title: Evaluation of the safety and feasibility of laparoscopic total gastrectomy in clinical stage I gastric cancer patients.
abstract: BACKGROUND
  This retrospective study was designed to assess the feasibility of laparoscopic total gastrectomy (LTG) in clinical stage I gastric cancer patients, and validate the appropriateness of the widespread adoption of LTG for experienced open surgeons.
  
  
  METHODS
  Eighty-eight patients with clinical stage I gastric cancer underwent LTG in our hospitals (n = 55) and affiliated hospitals (n = 33). Esophagojejunostomy was performed intracoporeally using a circular stapler with an incision in the left upper abdomen. We investigated the patients' clinicopathologic factor, and evaluated the effect of hospital volume on short-term outcomes.
  
  
  RESULTS
  Fixed insertion of the anvil head was successfully achieved in all patients (lift-up method in 58 patients and transoral method in 28 patients), although 2 patients were converted to open surgery. The approach using a circular stapler through a small incision from the upper left quadrant of the abdomen facilitated a good laparoscopic visual field for the plane of the esophagojejunostomy. Fourteen patients developed Clavien-Dindo classification grade II or more postoperative complications, and the overall operative morbidity rate was 15.9 %. No anastomotic leakage was encountered in this series. No significant difference was observed in clinical outcomes between patients in the high- and low-volume hospital groups.
  
  
  CONCLUSIONS
  Laparoscopic total gastrectomy can be performed safely on clinical stage I gastric cancer patients by surgeons with sufficient experience in open gastrectomy and therefore represents a feasible procedure that is not clinically impacted by hospital volume.
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan, ichikawa@koto.kpu-m.ac.jp.
authors: Daisuke
authors: D
authors: Ichikawa
authors: Shuhei
authors: S
authors: Komatsu
authors: Takeshi
authors: T
authors: Kubota
authors: Kazuma
authors: K
authors: Okamoto
authors: Hirotaka
authors: H
authors: Konishi
authors: Atsushi
authors: A
authors: Shiozaki
authors: Hitoshi
authors: H
authors: Fujiwara
authors: Eigo
authors: E
authors: Otsuji
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D000714:Anastomosis, Surgical; D004946:Esophagostomy; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods*; D061846:Hospitals, Low-Volume; D006801:Humans; D007564:Japan; D007582:Jejunostomy; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome