Laparoscopy-assisted total gastrectomy for gastric cancer: A multicenter retrospective analysis

doi:10.1016/j.surg.2009.03.023

Surgery

Volume 146, Issue 3, September 2009, Pages 469-474

https://doi.org/10.1016/j.surg.2009.03.023 Get rights and content

Background

Laparoscopy-assisted distal gastrectomy (LADG) has been applied to the treatment of gastric cancer, and there are now several publications regarding its safety and feasibility. In contrast, there have been few reports on laparoscopy-assisted total gastrectomy (LATG), because this procedure is performed less frequently and is technically more difficult to perform than LADG. The purpose of the present study was to evaluate short-term outcomes in a multicenter study of LATG, as well as its safety and feasibility.

Methods

A retrospective multicenter study was carried out in Korea involving 1,485 patients who underwent laparoscopy-assisted gastrectomy for gastric cancer at 10 institutions between April 1998 and December 2005. Of these patients, 131 underwent LATG. We evaluated and analyzed the short-term outcomes and the clinicopathologic characteristics of the 131 patients.

Results

The mean (± SD) operation time was 270 ± 79 min; 1 patient required conversion to an open procedure. The mean number of retrieved lymph nodes was 34.7. The mean duration of hospital stay was 11.3 days, and first intake of soft diet was at 5.8 days. The rate of postoperative morbidity was 19% (25/131 patients); there was no mortality. The most common postoperative morbidity was wound complications at the mini-laparotomy site, and there were 3 cases of anastomotic leakage. Six patients (5%) had recurrence of cancer, and 9 patients (7%) died during the follow-up period.

Conclusion

Our results suggest that LATG is a safe and feasible procedure for gastric cancer patients. A prospective, multicenter, randomized trial of LATG is needed to confirm the efficacy of this procedure.

Section snippets

Methods

In January 2006, a prospective, multicenter, randomized clinical trial comparing open versus laparoscopic gastrectomy for early-stage gastric cancer began in Korea. This randomized trial is being conducted at 10 hospitals, where 10 surgeons each have performed more than 50 open and laparoscopic gastrectomies for gastric cancer and perform more than 80 gastrectomies annually. Before starting the trial, we collected retrospectively data on all laparoscopic gastrectomies for gastric cancer

Clinical characteristics of patients (Table I)

The mean age of the patients was 57 years (range, 24–82), and the ratio of males to females was 1.3:1 (74 males, 57 females). The mean BMI was 23.0 kg/m² (range, 16–30), and there was no difference in BMI between males and females (P = .651). Fifty (38.2%) of the 131 patients had comorbidities, the most common being hypertension. Eleven (8.4%) patients had a previous operative history; 2 patients had undergone upper gastrointestinal tract surgery, 3 patients had undergone lower gastrointestinal

Discussion

Gastric cancer remains one of the most common neoplasms in Asia and some Western countries, although the incidence is decreasing worldwide. In recent years, the earlier detection of gastric cancer has meant more patients with early gastric cancer and an increase in the awareness of minimally invasive approaches for treatment.

Laparoscopic surgery is considered the criterion standard for the treatment of several benign diseases and some malignant diseases, such as colon cancer.⁴ Since the first

