Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer

Objective: To evaluate the safety and effectiveness of laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer. Design: Review of findings from a prospectively acquired institutional database. Setting: University hospital. Patients: Fifty-five consecutive patients operated on by the same surgeon between October 1997 and March 2008. Main Outcome Measures: Blood loss, complication rate, and survival. Results: All operations were accomplished without conversion to open laparotomy. The median operative time was 406 minutes. The median blood loss was 102 mL. A median of 46 lymph nodes were harvested. The TNM stages of the tumor were I in 17 patients (31%), II in 12 (22%), III in 16 (29%), and IV in 10 (18%). A total of 21 complications occurred in 18 patients (33%) with no postoperative mortality. At last follow-up, 44 of the 55 patients were alive without tumor recurrence and 3 with recurrence at a median follow-up of 16 months, whereas 8 had died of recurrence or another cause. Conclusions: The mortality rate of zero and acceptable morbidity of our series indicate that laparoscopic total gastrectomy with D2 lymphadenectomy is technically feasible and safe in the hands of experienced surgeons. Longterm follow-up is mandatory to validate oncologic outcome.