 4.2 days) than in the OTG group (11.7 ± 7.3 days; p = 0.057). Among matched patients, there was no significant difference between complication rate (24 vs. 32 %; p = 0.504) or leakage rate (6 vs. 4 %). During median follow-up of 50 (range, 10-92) months, there was no significant difference in the disease-free survival rate between the matched groups, respectively (94.5 vs. 87.1 %: p = 0.148). As for patients with TNM stage I gastric cancer, the disease-free survival rate (100 vs. 90.9 %; p = 0.5) and the cumulative survival rate (91.5 vs. 95.2 %; p = 0.618) did not differ significantly between the LATG and OTG groups.
  
  
  CONCLUSIONS
  LATG for gastric cancer has the advantage over an OTG in terms of better short-term outcomes and similar long-term outcome. LATG is an acceptable alternative to OTG for the treatment of gastric cancer.
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam 463-707, Gyenggi-do, South Korea.
authors.forename: Moon-Soo
authors.initials: MS
authors.lastname: Lee
authors.forename: Ju-Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Do Joong
authors.initials: DJ
authors.lastname: Park
authors.forename: Hyuk-Joon
authors.initials: HJ
authors.lastname: Lee
authors.forename: Hyung-Ho
authors.initials: HH
authors.lastname: Kim
authors.forename: Han-Kwang
authors.initials: HK
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak; D003251:Constriction, Pathologic / Q000209:etiology; D018572:Disease-Free Survival; D004435:Eating; D004947:Esophagus / Q000601:surgery; D005260:Female; D005414:Flatulence; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D010535:Laparoscopy; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D013997:Time Factors
references.citation: World J Surg. 2006 Oct;30(10):1870-6; discussion 1877-8
references.pmid: 16957826
references.citation: Surg Endosc. 2008 Sep;22(9):1997-2002
references.pmid: 18594925
references.citation: J Surg Oncol. 2005 Jul 1;91(1):90-4
references.pmid: 15999352
references.citation: Surg Endosc. 2012 Jun;26(6):1702-9
references.pmid: 22207307
references.citation: Dig Dis Sci. 2007 Feb;52(2):543-8
references.pmid: 17211711
references.citation: Ann Surg. 2007 Jan;245(1):68-72
references.pmid: 17197967
references.citation: Cancer J. 2005 Jan-Feb;11(1):18-25
references.pmid: 15831220
references.citation: J Surg Oncol. 2009 Dec 15;100(8):693-8
references.pmid: 19731245
references.citation: Ann Surg. 1997 Nov;226(5):613-20
references.pmid: 9389395
references.citation: Surg Laparosc Endosc Percutan Tech. 2005 Dec;15(6):309-14
references.pmid: 16340559
references.citation: Surg Endosc. 2010 Oct;24(10):2475-9
references.pmid: 20396906
references.citation: J Surg Oncol. 2009 Oct 1;100(5):392-5
references.pmid: 19598150
references.citation: Eur J Surg Oncol. 2000 Mar;26(2):168-71
references.pmid: 10744938
references.citation: J Gastrointest Surg. 2011 Jan;15(1):57-62
references.pmid: 20967510
references.citation: Surg Laparosc Endosc Percutan Tech. 2007 Feb;17(1):33-7
references.pmid: 17318052
references.citation: Surg Laparosc Endosc. 1994 Apr;4(2):146-8
references.pmid: 8180768
references.citation: Gastric Cancer. 1999 Dec;2(4):230-234
references.pmid: 11957104
references.citation: Surgery. 2009 Sep;146(3):469-74
references.pmid: 19715803
references.citation: Br J Surg. 2007 Feb;94(2):204-7
references.pmid: 17058319
references.citation: Surg Endosc. 2009 Nov;23(11):2416-23
references.pmid: 19266232