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Totally laparoscopic 95 % gastrectomy for cancer: technical considerations

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Abstract

Introduction

Total gastrectomy is the standard treatment for tumours arising in the proximal stomach and for diffuse cancer according to the Lauren classification. Laparoscopic approach is progressively accepted and provides encouraging results. In order to reduce complications associated to the esophago-jejunal anastomosis, the concept of the 95 % open gastrectomy was developed in Japan, in the early 1980s. This procedure provides the spearing of a small remnant gastric stump of 2 cm and allows performing a gastro-jejunal anastomosis. Unlike the 7/8 gastrectomy, the 95 % gastrectomy allows the complete resection of the gastric fundus and an optimized pericardial lymph node dissection (group 1 and 2). We herein describe, step-by-step, our technique of full laparoscopic 95 % gastrectomy (G95 %), with D2 lymphadenectomy, including complete lymphadenectomy of the cardial nodes.

Discussion

When it is possible to respect the oncologic criteria regarding proximal resection margin, 95 % gastrectomy would offer best short-term results, such as lower anastomotic leak rate and a better quality of life, limiting the effect of disruption of the eso-gastric junction.

Conclusion

In selected patients, laparoscopic G95 % is feasible and safe; it could be performed without any additional technical difficulties. Controlled clinical trials are necessary to confirm the encouraging results of the cases series, recently reported in literature.

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Conflicts of interest

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Authors and Affiliations

  1. Service de Chirurgie Générale et Mininvasive, Centre Hospitalier de Luxembourg, U26 4 rue Barblé, 1210, Luxembourg, Luxembourg

    Luca Arru, Juan Santiago Azagra, Silviu Tiberiu Makkai-Popa, Virginie Poulain & Martine Goergen

  2. Service de Chirurgie Digestive et Cancérologique, CHU Bocage, 14 rue Gaffarel, 21079, Dijon, France

    Olivier Facy

Authors
  1. Luca Arru
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  2. Juan Santiago Azagra
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  3. Olivier Facy
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  4. Silviu Tiberiu Makkai-Popa
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  5. Virginie Poulain
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  6. Martine Goergen
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Correspondence to Luca Arru.

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Arru, L., Azagra, J.S., Facy, O. et al. Totally laparoscopic 95 % gastrectomy for cancer: technical considerations. Langenbecks Arch Surg 400, 387–393 (2015). https://doi.org/10.1007/s00423-015-1283-1

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  • DOI: https://doi.org/10.1007/s00423-015-1283-1

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