TY - JOUR
T1 - Critical factors that influence the early outcome of laparoscopic total gastrectomy
AU - Kawamura, Yuichiro
AU - Satoh, Seiji
AU - Suda, Koichi
AU - Ishida, Yoshinori
AU - Kanaya, Seiichiro
AU - Uyama, Ichiro
N1 - Publisher Copyright:
© 2014, The International Gastric Cancer Association and The Japanese Gastric Cancer Association.
PY - 2015/7/27
Y1 - 2015/7/27
N2 - Background: Laparoscopic distal gastrectomy (LDG) is a routinely performed procedure. However, clinical expertise in laparoscopic total gastrectomy (LTG) is insufficient, and it is only performed at specialized institutions. This study aimed to identify critical factors associated with complications after laparoscopic gastrectomy (LG), particularly LTG. Methods: A large-scale database was used to identify critical factors influencing the early outcomes of LTG. Of 1248 patients with resectable gastric cancer who underwent LG, 259 underwent LTG. Predictive risk factors were determined by analyzing relationships between clinical characteristics and postoperative complications. Major complications after LTG were analyzed in detail. Results: Multivariate analysis of all LG procedures revealed LTG as a risk factor for complications. Morbidity in the LDG and LTG groups was 6.2 % (52 of 835 patients) and 22.4 % (58 of 259 patients), respectively. Major post-LTG complications included anastomotic leakages and pancreatic fistulae. The rate of anastomotic leakage was significantly higher in the LTG group (5.0 %) than in the LDG group (1.2 %); however, it showed a tendency to decrease in more recent cases. Pancreatic fistulae occurred frequently after LTG with D2 lymphadenectomy (LTG-D2), particularly in cases of concomitant pancreatosplenectomy. Obesity was also associated with pancreatic fistula formation after LTG with pancreatosplenectomy. Conclusions: Compared with LDG, LTG is a developing procedure. Advances in the surgical techniques associated with the LTG procedure will improve the short-term outcomes of esophagojejunostomy. With regard to LTG-D2, establishing optimal and safe #10 node dissection is one of the most urgent issues. Pancreatic fistula after LTG with pancreatosplenectomy must be investigated in the future.
AB - Background: Laparoscopic distal gastrectomy (LDG) is a routinely performed procedure. However, clinical expertise in laparoscopic total gastrectomy (LTG) is insufficient, and it is only performed at specialized institutions. This study aimed to identify critical factors associated with complications after laparoscopic gastrectomy (LG), particularly LTG. Methods: A large-scale database was used to identify critical factors influencing the early outcomes of LTG. Of 1248 patients with resectable gastric cancer who underwent LG, 259 underwent LTG. Predictive risk factors were determined by analyzing relationships between clinical characteristics and postoperative complications. Major complications after LTG were analyzed in detail. Results: Multivariate analysis of all LG procedures revealed LTG as a risk factor for complications. Morbidity in the LDG and LTG groups was 6.2 % (52 of 835 patients) and 22.4 % (58 of 259 patients), respectively. Major post-LTG complications included anastomotic leakages and pancreatic fistulae. The rate of anastomotic leakage was significantly higher in the LTG group (5.0 %) than in the LDG group (1.2 %); however, it showed a tendency to decrease in more recent cases. Pancreatic fistulae occurred frequently after LTG with D2 lymphadenectomy (LTG-D2), particularly in cases of concomitant pancreatosplenectomy. Obesity was also associated with pancreatic fistula formation after LTG with pancreatosplenectomy. Conclusions: Compared with LDG, LTG is a developing procedure. Advances in the surgical techniques associated with the LTG procedure will improve the short-term outcomes of esophagojejunostomy. With regard to LTG-D2, establishing optimal and safe #10 node dissection is one of the most urgent issues. Pancreatic fistula after LTG with pancreatosplenectomy must be investigated in the future.
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U2 - 10.1007/s10120-014-0392-9
DO - 10.1007/s10120-014-0392-9
M3 - Article
C2 - 24906557
AN - SCOPUS:84938975735
SN - 1436-3291
VL - 18
SP - 662
EP - 668
JO - Gastric Cancer
JF - Gastric Cancer
IS - 3
ER -