Surgical Endoscopy

, Volume 26, Issue 11, pp 3273–3281 | Cite as

Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer: case–control study

  • Bang Wool Eom
  • Young-Woo Kim
  • Sang Eok Lee
  • Keun Won Ryu
  • Jun Ho Lee
  • Hong Man Yoon
  • Soo-Jeong Cho
  • Myeong-Cherl Kook
  • Soo Jin Kim



Few results regarding the long-term survival from laparoscopy-assisted total gastrectomy (LATG) have been reported. The purpose of this study was to investigate the feasibility of LATG in terms of long-term survival and morbidity.


A case–control study was conducted on 100 cases of LATG and 348 cases of open total gastrectomy (OTG) performed for treating clinical stage I (cT1N0, cT1N1, and cT2N0) gastric cancer from August 2003 to December 2008 at the National Cancer Center of Korea. The clinicopathological characteristics, surgical outcomes, and complications were compared between the LATG and OTG groups. The overall survival rate and disease-free survival rate were analyzed using a Cox proportional hazards model for multivariate analysis.


The rate of postoperative complications was 27 %, the most common being anastomotic stenosis from LATG (9 %). There were no significant differences in surgical outcomes and complications between the LATG and OTG groups except for a longer operating time for LATG. Survival rates were also similar between groups; the hazard ratio of LATG versus OTG was 0.43 (95 % confidence interval [CI] = 0.15–1.20; p = 0.107) for overall survival and 0.47 (95 % CI = 0.19–1.18; p = 0.106) for disease-free survival.


LATG may be a feasible procedure with acceptable complications and long-term survival rate for clinical stage I gastric cancer.


Laparoscopy Total gastrectomy LATG Gastric cancer 



This work was supported by a grant from the National Cancer Center of Korea (no. NCC-0310060-1,2,3).


Drs. Bang Wool Eom, Young-Woo Kim, Sang Eok Lee, Keun Won Ryu, Jun Ho Lee, Hong Man Yoon, Soo-Jeong Cho, Myeong-Cherl Kook, and Soo Jin Kim have no conflicts of interest or financial ties to disclose.


