Surgical Endoscopy

, Volume 30, Issue 9, pp 3965–3975 | Cite as

Eleven-year experience with 3000 cases of laparoscopic gastric cancer surgery in a single institution: analysis of postoperative morbidities and long-term oncologic outcomes

  • Young Suk Park
  • Sang-Yong Son
  • Aung Myint Oo
  • Do Hyun Jung
  • Dong Joon Shin
  • Sang-Hoon Ahn
  • Do Joong Park
  • Hyung-Ho KimEmail author



The present study summarizes the 11-year laparoscopic gastric cancer surgery experience of a single institution in South Korea and evaluates the current trends of laparoscopic gastric cancer surgery through our experience.


A total of 3000 minimally invasive gastric cancer surgeries were performed at Seoul National University Bundang Hospital between May 2003 and January 2014. The types of laparoscopic gastrectomy used, surgical techniques, postoperative morbidities, and long-term oncologic outcomes were analyzed.


The proportion of challenging procedures such as laparoscopic total gastrectomy and laparoscopic gastrectomy for patients with advanced gastric cancer increased during the study period. The frequency of laparoscopic function-preserving gastrectomy for patients with early-stage cancer also increased. The overall rate of complications was 16.7 %; surgical and systemic complication rates were 11.8 and 6.2 %, respectively. There was one case of postoperative mortality due to delayed bleeding after discharge. Male gender, high BMI, long operating times, combined resection of other organs, and total and proximal gastrectomies were independent predictors of surgical morbidities; however, pathologic T-stage was not a predictable factor. Accumulated experience in laparoscopic surgery decreased the surgical complication rates of total and proximal gastrectomies more than it did in distal gastrectomy over time. The 5-year overall survival rates of patients in advanced stages and those who underwent laparoscopic total gastrectomy were comparable to those reported previously.


Our results indicate the trends toward the expansion of laparoscopic approaches to technically demanding procedures and an increased use of laparoscopic function-preserving surgeries for patients with EGC with acceptable outcomes.


Laparoscopy Gastric cancer Morbidity Survival 



The authors thank the Medical Research Collaborating Center at Seoul National University Bundang Hospital for performing analyses.

Compliance with ethical standards


Young Suk Park, Sang-Yong Son, Aung Myint Oo, Do Hyun Jung, Dong Joon Shin, Sang-Hoon Ahn, Do Joong Park, and Hyung-Ho Kim have no conflicts of interest.

Supplementary material

464_2015_4708_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 25 kb)


