title: Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study.
abstract: D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC.
  
  
  
  A single-institution retrospective study was conducted. Ninety-two consecutive AGC patients who underwent radical TLTG were enrolled. The primary end point was morbidity. The patients were observed for 3 years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS).
  
  
  
  Early and late morbidities (Clavien-Dindo grade ≥3) were 26.1 and 6.5 %, respectively. Operative time, estimated blood loss, number of dissected lymph nodes, and postoperative hospital stay were 444 (278-694) min, 100 (0-2267) g, 48 (16-89), and 23 (9-136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9 %, respectively. Factors associated with postoperative complications and 3yOS were operative time [OR 1.011 (1.006-1.017), p < 0.01] and cancer recurrence within 3 years [HR 312.191 (1.126-86573.245], p = 0.045], respectively. 3yRFS was associated with tumor size (≥50 mm) [HR 10.325 (1.328-80.289), p = 0.026], pathological N factor ≥2 [HR 3.188 (1.196-8.495), p = 0.02], and postoperative pancreatic fistula combined with intra-abdominal abscesses Clavien-Dindo grade ≥2; [HR 3.670 (1.440-9.351), p = 0.006].
  
  
  
  TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakauchi
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan. ko-suda@nifty.com.
authors.forename: Koichi
authors.initials: K
authors.lastname: Suda
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kadoya
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Uyama
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D061646:Operative Time; D010180:Pancreatectomy / Q000379:methods*; D010185:Pancreatic Fistula / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013812:Therapeutics; D047368:Tumor Burden
keywords: D2 total gastrectomy; Gastric cancer; Long-term outcomes; Pancreatic fistula; Single-institution retrospective study; Totally laparoscopic total gastrectomy