Comparative outcomes between totally laparoscopic total gastrectomy with the modified overlap method for early gastric cancer and advanced gastric cancer: review of 149 consecutive cases.

Abstract

Introduction: Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) has not been conclusively substantiated. Aim: To evaluate TLTG treatment of AGC by comparing its effectiveness and surgical outcomes to those of TLTG treatment of early gastric cancer (EGC). Material and methods: We performed TLTG with the (modified) overlap method for 149 gastric cancer cases between March 2012 and December 2018. We evaluated clinicopathologic characteristics, complications (including esophagojejunostomy site complications), and surgical outcomes. We also evaluated these variables in terms of their associations with EGC and AGC. Results: Ninety-two males and 57 females, with a mean age of 60.7 years, were included. The mean operation time was 147.7 min. The mean number of harvested lymph nodes was 39.6. Thirteen (8.7%) patients experienced early complications, and 6 (4.0%) experienced late complications (Clavien-Dindo classification ≥ III). Eight (5.4%) patients underwent reoperation, and 8 (5.4%) were readmitted due to complications. There were no statistically significant differences in operation time, hospital stay, or surgical mortality between EGC and AGC. However, there were significant differences in early complications, late complications, rate of reoperation, and rate of readmission between EGC and AGC. Conclusions: Although it has some limitations, TLTG with the (modified) overlap method for AGC treatment is feasible, safe, and associated with favorable outcomes.

First experience of junior surgeons with laparoscopic distal gastrectomy: in view of comparison with experienced surgeons.

“…Laparoscopic gastrectomy is a complex procedure that includes lymph node dissection and various intestinal anastomoses [ 17 , 18 ], requiring a considerable learning curve to overcome [ 1 , 15 ]. The learning curve, the definition of which is clearly arbitrary, depends on factors such as the talent of surgeons, quality of teaching programs, and amount of experience of the surgeons [ 19 , 20 ].…”

Totally laparoscopic total gastrectomy using the modified overlap method and conventional open total gastrectomy: A comparative study

“…We performed TLTG with modified overlap method and OTG with circular stapled method, which was similar to our previous studies[ 3 , 10 ]. Both procedures were performed by a single experienced surgeon who conducts approximately 300 cases of gastrectomy annually.…”

“…Recently, we developed a modified overlap method for totally LTG (TLTG) for overcoming these disadvantages of linear stapled method[ 10 ]. This method is performed with an intracorporeal side to side esophagojejunal anastomosis using a 45-mm linear stapler at 45° from the longitudinal direction of the esophagus (Figure 1 ).…”