Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study

Masaya Nakauchi, Koichi Suda, Shinichi Kadoya, Kazuki Inaba, Yoshinori Ishida, Ichiro Uyama

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC. Methods: A single-institution retrospective study was conducted. Ninety-two consecutive AGC patients who underwent radical TLTG were enrolled. The primary end point was morbidity. The patients were observed for 3 years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS). Results: Early and late morbidities (Clavien–Dindo grade ≥3) were 26.1 and 6.5 %, respectively. Operative time, estimated blood loss, number of dissected lymph nodes, and postoperative hospital stay were 444 (278–694) min, 100 (0–2267) g, 48 (16–89), and 23 (9–136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9 %, respectively. Factors associated with postoperative complications and 3yOS were operative time [OR 1.011 (1.006–1.017), p < 0.01] and cancer recurrence within 3 years [HR 312.191 (1.126–86573.245], p = 0.045], respectively. 3yRFS was associated with tumor size (≥50 mm) [HR 10.325 (1.328–80.289), p = 0.026], pathological N factor ≥2 [HR 3.188 (1.196–8.495), p = 0.02], and postoperative pancreatic fistula combined with intra-abdominal abscesses Clavien–Dindo grade ≥2; [HR 3.670 (1.440–9.351), p = 0.006]. Conclusions: TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.

Original languageEnglish
Pages (from-to)4632-4639
Number of pages8
JournalSurgical endoscopy
Volume30
Issue number10
DOIs
Publication statusPublished - 01-10-2016

All Science Journal Classification (ASJC) codes

  • Surgery

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