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Although laparoscopic total gastrectomy (LTG) compared to open total gastrectomy (OTG) has been widely used for advanced gastric cancer patients, its oncologic validity is yet to be proven. We performed systemic review and meta-analysis to compare LTG versus OTG for early and advanced stages of gastric cancer. Short- and long-term outcomes of both procedures were analyzed using original studies collected by searching Google Scholar, Medline, PubMed, Embase, and Cochrane library in accordance with the PRISMA guidelines. To analyze procedures more precisely, we categorized studies into advanced gastric cancer (AGC) and early gastric cancer (EGC) groups and matched lymph node (LN) dissection, and metastasis ratio. Nineteen studies with a total of 3943 patients were included. LTG required more operative time and had less dissected LNs, indicating a favorable quality of OTG. However, LTG was superior with less blood loss, a shorter postoperative hospital stay, and lower postoperative complication rates. The 5-year survival rate was similar in both groups in which extent of LN dissection and lymph node metastasis ratio were controlled. Although more LNs were removed in OTG, the discrepancy had an insignificant impact on the survival rate. To the best of our knowledge, this study is the first to employ quantitative synthesis in evaluation of long-term oncologic validity of LTG and OTG in AGC, with LN dissection and N stage controlled setting. Non-inferiority of LTG on oncologic outcome and superiority of LTG on perioperative outcome lead to a conclusion that LTG has potential as a valid treatment modality in AGC.
Short and long-term outcomes of laparoscopic total gastrectomy for gastric cancer: A single-center experience (retrospective cohort study)
2018, International Journal of Surgery
Limited studies have been designed to evaluate the short and long-term outcomes of laparoscopic total gastrectomy (LTG). The objective of this study was to evaluate the feasibility, safety, and oncological outcomes of LTG.
A total of 290 consecutive patients underwent radical gastrectomy for gastric cancer in our institution between 2010 and 2016, from which 110 were performed laparoscopically and included in the study. Short and long-term outcomes of LTG, such as operative results, postoperative courses, morbidities, and mortality, were investigated and compared with those of laparoscopy distal gastrectomy (LDG) patients.
From the total of 110 patients who underwent LTG, no one underwent conversion. The mean operation time was 267 ± 88 min. The mean reconstruction time was 45.3 ± 15 min, and the mean intraoperative blood loss was 75.4 ± 20 ml. The time until the first flatus was 4 ± 1.5 days. The time to start soft diet was 7 ± 1.8 days. The length of postoperative hospital stay was 9 ± 2 days. The mean number of retrieved lymph nodes was 34.7 ± 9. Compared with the LDG group, the mean operation time, the mean reconstruction time, number of retrieved lymph nodes, and time of start soft diet were significantly longer in the LTG group (P＜0.05).The postoperative complication rates of the LTG group and LDG group were 10% and 8.3% (P＞0.05), respectively. The 3-year cumulative survival rates of the LTG group and LDG group were 53.8% and 56.6% (P = 0.21), respectively.
LTG for gastric cancer is a safe, reliable and minimally invasive procedure with short and long-term outcomes similar to those of LDG.
Minimally invasive gastrectomy for gastric cancer: A national perspective on oncologic outcomes and overall survival
2017, Surgical Oncology
Citation Excerpt :
Concerns that a MIS approach might compromise oncologic principles, including adequate margins and appropriate lymph node harvest, have slowed its adoption [7]. Though multiple Eastern retrospective studies and prospective randomized controlled trials (RCT) have shown non-inferiority for MIS gastrectomy compared to open resection for early stage cancers, similar evidence from Western countries is limited [12–25]. Potential differences in the biology of gastric cancer, patient population characteristics, surgical techniques, screening policies and referral patterns between Eastern and Western populations have been frequently debated in determining whether the extensive experience in the East with MIS gastrectomy can be immediately generalizable to the West [26–30].
Minimally invasive (MI) gastrectomy has become increasingly common as a resection technique for gastric cancer; however, data are limited regarding peri-operative morbidity, oncologic outcomes and long-term survival, particularly in the Western patient population.
The 2010–2012 National Cancer Data Base was queried for adult patients who underwent gastrectomy for localized, intestinal-type gastric adenocarcinoma. Patients were classified by surgical approach (MI vs. open gastrectomy) on an intent-to-treat basis. Groups were propensity score matched using a 1:1 nearest neighbor algorithm, and outcomes were compared. Survival was estimated using the Kaplan-Meier method.
