Feasibility and Safety of Totally Laparoscopic Radical Gastrectomy for Advanced Gastric Cancer: Comparison with Early Gastric Cancer

Abstract

PurposeTotally laparoscopic gastrectomy (TLG) for advanced gastric cancer (AGC) is a technically and oncologically challenging procedure for surgeons. This study aimed to compare the oncologic feasibility and technical safety of TLG for AGC versus early gastric cancer (EGC).Materials and MethodsBetween 2011 and 2016, 535 patients (EGC, 375; AGC, 160) underwent curative TLG for gastric cancer. Clinicopathologic characteristics and surgical outcomes of both patient groups were analyzed and compared.ResultsPatients with AGC required a longer operation time and experienced more intraoperative blood loss than those with EGC did. However, patients from both the AGC and EGC groups demonstrated similar short-term surgical outcomes such as postoperative morbidity (14.4% vs. 13.3%, P=0.626), mortality (0% vs. 0.5%, P=0.879), time-to-first oral intake (2.7 days for both groups, P=0.830), and postoperative hospital stay (10.2 days vs. 10.1 days, P=0.886). D2 lymph node dissection could be achieved in the AGC group (95%), with an adequate number of lymph nodes being dissected (36.0±14.9). In the AGC group, the 3-year overall and disease-free survival rates were 80.5% and 73.7%, respectively.ConclusionsTLG is as safe and effective for AGC as it is for EGC.

Long-Term Outcomes of Laparoscopic versus Open Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score-Matched Analysis

“…With the development of laparoscopic instruments, totally LTG (TLTG) using linear staplers has recently become popular. Our center reported that the short-term outcome of TLTG was not inferior to that of LATG and that TLTG could be safely performed in patients with AGC [28,29]. Nakauchi et al [10] also reported their experience with TLTG in 92 patients; the results supported the technical feasibility of TLTG and acceptable 3-year follow-up results.…”

Laparoscopic lymph nodes dissection for advanced gastric cancer: the current status and the perspective

“…Recently, many retrospective comparative studies and several prospective RCTs have reported that LG for AGC was safe and feasible when compared to the short-term and long-term outcomes observed with OG [2][3][4][5][6][7][8][9][10][11][12][13] . Table 1 summarizes these studies about LG for AGC in recent years.…”

“…Especially, some authors demonstrated the technical safety of LDG with D2 LND for locally AGC in the multi-institutional, prospective, phase II study [2][3][4][5]11] . Moreover, the 3-year or 5-year overall or disease-free survival rates have been gradually reported from China, Korea, and Japan [7][8][9][10][11][12][13] . Majority of them reported that LG is feasible and safe for the treatment of AGC with D2 LND compared with OG, and no significant differences were observed in long-term over all survival (OS) and disease free survival (DFS) between the LG group and OG group.…”

The safety and feasibility of intra‐corporeal gastroduodenostomy using a self‐pulling and latter transected method (Delta SPLT) in totally laparoscopic distal gastrectomy

“…Patients experience less estimated blood loss, milder postoperative pain, and shorter hospital stays with TLG compared with laparoscopy-assisted gastrectomy. 4 Delta-shaped gastroduodenostomy (DA) is recognized as one of the most common reconstruction methods in Japan and Korea. 5 However, the application of DA in China remains restricted as patients are often diagnosed at late tumor stages.…”

“…With the emergence of more advanced instruments, totally laparoscopic gastrectomy (TLG) is increasingly popular. Patients experience less estimated blood loss, milder postoperative pain, and shorter hospital stays with TLG compared with laparoscopy‐assisted gastrectomy 4 . Delta‐shaped gastroduodenostomy (DA) is recognized as one of the most common reconstruction methods in Japan and Korea 5 .…”