title: Laparoscopic Total Gastrectomy for Remnant Gastric Cancer Following Distal Gastrectomy with Radical Lymphadenectomy.
abstract: OBJECTIVE
  In cases of remnantgastric cancer (RGC) with previous lymphadenectomy, laparoscopic total gastrectomy (LTG) is still uncommon because of the technical difficulties associated with adhesions from previous gastric cancer surgery and variations in anastomotic reconstruction. Here we demonstrate our procedure of LTG for RGC following distal gastrectomy (DG) with radical lymphadenectomy and review its clinical results.
  
  
  METHODS
  From October 2008 to June 2014, we carried out three consecutive LTGs for RGC with previous lymphadenectomy. All cases had a past history of primary gastric cancer that had required open or laparoscopic DG with D2 radical lymphadenectomy. The preoperative TNM statuses of RGC were all cT1N0M0.
  
  
  RESULTS
  All patients successfully underwent LTG without open conversion or intraoperative complications. The median operative duration was 360 min; the median blood loss was 45 mL. The median number of retrieved lymph nodes was 23. No complications occurred postoperatively, and the median length of postoperative hospitalization was 20 days. The pathological TNM statuses of the RGC were all T1N0M0. Resection margins were negative in all cases (R0).
  
  
  CONCLUSIONS
  Our novel procedure of LTG for RGC following DG with radical lymphadenectomy is technically acceptable, safe, and feasible.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Masazumi
authors.initials: M
authors.lastname: Zaima
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Harada
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kawamura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D016063:Blood Loss, Surgical; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D018530:Gastric Stump / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D012086:Reoperation; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome