LATG with Extracorporeal Esophagojejunostomy: Is This Minimal Invasive Surgery for Gastric Cancer?

Abstract

With the concept of minimal invasiveness, if the patient's DisXE exceeds 9 cm, the length of the minilaparotomy incision in laparoscopic surgery could be disadvantageous. Nevertheless, we consider LATG the treatment of choice for early gastric cancer. If the patient's DisXE exceeds 9 cm, we consider intracorporeal anastomosis with the laparoscopic total gastrectomy. The type of esophagojejunostomy may be determined preoperatively by using three-dimensional abdominal computed tomography.

Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy

“…Previously, we have performed extracorporeal esophagojejunostomy [5,6]. However, it is sometimes difficult to complete anastomosis by minilaparotomy in the narrow and deep operating fields.…”

“…Also with LTG, several groups have reported the use of extracorporeal esophagojejunostomy through minilaparotomy, similar to conventional surgery [5,6]. However, with such a procedure, it is sometimes difficult to complete anastomosis.…”

Risk of recurrence after laparoscopy-assisted radical gastrectomy for gastric cancer performed by a single surgeon

“…Second, there is a degree of technical difficulty associated with this procedure; for example, in the present study, AGC cases were treated with total omentectomy and D2 node dissection, which proved to be quite difficult procedures, even for an experienced laparoscopic surgeon. In addition, for cancers located in the upper third of the stomach, the anastomosis of the esophagojejunostomy as well as the dissection of LN 11d and LN 10 have been reported to be difficult to perform [21]. These problems could be resolved by using a robotic operation system, but its high cost remains a problem.…”

“…7, 8a, 9) were performed; esophagogastrostomy was achieved by using a circular stapler in extracorporeal end-to-side fashion. In cases of AGC, total gastrectomy, omentectomy, and D2 lymph node dissection were performed, and reconstruction involved an extracorporeal end-to-side Roux-en-Y esophagojejunostomy generated by using the circular stapler through an upper minilaparotomy [21].…”

A systematic review of laparoscopic total gastrectomy for gastric cancer

“…In these 13 studies, esophagojejunostomies were performed intracorporeally. Initially, esophagojejunostomy was performed with a circular stapler through a 10-cm skin incision, using an anvil head inserted into the esophagus after a purse-string suture had been hand-sewn on the esophageal stump [27,28]. However, a detailed view of the surgical site could not be achieved using this technique.…”