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Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center

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Despite the popularity of laparoscopic distal gastrectomy (LDG), laparoscopic total gastrectomy (LTG) remains a challenging procedure because of its technical difficulties and possible complications. In this study, the authors evaluated the short-term surgical outcomes and operative risks of LTG.


The records of 118 patients who underwent LTG for middle or upper gastric cancer were retrieved from a prospectively constructed database of 1,064 patients who underwent laparoscopic gastrectomy between 2007 and 2011. Surgical outcomes of LTG, such as operative results, postoperative courses, morbidities, and mortality, were investigated and compared with those of LDG patients.


Of the 118 LTG patients, one underwent open conversion and three experienced an intraoperative complication. Mean operating time was 292 ± 88 min, and the mean total number of harvested lymph nodes was 41 ± 16. As compared with the LDG group, the LTG group had a significantly longer operation time (292 vs. 220 min, p < 0.001), and significantly more intraoperative blood loss (256 vs. 191 ml, p = 0.002). The overall morbidity rate after LTG was 22.9 %, which was significantly higher than after LDG (12.7 %, p = 0.002). There were two postoperative mortalities in the LTG group. The most common complications after LTG were anastomosis leakage (n = 9) and luminal bleeding (n = 9), which were followed by anastomosis stricture (n = 4) and abdominal infection (n = 3). Univariate and multivariate analysis revealed that old age [≥60 years, odds ratio (OR) = 2.55, 95 % confidence interval (CI) = 0.95–6.84], intraoperative blood loss >200 ml (OR = 3.33, 95 % CI = 1.14–9.70), and D2 lymphadenectomy (OR = 3.87, 95 % CI = 1.30–11.55) were independent risk factors for postoperative complications after LTG.


LTG is a feasible and acceptable procedure for treatment of middle or upper early gastric cancer. Further refinement of anastomosis techniques and considerable experience of laparoscopic gastrectomy are required for proper application of LTG in gastric carcinoma.

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  1. Jung KW, Park S, Kong HJ, Won YJ, Boo YK, Shin HR, Park EC, Lee JS (2010) Cancer statistics in Korea: incidence, mortality and survival in 2006–2007. J Korean Med Sci 25:1113–1121

    Article  PubMed  Google Scholar 

  2. Lee HJ, Yang HK, Ahn YO (2002) Gastric cancer in Korea. Gastric Cancer 5:177–182

    Article  PubMed  Google Scholar 

  3. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

    PubMed  CAS  Google Scholar 

  4. Tada M, Murakami A, Karita M, Yanai H, Okita K (1993) Endoscopic resection of early gastric cancer. Endoscopy 25:445–450

    Article  PubMed  CAS  Google Scholar 

  5. Kitano S, Shiraishi N (2004) Current status of laparoscopic gastrectomy for cancer in Japan. Surg Endosc 18:182–185

    Article  PubMed  CAS  Google Scholar 

  6. 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 11:69–77

    Article  PubMed  Google Scholar 

  7. Hosono S, Arimoto Y, Ohtani H, Kanamiya Y (2006) Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy. World J Gastroenterol 12:7676–7683

    PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Memon MA, Khan S, Yunus RM, Barr R, Memon B (2008) Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc 22:1781–1789

    Article  PubMed  Google Scholar 

  10. Ohtani H, Tamamori Y, Noguchi K, Azuma T, Fujimoto S, Oba H, Aoki T, Minami M, Hirakawa K (2010) A meta-analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer. J Gastrointest Surg 14:958–964

    Article  PubMed  Google Scholar 

  11. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72

    Article  PubMed  Google Scholar 

  12. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225

    Article  PubMed  Google Scholar 

  13. Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250:177–186

    Article  PubMed  Google Scholar 

  14. Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma-2nd English edition. Gastric Cancer 1:10–24

    Article  PubMed  Google Scholar 

  15. Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil™) after laparoscopic total gastrectomy. Surg Endosc 23:2624–2630

    Article  PubMed  Google Scholar 

  16. Asao T, Hosouchi Y, Nakabayashi T, Haga N, Mochiki E, Kuwano H (2001) Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer. Br Journal Surg 88:128–132

    Article  CAS  Google Scholar 

  17. Jeong GA, Cho GS, Kim HH, Lee HJ, Ryu SW, Song KY (2009) Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery 146:469–474

    Article  PubMed  Google Scholar 

  18. Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, Cho SJ, Lee JY, Kim CG, Choi IJ (2009) Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 100:392–395

    Article  PubMed  Google Scholar 

  19. 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 22:1997–2002

    Article  PubMed  Google Scholar 

  20. Tanimura S, Higashino M, Fukunaga Y, Osugi H (2003) Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Gastric Cancer 6:64–68

    Article  PubMed  Google Scholar 

  21. Usui S, Yoshida T, Ito K, Hiranuma S, Kudo S, Iwai T (2005) Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy. Surg Laparosc Endosc Percutan Tech 15:309–314

    Article  PubMed  Google Scholar 

  22. Lang H, Piso P, Stukenborg C, Raab R, Jähne J (2000) Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 26:168–171

    Article  PubMed  CAS  Google Scholar 

  23. Kim JH, Park SS, Kim J, Boo YJ, Kim SJ, Mok YJ, Kim CS (2006) Surgical outcomes for gastric cancer in the upper third of the stomach. World J Surg 30:1870–1876

    Article  PubMed  Google Scholar 

  24. Park DJ, Lee HJ, Kim HH, Yang HK, Lee K, Choe K (2005) Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 92:1099–1102

    Article  PubMed  CAS  Google Scholar 

  25. Okabe H, Obama K, Tanaka E, Nomura A, Kawamura J, Nagayama S, Itami A, Watanabe G, Kanaya S, Sakai Y (2009) Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc 23:2167–2171

    Article  PubMed  Google Scholar 

  26. 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 35:896–899

    Article  PubMed  Google Scholar 

  27. Hur H, Jeon HM, Kim W (2008) Laparoscopic pancreas- and spleen-preserving D2 lymph node dissection in advanced (cT2) upper-third gastric cancer. J Surg Oncol 97:169–172

    Article  PubMed  Google Scholar 

  28. 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 23:2416–2423

    Article  PubMed  Google Scholar 

  29. Jin SH, Kim DY, Kim H, Jeong IH, Kim MW, Cho YK, Han SU (2007) Multidimensional learning curve in laparoscopy-assisted gastrectomy for gastric cancer. Surg Endosc 21:28–33

    Article  PubMed  Google Scholar 

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Authors O Jeong, Y K Park, S Y Ryu, M R Jung, and G Y Kim have no conflicts of interest or financial interests to declare in association with this study. No funding or grant was provided.

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Correspondence to Young Kyu Park.

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Presented at the SAGES 2012 Annual Meeting, March 7–10, 2012, San Diego, CA.

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Jeong, O., Ryu, S.Y., Zhao, XF. et al. Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center. Surg Endosc 26, 3418–3425 (2012).

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