Laparoscopic-assisted total gastrectomy versus open total gastrectomy for upper and middle gastric cancer in short-term and long-term outcomes.
OBJECTIVE
In recent years, laparoscopy-assisted distal gastrectomy has become the recognized procedure for treatment of early gastric cancer because of improved cosmesis and reduced postoperative pain. However, there are a few reports of laparoscopic-assisted total gastrectomy (LATG) performed for gastric cancer in the upper third or middle third stomach due to the difficulties of surgical techniques and the safety of oncologic short-term and long-term outcomes.


METHODS
Between January 2006 and December 2009, 84 patients with upper third or middle third gastric cancer underwent LATG or conventional open total gastrectomy (OTG). Of these patients, 34 patients underwent LATG and they were compared with patients who underwent OTG regarding short-term and long-term outcome.


RESULTS
The proximal margins (P=0.343) and distal margins (P=0.685) did not differ between the LATG and OTG groups. Postoperative morbidity occurred in 8 (16.0%) OTG and 6 (17.6%) LATG cases and postoperative mortality occurred 2 (4.0%) and 0 (0.0%) cases of OTG and LATG, respectively. Recurrence occurred in 8 (16.0%) cases and 1 (2.9%) case in the OTG and LATG group, respectively (P=0.077). The 5-year survival rate in the OTG group was 77.5% and in the LATG was 93.2% with no significant difference (P=0.082).


CONCLUSIONS
Our results confirm that LATG with extended lymphadenectomy for middle or upper early and locally advanced gastric cancer can achieve a radical oncologic resection equivalent to that of OTG. In addition, LATG is a feasible and safe procedure, and has several advantages over conventional OTG.
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Sung R
SR
Lee
Hyung O
HO
Kim
Byung H
BH
Son
Jun H
JH
Shin
Chang H
CH
Yoo
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome