Technical feasibility and safety of laparoscopy‐assisted total gastrectomy in gastric cancer: A comparative study with laparoscopy‐assisted distal gastrectomy

Lee, Sang Eok; Ryu, Keun Won; Nam, Byung Ho; Lee, Jun Ho; Kim, Young Woo; Yu, Jun; Cho, Soo‐Jeong; Lee, Jong Yeul; Kim, Chan Gyoo; Choi, Il Ju; Kook, Myeong Cherl; Park, Sook Ryun; Kim, Min Ju; Lee, Jong Seok

doi:10.1002/jso.21345

Cited by 99 publications

(63 citation statements)

References 33 publications

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“…However, it has not become as popular as LADG because of its technical difficulty and because of concerns regarding postoperative complications [8,9]. Lee and colleagues [10] compared the surgical outcomes of LATG with those of LADG and found that the postoperative complication rate of LATG was higher than that of LADG, especially that of anastomotic stricture.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

et al. 2011

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Total gastrectomy or proximal gastrectomy is usually performed either as an open procedure or laparoscopically for the treatment of early gastric cancer (EGC) in the upper stomach. However, quality of life after either total or proximal gastrectomy is not so satisfactory. The authors report a novel surgical procedure, laparoscopyassisted subtotal gastrectomy (LAsTG), by which a very small remnant stomach is preserved, for the surgery of selected EGCs in the upper stomach. Twenty-three patients with EGC in the upper stomach underwent LAsTG. After lymph node dissection and mobilization of the stomach, the stomach was transected about 2 cm proximal to the tumor and a very small remnant stomach was preserved. An anvil was inserted transorally into the remnant stomach by using the OrVil TM system. The reconstruction method was Rouxen-Y, and hemidouble-stapling gastrojejunostomy with a circular stapler was performed intracorporeally. There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 266.7 min and 54.6 ml, respectively. The overall incidence of early postoperative complications was 17.4%, and two patients underwent reoperation because of duodenal stump leakage and stenosis of the Y-anastomosis, respectively. During the follow-up period, two patients experienced gastrojejunostomy stenosis and both were treated successfully by endoscopic balloon dilation. LAsTG may be performed in selected patients with EGC in the upper stomach. With the described method, a very small remnant stomach can be preserved.

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Section: Introductionmentioning

confidence: 99%

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

et al. 2011

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“…Conversely, the rate of anastomotic leakage was reported to be high, at 1.5% to 10.4%, after LATG, which is the current standard procedure used for tumors invading the upper stomach. 3,5 LAsTG was therefore considered to be a less hazardous surgery in terms of anastomotic leakage compared with LATG.…”

Section: Discussionmentioning

confidence: 99%

“…18 Conversely, the blood loss due to LATG was reported to be 182 to 190.7 mL. 3,9 Thus, LAsTG may slightly increase the risk of bleeding, especially around the spleen, compared with conventional LADG. However, the risk seems to be low compared with LATG.…”

Section: Discussionmentioning

confidence: 99%

“…2,21 The difference in the length of the surgery between LAsTG and conventional LADG might result from the special care required for the reconstruction and operation to avoid injuring the spleen. The length of LATG was reported to be much longer, at 205.5 to 305.4 minutes, 3,5 which would be explained by the technical difficulty of LATG. LAsTG therefore has an advantage over LATG in terms of the length of the operation.…”

mentioning

confidence: 99%

“…As laparoscopyassisted total gastrectomy (LATG) and proximal gastrectomy (LAPG) are technically more difficult than laparoscopy-assisted distal gastrectomy (LADG), the complication rates of LATG and LAPG are higher than that of LADG. [3][4][5][6][7][8][9] Moreover, the quality of life after LATG and LAPG is reported to be inferior to that after LADG. 10,11 For tumors invading the upper stomach, total gastrectomy with nodal dissection had been recommended, regardless of the tumor progression or the distance from the esophagogastric junction.…”

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confidence: 99%

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Feasibility and Safety of Laparoscopy-Assisted Subtotal Gastrectomy for Gastric Cancer Invading the Upper Stomach

Wakasugi

Cho

Sato

et al. 2016

International Surgery

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This study evaluated the feasibility and safety of laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach for clinical T1 gastric cancer invading the upper stomach. Forty-three consecutive patients who underwent laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach were examined. In addition to the conventional laparoscopy-assisted distal gastrectomy, some short and posterior gastric arteries were resected. A minimal remnant stomach-jejunum anastomosis was made by using a circular stapler with regular anvil or transoral anvil. Transoral anvil was selected in 19 patients, and regular anvil was used in 24 patients. The median operation time was 288 minutes, and the median blood loss was 50 mL. Conversion to open surgery was required in 2 patients due to bleeding. No patient required conversion to open surgery due to the difficulty of the anastomosis. Nine patients developed postoperative complications, including grade 3 duodenal stump leakage in 1 patient and grade 2 anastomotic bleeding in another patient. No mortality was observed. Laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach is safe and feasible for early gastric cancer invading the upper stomach.

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Impact of anastomotic complications on outcome after laparoscopic gastrectomy for early gastric cancer

Nagasako

Satoh

Isogaki

et al. 2012

British Journal of Surgery

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Technical feasibility and safety of laparoscopy‐assisted total gastrectomy in gastric cancer: A comparative study with laparoscopy‐assisted distal gastrectomy

Abstract: LATG is a technically feasible procedure as compared with LADG. However, its postoperative complication rate is higher than that of LADG, especially that of anastomotic stricture. A more effective anastomotic method during LATG is required to prevent stricture.

Cited by 99 publications

References 33 publications

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

Feasibility and Safety of Laparoscopy-Assisted Subtotal Gastrectomy for Gastric Cancer Invading the Upper Stomach

Impact of anastomotic complications on outcome after laparoscopic gastrectomy for early gastric cancer

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