Surgical Outcomes and Operative Risk of Laparoscopic Total Gastrectomy for Gastric Carcinoma: Results From a Large Single Center Cohort

Oh Jeong, MD, Young Kyu Park, MD PhD, Mi Ran Jeong, MD, Kwang Yong Kim, MD. Department of Surgery, Chonnam National University Hwasun Hospital, South Korea


Background: Compared to the widespread use of laparoscopic distal gastrectomy (LDG) for early gastric cancer, laparoscopic total gastrectomy (LTG) still remains as a challenging procedure, because of its technical difficulties and concerns about subsequent complications. In this study, we evaluated surgical outcomes and operation risk of LTG in comparison with those of LDG, and sought to analyze risk factors for postoperative morbidity and mortality of LTG for gastric carcinoma.
Methods: Among prospectively constructed data of 1064 patients undergoing laparoscopic gastrectomy between April 2007 and May 2011, there were 118 patients who underwent LTG for middle and upper gastric cancer. Surgical outcomes, such as operative results, hospital stay, morbidity and mortality, were investigated, and were compared with those of LDG.
Results: There were 77 males and 41 females with a mean age of 63.7 years. When compared with LDG, patients with LTG showed older age, lower BMI, larger tumor size, and more advanced tumor depth with regard to the clinicopathological features. Of 118 patients, there was one case of open conversion and three cases of intraoperative complication. Nineteen (16.1%) patients underwent D2 lymphadenectomy, and 73 (61.9%) underwent complete omentectomy. Mean operating time was 292 ± 88 min and total harvested lymph nodes were 41 ± 16. Patients with LTG experienced significantly longer operation time (292 vs. 220 min, p < 0.001) and more intraoperative blood loss (256 vs. 191 ml, p = 0.002) than those with LDG. Overall morbidity rate was 22.9% (27 of 118 patients), which was significantly higher than those with LDG (22.9% vs. 12.7%, p = 0.002). There were 2 (1.7%) cases of postoperative mortality. The most common complication was anastomosis leakage (n=9) and luminal bleeding (n=9), followed by abdominal infection (n=3) and abdominal bleeding (n=2). Univariate and multivariate analysis of risk factor of postoperative morbidity revealed that old age (≥ 60yrs, OR=2.55, 95% CI=0.95-6.84) and D2 lymphadenectomy (OR=3.87, 95% CI=1.30-11.55) were independent risk factor for postoperative complications.
Conclusions: LTG is feasible technique for the treatment of upper and middle gastric cancer. However, it carries greater operative risk than those of LDG. Further improvement of anastomosis technique and much experience of laparoscopic gastrectomy are warranted for the proper application of LTG for gastric carcinoma.

Session Number: SS18 – Foregut
Program Number: S097

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