title: Total laparoscopic resection for advanced gastric cancer is safe and feasible in the Western population.
abstract: There is debate surrounding the use of laparoscopic resection for advanced gastric cancer in the Western population. Here we aim to assess the feasibility and short-term outcomes of laparoscopic gastrectomy in consecutive patients in a Western population.
  
  
  
  From 2012 to 2014, retrospective review of 28 patients with clinically staged advanced gastric cancer (≥T3 or ≥N1) treated with laparoscopic resection.
  
  
  
  Sixty-one percentage of patients were male. Median age was 67 years (range 35-86). Median BMI was 26.5 (range 19.4-46.1). Resection types were proximal (n = 2), distal (n = 14), and total (n = 12). Twenty-six (93 %) patients underwent D2 lymphadenectomy. Four patients underwent conversion to open. Median blood loss was 125 mL (range 30-300). Median LOS was 7 days (range 4-16). Of postoperative complications, five were minor: arrhythmia (n = 1), surgical site infection (n = 3), in-hospital fall (n = 1); and four were major (intra-abdominal abscess, stricture, PE, and anastomotic bleed). T stages were Tx (n = 1), T2 (n = 3), T3 (n = 18), and T4 (n = 6). N stages were N0 (n = 4), N1 (n = 8), N2 (n = 1), and N3 (n = 15). Median tumor size was 5.8 cm (range 0-9.5). Median lymph node yield was 22 (range 6-53). All margins were negative. Median follow-up was 12.8 months (range 2-27). Six patients have died of progressive disease.
  
  
  
  Following total laparoscopic resection for advanced gastric cancer, oncologic endpoints, postoperative course, and early cancer-specific follow-up are excellent. The results demonstrated here support the routine use of these techniques in the Western patient population.
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Sts., Buffalo, NY, 14263, USA.
authors.forename: Rebecca
authors.identifier: 0000-0001-6299-8935
authors.initials: R
authors.lastname: Tuttle
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Sts., Buffalo, NY, 14263, USA. steven.hochwald@roswellpark.org.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Sts., Buffalo, NY, 14263, USA.
authors.forename: Moshim
authors.initials: M
authors.lastname: Kukar
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Kfir
authors.initials: K
authors.lastname: Ben-David
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Advanced gastric cancer; Laparoscopic gastrectomy; Total laparoscopic resection