  1. 1.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Lirici MM, Napolitano C, Piro F (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237PubMedCrossRefGoogle Scholar
  2. 2.
    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72PubMedCrossRefGoogle Scholar
  3. 3.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  4. 4.
    Mochiki E, Kamiyama Y, Aihara R, Nakabayashi T, Asao T, Kuwano H (2005) Laparoscopic assisted distal gastrectomy for early gastric cancer: five years experience. Surgery 137:317–322PubMedCrossRefGoogle Scholar
  5. 5.
    Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, Bae JM (2008) Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 15:1625–1631PubMedCrossRefGoogle Scholar
  6. 6.
    Memon MA, Khan S, Yunus RM, Barr R, Memon B (2008) Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc 22:1781–1789PubMedCrossRefGoogle Scholar
  7. 7.
    Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727PubMedCrossRefGoogle Scholar
  8. 8.
    Lee SE, Kim YW, Lee JH, Ryu KW, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Nam BH, Park SR, Kim MJ, Lee JS (2009) Developing an institutional protocol guideline for laparoscopy-assisted distal gastrectomy. Ann Surg Oncol 16:2231–2236PubMedCrossRefGoogle Scholar
  9. 9.
    Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Park SR, Kim MJ, Lee JS (2009) Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 100:392–395PubMedCrossRefGoogle Scholar
  10. 10.
    Sakuramoto S, Kikuchi S, Futawatari N, Katada N, Moriya H, Hirai K, Yamashita K, Watanabe M (2009) Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc 23:2416–2423PubMedCrossRefGoogle Scholar
  11. 11.
    Topal B, Leys E, Ectors N, Aerts R, Penninckx F (2008) Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 22:980–984PubMedCrossRefGoogle Scholar
  12. 12.
    Mochiki E, Toyomasu Y, Ogata K, Andoh H, Ohno T, Aihara R, Asao T, Kuwano H (2008) Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc 22:1997–2002PubMedCrossRefGoogle Scholar
  13. 13.
    Takiguchi S, Sekimoto M, Fujiwara Y, Miyata H, Yasuda T, Doki Y, Yano M, Monden M (2005) A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis. Surg Today 35:896–899PubMedCrossRefGoogle Scholar
  14. 14.
    Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 23:2624–2630PubMedCrossRefGoogle Scholar
  15. 15.
    Usui S, Nagai K, Hiranuma S, Takiguchi N, Matsumoto A, Sanada K (2008) Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer 11:233–237PubMedCrossRefGoogle Scholar
  16. 16.
    Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, Nakahara M, Nishida T (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197:e13–e17PubMedCrossRefGoogle Scholar
  17. 17.
    Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, Uyama I (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:e25–e29PubMedCrossRefGoogle Scholar
  18. 18.
    Bracale U, Marzano E, Nastro P, Barone M, Cuccurullo D, Cutini G, Corcione F, Pignata G (2010) Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 24:2475–2479PubMedCrossRefGoogle Scholar
  19. 19.
    Pak KH, Hyung WJ, Son T, Obama K, Woo Y, Kim HI, An JY, Kim JW, Cheong JH, Choi SH, Noh SH (2012) Long-term oncologic outcomes of 714 consecutive laparoscopic gastrectomies for gastric cancer: results from the 7-year experience of a single institute. Surg Endosc 26(1):130–136PubMedCrossRefGoogle Scholar
  20. 20.
    Lee SW, Nomura E, Bouras G, Tokuhara T, Tsunemi S, Tanigawa N (2010) Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. J Am Coll Surg 211:33–40PubMedCrossRefGoogle Scholar
  21. 21.
    Lee J, Kim W (2009) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol 100:693–698PubMedCrossRefGoogle Scholar
  22. 22.
    Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, Osugi H (2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22:1161–1164PubMedCrossRefGoogle Scholar
  23. 23.
    Du J, Zheng J, Li Y, Li J, Ji G, Dong G, Yang Z, Wang W, Gao Z (2010) Laparoscopy-assisted total gastrectomy with extended lymph node resection for advanced gastric cancer—reports of 82 cases. Hepatogastroenterology 57:1589–1594PubMedGoogle Scholar
  24. 24.
    Sobin LH (2002) In: Wittekind C (ed) TNM classification of malignant tumours, 6th edn. Wiley-Liss, New YorkGoogle Scholar
  25. 25.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer 1:10–24PubMedCrossRefGoogle Scholar
  26. 26.
    Di Leo A, Marrelli D, Roviello F, Bernini M, Minicozzi A, Giacopuzzi S, Pedrazzani C, Baiocchi LG, de Manzoni G (2007) Lymph node involvement in gastric cancer for different tumor sites and T stage: Italian Research Group for Gastric Cancer (IRGGC) experience. J Gastrointest Surg 11:1146–1153PubMedCrossRefGoogle Scholar
  27. 27.
    Shin SH, Jung H, Choi SH, An JY, Choi MG, Noh JH (2009) Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer. Ann Surg Oncol 16:1304–1309PubMedCrossRefGoogle Scholar
  28. 28.
    Ikeguchi M, Kaibara N (2004) Lymph node metastasis at the splenic hilum in proximal gastric cancer. Am Surg 70:645–648PubMedGoogle Scholar
  29. 29.
    Yu W, Choi GS, Chung HY (2006) Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 93:559–563PubMedCrossRefGoogle Scholar
  30. 30.
    Kawamura H, Yokota R, Homma S, Kondo Y (2010) Comparison of respiratory function recovery in the early phase after laparoscopy-assisted gastrectomy and open gastrectomy. Surg Endosc 24:2739–2742PubMedCrossRefGoogle Scholar
  31. 31.
    Hyung WJ, Lim JS, Song J, Choi SH, Noh SH (2008) Laparoscopic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. J Am Coll Surg 207:e6–e11PubMedCrossRefGoogle Scholar
  32. 32.
    Kaneko S, Yoshimura T (2001) Time trend analysis of gastric cancer incidence in Japan by histological types, 1975–1989. Br J Cancer 84:400–405PubMedCrossRefGoogle Scholar
  33. 33.
    Wang JY, Hsieh JS, Huang CJ, Huang YS, Huang TJ (1996) Clinicopathologic study of advanced gastric cancer without serosal invasion in young and old patients. J Surg Oncol 63:36–40PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Bang Wool Eom
    • 1
  • Young-Woo Kim
    • 1
  • Sang Eok Lee
    • 2
  • Keun Won Ryu
    • 1
  • Jun Ho Lee
    • 1
  • Hong Man Yoon
    • 1
  • Soo-Jeong Cho
    • 1
  • Myeong-Cherl Kook
    • 1
  • Soo Jin Kim
    • 3
  1. 1.Gastric Cancer Branch, Research Institute & HospitalNational Cancer CenterGyeonggi-doSouth Korea
  2. 2.Department of SurgeryKonyang University HospitalChungcheongnam-doSouth Korea
  3. 3.Center for Clinical Services, Research Institute & HospitalNational Cancer CenterGyeonggi-doSouth Korea

Personalised recommendations