Completely Laparoscopic Total Gastrectomy for Early and Advanced Gastric Cancer

Fabrizio Moisan, MD, Enrique Norero, MD, Jose Galindo, MD, Fernando Crovari, MD, Nicolas Jarufe, MD, Eduardo Vinuela, MD, Sergio Baez, MD, Perez Gustavo, MD, Camilo Boza, MD, Alex Escalona, MD, Ricardo Funke, MD

Hospital Clinico Pontificia Universidad Catolica de Chile. Hospital Dr. Sotero del Rio.

Introduction: The application of laparoscopic gastric surgery has increased rapidly for the treatment of early gastric cancer. However, total laparoscopic gastrectomy for proximal and middle third advanced tumors remains controversial, particularly in terms of oncologic outcomes.

Aim: To report the perioperative morbidity and 5-year survival of laparoscopic curative total gastrectomy in early and advanced gastric cancer.
Methods: Retrospective cohort study. Patients between 2005 and 2012 with an R0 resection operated in two Chilean centers were included. A totally laparoscopic technique was used and D2 lymph node dissection was practiced routinely. An intracorporeal hand-sew esophagojejunostomy was performed in all cases. Tumor stage was classified according to TNM AJCC 7th edition. Kaplan-Meier analysis with log rank test was performed to calculate survival.

Results: Forty-eight patients were included; mean age was 61±13 years, with 63% of males. Perioperative complication rate was 23% (mayor complications: Esophagojejunostomy leak 6.3%, duodenal stump leak 2.1%), and no perioperative mortality was observed in this series. Median hospital stay was 8 (IQR 8-12) days. Median number of resected lymph nodes was 32 (IQR 23-46). Deep of invasion was: T1 52%, T2 13%, T3 15% and T4a 20%. Lymph node category was N0 70%, N1 8%, N2 11% and N3 11%. The AJCC stages were 1, 2 and 3 in: 59%, 22% and 19% respectively. Median follow-up period was 30 (IQR 8-51) months. The overall 5 year survival was 77%. Five year survival in advanced and early tumors was 60% and 90% respectively, in N+ and N0, 55% and 85% respectively, and according to different AJCC stages, 92%, 53% and 38% in stage 1, 2 and 3, respectively.

Conclusion: In this series, with only proximal tumors and half of the patients with advanced gastric cancer treated with laparoscopic total gastrectomy, morbidity and 5 year overall and stage-by-stage survival was similar to open gastrectomy series.

Session: Podium Presentation

Program Number: S068

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