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

Abstract

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. (Surgery 2009;146:469-74.)