Luciana J El-Kadre, MD, PHD, FACS, Augusto C Tinoco, MD, PHD, FACS, Matheus R Netto, MD. Sao Jose do Avai Hopsital
Although laparoscopic gastrectomy is becoming more popular as a curative option for gastric cancer, there are concerns about its oncological adequacy. We have compared the outcomes of laparoscopic total gastrectomy (LTG) and laparoscopic subtotal gastrectomy (LSG), both with D2 lymphadenectomies, for the treatment of advanced gastric cancers.
From 1993 to 2014, 239 patients were operated on laparoscopic gastrectomy at our department. Data could be collected, on a retrospective way, from the medical records of 103 patients who underwent LSG (n=72) or LTG (n=31), both with D2 lymphadenectomy and R0 resection,from 2006 to 2014.
Most patients were in advanced stages of cancer, with poor nutritional status. Adenocarcinoma was the most common find, with 43% of cases in stage IIA and 31% in stage IIIB.
Intracorporeal Roux-en-Y or Billroth II anastomoses were employed to reconstruct the gastrointestinal tract. Postoperative complications, for LSG and LTG, were 18% and 35.4%. There were four leaks in the LSG, two in the duodenum stump and two on the gastroesophageal anastomosis. Both patients with a duodenal leak died. This complication occurred six, seven, nine and 11 days after surgery. From these cases, 75% had an albumin level < 3 mg/dl. For the LTG group, there were four leaks, all at the esophageal anastomosis, with two deaths. Leaks presented at days four, eight, nine and ten after surgery. From these patients, 50% had an albumin level < 3mg/dl.
Mean hospital stay was 6 days and 9 days (p= 0.12); mortality rate during hospital stay was 4.9% and 7.7%; three-year survival rate, 53.1% and 59.3%; and five-year survival rate, 46.9% and 40.7%. Hospital acquired pneumonia was the most prevalent clinical complication, while deaths arising from surgical complications were caused mainly by gastro-jejunal or esophago-jejunal anastomosis leaks.
LSG and LTG are feasible alternatives to open surgery and survival rates were comparable. The increased risk of complications observed in LTG did not influence the overall mortality rate. To our knowledge, this is the first comparison ofentirely laparoscopic total and subtotal gastrectomy, and these findings should contribute to the ultimate acceptance of laparoscopic gastrectomy as a safe procedure for gastric cancer treatment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93659
Program Number: S095
Presentation Session: Flexible Endoscopy I
Presentation Type: Podium