Among 5420 patients, 1423 (26%) underwent MI gastrectomy. Following adjustment with propensity matching, all baseline characteristics were highly similar between 1175 patients in each treatment group. Between propensity-matched groups, MI gastrectomy patients had similar rates of margin-negative resections (91 vs. 90%, p = 0.447), median lymph node harvest (16 vs. 15, p = 0.104), and utilization of adjuvant therapies (28 vs. 28%, p = 0.748). MI gastrectomy was associated with shorter hospital stay (8 vs. 9 days, p < 0.001) without an increase in unplanned readmissions (7 vs. 6%, p = 0.456) or 30-day mortality (2 vs. 3%, p = 0.655). There was no difference in 3-year overall survival (50 vs. 55%, p = 0.359).
On a national level, MI gastrectomy for gastric cancer appears to be associated with similar perioperative and long-term outcomes compared to the traditional open approach. While prospective studies remain essential, these data provide greater equipoise for ongoing trials and institutional efforts to further implement and evaluate this technique.
Short-term outcomes of intracorporeal esophagojejunostomy using the transorally inserted anvil versus extracorporeal circular anastomosis during laparoscopic total gastrectomy for gastric cancer: a propensity score matching analysis
2016, Journal of Surgical Research
To assess the short-term outcomes of intracorporeal Roux-en-Y esophagojejunostomy using the transorally inserted anvil (OrVil) compared with extracorporeal circular Roux-en-Y anastomosis during laparoscopic total gastrectomy (LTG) for gastric cancer.
From January 2011–April 2014, a total of 165 consecutive patients with gastric cancer underwent either intracorporeal Roux-en-Y esophagojejunostomy (n = 25) using the Orvil or extracorporeal circular anastomosis (n = 140) during LTG. After generating propensity scores with six covariates, including gender, age, body mass index (BMI), Eastern Cooperative Oncology Group performance status, tumor location, and tumor size, 25 patients undergoing the OrVil method (intracorporeal group) were one-to-one matched with 25 patients undergoing the extracorporeal method (extracorporeal group). The short-term outcomes were compared between the two groups.
Both groups were balanced regarding baseline variables. The total operative time was not significantly different between the two groups (216.5 ± 24.9 min versus 224.0 ± 30.5 min, P = 0.344), whereas either the duration of anvil insertion (9.9 ± 2.4 min versus 12.9 ± 2.0 min, P < 0.001) or reconstruction completion (44.4 ± 9.4 min versus 50.1 ± 5.4 min, P = 0.012) in the intracorporeal group was less. The mean length of minilaparotomy in the intracorporeal group was shorter (5.6 ± 0.4 cm versus 7.2 ± 1.7 cm, P < 0.001). No significant differences were observed in intraoperative complication rate, estimated blood loss, length of proximal margin, or postoperative recovery course (including the time to first flatus, liquid resumption, liquid, and soft diet) between the two groups. No patients suffered from anastomosis-related complications. The overall morbidity rates of 28.0% in the intracorporeal group and 32.0% in the extracorporeal group were comparable (P = 0.758).
Intracorporeal Roux-en-Y esophagojejunostomy using the transorally inserted anvil system may be a safe procedure during LTG for gastric cancer. However, a longer follow-up in a well-designed randomized controlled trial is necessary to more thoroughly evaluate this technique.
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Pigs were laparotomized under general anesthesia. An 8 × 8-cm, round portion of the anterior gastric wall was excised and replaced by an AGW. The AGW was composed of a copolymer comprising 50% lactic acid and 50% caprolactone. The animals were relaparotomized 4, 8, or 12 weeks after implantation, after which they underwent resection of the entire stomach for gross and histologic evaluation of the graft sites.
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The BAP sheets helped to restore extensive gastric defects without causing any deformation. The use of BAP sheets may become a new therapeutic method that prevents alterations of gastric volume after extensive gastrectomy for stomach cancer and other diseases.
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Original CommunicationLaparoscopy-assisted total gastrectomy for gastric cancer: A multicenter retrospective analysis

Background

Methods

Results

Conclusion

Section snippets

Methods

Clinical characteristics of patients (Table I)

Discussion

Eur J Surg Oncol

Laparoscopy-assisted Billroth I gastrectomy

Surg Laparosc Endosc

The technique of laparoscopically assisted total gastrectomy with jejunal interposition for early gastric cancer

Surg Endosc

Laparoscopic conversion of an omega in a Roux-en-Y reconstruction after mini-invasive total gastrectomy for cancer: a technical report

Surg Laparosc Endosc Percutan Tech

Laparoscopy-assisted gastrectomy for cancer: initial experience

Minimally invasive surgery for gastric cancer

Surg Endosc

Original Communication
Laparoscopy-assisted total gastrectomy for gastric cancer: A multicenter retrospective analysis