  1. 1.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(2):146–148PubMedGoogle Scholar
  2. 2.
    Jeong O, Park YK (2011) Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer 11(2):69–77. doi: 10.5230/jgc.2011.11.2.69 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Son SY, Kim HH (2014) Minimally invasive surgery in gastric cancer. World J Gastroenterol 20(39):14132–14141. doi: 10.3748/wjg.v20.i39.14132 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lee JH, Lee CM, Son SY, Ahn SH, Park DJ, Kim HH (2014) Laparoscopic versus open gastrectomy for gastric cancer: long-term oncologic results. Surgery 155(1):154–164. doi: 10.1016/j.surg.2013.06.015 CrossRefPubMedGoogle Scholar
  5. 5.
    Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched korean multicenter study. J Clin Oncol 32(7):627–633. doi: 10.1200/JCO.2013.48.8551 CrossRefPubMedGoogle Scholar
  6. 6.
    Lee JH, Son SY, Lee CM, Ahn SH, Park DJ, Kim HH (2013) Morbidity and mortality after laparoscopic gastrectomy for advanced gastric cancer: results of a phase II clinical trial. Surg Endosc 27(8):2877–2885. doi: 10.1007/s00464-013-2848-0 CrossRefPubMedGoogle Scholar
  7. 7.
    Eom BW, Kim YW, Lee SE, Ryu KW, Lee JH, Yoon HM, Cho SJ, Kook MC, Kim SJ (2012) Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer: case-control study. Surg Endosc 26(11):3273–3281. doi: 10.1007/s00464-012-2338-9 CrossRefPubMedGoogle Scholar
  8. 8.
    Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R (2013) Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc 27(5):1509–1520. doi: 10.1007/s00464-012-2661-1 CrossRefPubMedGoogle Scholar
  9. 9.
    Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z (2014) Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis. PLoS One 9(2):e88753. doi: 10.1371/journal.pone.0088753 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Isobe Y, Nashimoto A, Akazawa K, Oda I, Hayashi K, Miyashiro I, Katai H, Tsujitani S, Kodera Y, Seto Y, Kaminishi M (2011) Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry. Gastric Cancer 14(4):301–316. doi: 10.1007/s10120-011-0085-6 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123. doi: 10.1007/s10120-011-0042-4 CrossRefGoogle Scholar
  12. 12.
    Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5(1):1–5. doi: 10.1007/s101200200000 CrossRefPubMedGoogle Scholar
  13. 13.
    Noh SY, Lee JH, Ahn SH, Son SY, Lee CM, Park DJ, Kim HH, Lee HJ, Yang HK (2012) Intracorporeal end-to-side esophagojejunostomy using a laparoscopic purse-string clamp during laparoscopic total gastrectomy. J Minim Invasive Surg 15(2):32–37. doi: 10.7602/jmis.2012.15.2.32 CrossRefGoogle Scholar
  14. 14.
    Ahn SH, Jung DH, Son SY, Lee CM, Park DJ, Kim HH (2014) Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer 17(3):562–570. doi: 10.1007/s10120-013-0303-5 CrossRefPubMedGoogle Scholar
  15. 15.
    Lee CM, Rao J, Son SY, Ahn SH, Lee JH, Park DJ, Kim HH (2013) Laparoscopic gastrectomy for gastric cancer with simultaneous organ resection. J Laparoendosc Adv Surg Tech A 23(10):861–865. doi: 10.1089/lap.2013.0081 CrossRefPubMedGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240(2):205–213. doi: 10.1097/ CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Zhang X, Tanigawa N (2009) Learning curve of laparoscopic surgery for gastric cancer, a laparoscopic distal gastrectomy-based analysis. Surg Endosc 23(6):1259–1264. doi: 10.1007/s00464-008-0142-3 CrossRefPubMedGoogle Scholar
  18. 18.
    Kim MC, Jung GJ, Kim HH (2005) Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 11(47):7508–7511CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Jin SH, Kim DY, Kim H, Jeong IH, Kim MW, Cho YK, Han SU (2007) Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc 21(1):28–33. doi: 10.1007/s00464-005-0634-3 CrossRefPubMedGoogle Scholar
  20. 20.
    Jung DH, Son SY, Park YS, Shin DJ, Ahn HS, Ahn SH, Park DJ, Kim HH (2014) The learning curve associated with laparoscopic total gastrectomy. Gastric Cancer. doi: 10.1007/s10120-014-0447-y Google Scholar
  21. 21.
    Kim MG, Kwon SJ (2014) Comparison of the outcomes for laparoscopic gastrectomy performed by the same surgeon between a low-volume hospital and a high-volume center. Surg Endosc 28(5):1563–1570. doi: 10.1007/s00464-013-3352-2 CrossRefPubMedGoogle Scholar
  22. 22.
    Tokunaga M, Hiki N, Fukunaga T, Miki A, Nunobe S, Ohyama S, Seto Y, Yamaguchi T (2009) Quality control and educational value of laparoscopy-assisted gastrectomy in a high-volume center. Surg Endosc 23(2):289–295. doi: 10.1007/s00464-008-9902-3 CrossRefPubMedGoogle Scholar
  23. 23.
    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251(3):417–420. doi: 10.1097/SLA.0b013e3181cc8f6b CrossRefPubMedGoogle Scholar
  24. 24.
    Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Lee HJ, Cho GS, Han SU, Hyung WJ, Korean Laparoscopic Gastrointestinal Surgery Study Group (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol 15(10):2692–2700. doi: 10.1245/s10434-008-0075-z CrossRefPubMedGoogle Scholar
  25. 25.
    Lee JH, Park DJ, Kim HH, Lee HJ, Yang HK (2012) Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien–Dindo classification. Surg Endosc 26(5):1287–1295. doi: 10.1007/s00464-011-2027-0 CrossRefPubMedGoogle Scholar
  26. 26.
    Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27(1):286–294. doi: 10.1007/s00464-012-2442-x CrossRefPubMedGoogle Scholar
  27. 27.
    Fang C, Hua J, Li J, Zhen J, Wang F, Zhao Q, Shuang J, Du J (2014) Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymphadenectomy for advanced gastric cancer. Am J Surg. doi: 10.1016/j.amjsurg.2013.09.028 Google Scholar
  28. 28.
    Park DJ, Han SU, Hyung WJ, Kim MC, Kim W, Ryu SY, Ryu SW, Song KY, Lee HJ, Cho GS, Kim HH, Korean Laparoscopic Gastrointestinal Surgery Study Group (2012) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc 26(6):1548–1553. doi: 10.1007/s00464-011-2065-7 CrossRefPubMedGoogle Scholar
  29. 29.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241(2):232–237CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    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(9):1997–2002. doi: 10.1007/s00464-008-0015-9 CrossRefPubMedGoogle Scholar
  31. 31.
    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(4):980–984. doi: 10.1007/s00464-007-9549-5 CrossRefPubMedGoogle Scholar
  32. 32.
    Bo T, Peiwu Y, Feng Q, Yongliang Z, Yan S, Yingxue H, Huaxing L (2013) Laparoscopy-assisted vs. open total gastrectomy for advanced gastric cancer: long-term outcomes and technical aspects of a case-control study. J Gastrointest Surg 17(7):1202–1208. doi: 10.1007/s11605-013-2218-1 CrossRefPubMedGoogle Scholar
  33. 33.
    Ahn SH, Lee JH, Park DJ, Kim HH (2013) Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer. Gastric Cancer 16(3):282–289. doi: 10.1007/s10120-012-0178-x CrossRefPubMedGoogle Scholar
  34. 34.
    Kosuga T, Ichikawa D, Komatsu S, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Otsuji E (2015) Feasibility and nutritional benefits of laparoscopic proximal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol. doi: 10.1245/s10434-015-4590-4 Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Young Suk Park
    • 1
  • Sang-Yong Son
    • 1
  • Aung Myint Oo
    • 1
    • 3
  • Do Hyun Jung
    • 1
  • Dong Joon Shin
    • 1
  • Sang-Hoon Ahn
    • 1
  • Do Joong Park
    • 1
    • 2
  • Hyung-Ho Kim
    • 1
    • 2
    Email author
  1. 1.Department of SurgerySeoul National University Bundang HospitalBundang-gu, Seongnam-shiSouth Korea
  2. 2.Department of Surgery, College of MedicineSeoul National UniversitySeoulSouth Korea
  3. 3.Department of General SurgeryTan Tock Seng HospitalNovenaSingapore

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