Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer

Abstract

Background: The use of laparoscopic total gastrectomy (LTG) for the treatment of advanced gastric cancer (AGC) has not yet gained widespread acceptance because of difficulties in performing D2 lymphadenectomy. The purpose of this study was to evaluate the safety and effectiveness of LTG with D2 lymphadenectomy in treating AGC.

Methods: A total of 94 patients who underwent LTG with D2 lymphadenectomy for AGC between January 2005 and October 2011 were included in this study. The patient data were obtained from a prospectively maintained institutional database. Morbidity was stratified by the Clavien-Dindo classification.

Results: Concurrent pancreatectomy or splenectomy was performed on 48 patients. The median operation time was 230 min, and the median number of lymph nodes harvested per patient was 60.5. The TNM stages of the tumor were Ib in 9 patients (9.6 %), IIa in 16 (17 %), IIb in 7 (7.4 %), IIIa in 16 (17 %), IIIb in 17 (18.1 %), IIIc in 25 (26.6 %), and IV in 4 (4.3 %). Major morbidity (≥ grade IIIa) occurred in 9 patients (9.6 %) without postoperative mortality. At last follow-up, tumor recurrence had occurred in 13 patients with a median follow-up time of 12.77 months.

Conclusions: The acceptable rate of major morbidity in our series suggested that laparoscopic total gastrectomy with D2 lymphadenectomy is applicable to AGC. Long-term follow-up is mandatory to validate long-term outcome.