Laparoscopy-assisted total gastrectomy with extended lymph node resection for advanced gastric cancer--reports of 82 cases

Abstract

Background/aims: As a result of increased surgeon's experience and the improvement in laparoscopic techniques, laparoscopic gastrectomy has been widely accepted for the management of early stage gastric cancer. Sufficient evidence has demonstrated the feasibility of laparoscopy-assisted distal gastrectomy for early gastric cancer. Radical laparoscopic treatment of more advanced gastric cancer is controversial. The purpose of the current study was to determine feasibility and advantage of laparoscopy-assisted total gastrectomy (LTG) versus open total gastrectomy (OTG) with D2 dissection of lymph nodes in patients with advanced gastric cancer.

Methodology: Between Nov 2005 and May 2009 in our single institute, 176 patients with advanced gastric cancer underwent total gastrectomy with D2 dissection of lymph nodes. 82 of these patients underwent LTG, 94 underwent OTG. Clinical data of the both procedures were compared. Disease-free survival was studied to assess short-term outcome differences between the groups.

Results: None of 82 patients was converted to laparotomy and no operative mortality was observed in LTG. Postoperative complication rate was 9.8% (8/82) in LTG, compared with 24.5% (23/94) in OTG. No major complications occurred among the all patients who underwent LTG. There were 2 deaths (2/94) due to myocardial infarction in 3 days after OTG. In comparison to OTG, LTG had the longer operating time (275 +/- 78 versus 212 +/- 51 min; p < 0.001), similar number of lymph nodes (34.2 +/- 13.5 versus 36.4 +/- 19.1; p = 0.331), less operative blood loss (156 +/- 112 ml versus 339 +/- 162 ml; p < 0.001), earlier recovery of bowel activity, earlier ambulation and reduced postoperative pain after surgery (p < 0.001). Tumor- free margins were obtained in all patients who underwent LTG. In a mean follow-up period of 22.5 months, local recurrence and metastasis were observed in 19 of 82 patients in LTG, 23 of 94 patients in OTG respectively.

Conclusions: Laparoscopically assisted total gastrectomy for middle and upper gastric cancer is considered to be a safe and feasible procedure. Short-term oncological outcomes for laparoscopic total gastrectomy with extended lymph nodes were the same as in open surgery.