Skip to main content

Advertisement

Log in

Comparison of short- and long-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in gastric cancer patients

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopy-assisted total gastrectomy (LATG) has been used more frequently despite the associated technical difficulty and concerns over oncological safety. This study was undertaken to compare the short- and long-term surgical outcomes following either LATG or open total gastrectomy (OTG) for gastric cancer.

Methods

A total of 120 LATG and 228 OTG were retrospectively matched with respect to sex, age (±5 years), and pathological tumor-node-metastasis stage for comparison of the clinical outcomes.

Results

The total complication rate among 120 LATG and 228 OTG was 18.3 % (22/120) and 16.2 % (37/228), respectively. The most common complication after LATG was anastomotic-related complication (6.7 %); five anastomotic leakages (4.2 %) and three anastomotic strictures were reported (2.5 %). That after OTG was wound complication (3.5 %), including seroma or infection. Matched patients analysis: Time to first gas passing and time to the resumption of a soft diet were significantly shorter in the LATG group than in the OTG group. The postoperative hospital stay of LATG was shorter in the LATG group (9.3 ± 4.2 days) than in the OTG group (11.7 ± 7.3 days; p = 0.057). Among matched patients, there was no significant difference between complication rate (24 vs. 32 %; p = 0.504) or leakage rate (6 vs. 4 %). During median follow-up of 50 (range, 10–92) months, there was no significant difference in the disease-free survival rate between the matched groups, respectively (94.5 vs. 87.1 %: p = 0.148). As for patients with TNM stage I gastric cancer, the disease-free survival rate (100 vs. 90.9 %; p = 0.5) and the cumulative survival rate (91.5 vs. 95.2 %; p = 0.618) did not differ significantly between the LATG and OTG groups.

Conclusions

LATG for gastric cancer has the advantage over an OTG in terms of better short-term outcomes and similar long-term outcome. LATG is an acceptable alternative to OTG for the treatment of gastric cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

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

    PubMed  CAS  Google Scholar 

  2. Kim MC, Jung GJ, Kim HH (2007) Morbidity and mortality of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer. Dig Dis Sci 52:543–548

    Article  PubMed  Google Scholar 

  3. Hamabe A, Omori T, Tanaka K, Nishida T (2011) Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc 26(6):1702–1709

    Article  PubMed  Google Scholar 

  4. 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 

  5. Usui S, Yoshida T, Ito K, Hiranuma S, Kudo SE, 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 

  6. Rossetti G, Del Genio G, Maffettone V, Napolitano V, Brusciano L, Russo G, Limongelli P, Fiume I, Pizza F, del Genio A (2007) Laparoscopic conversion of an omega in a Roux-en-Y reconstruction after mini-invasive total gastrectomy for cancer: a technical report. Surg Laparosc Endosc Percutan Tech 17:33–37

    Article  PubMed  Google Scholar 

  7. Lee J, Kim W (2009) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol 100:693–698

    Article  PubMed  Google Scholar 

  8. Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A (1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234

    Article  PubMed  Google Scholar 

  9. Shuang J, Qi S, Zheng J, Zhao Q, Li J, Kang Z, Hua J, Du J (2011) A case–control study of laparoscopy-assisted and open distal gastrectomy for advanced gastric cancer. J Gastrointest Surg 15:57–62

    Article  PubMed  Google Scholar 

  10. Otsuka K, Murakami M, Aoki T, Tajima Y, Kaetsu T, Lefor AT (2005) Minimally invasive treatment of stomach cancer. Cancer J 11:18–25

    Article  PubMed  Google Scholar 

  11. 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 100:392–395

    Article  PubMed  Google Scholar 

  12. 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 

  13. Tanimura S, Higashino M, Fukunaga Y, Kishida S, Ogata A, Fujiwara Y, Osugi H (2007) Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Br J Surg 94:204–207

    Article  PubMed  CAS  Google Scholar 

  14. Kim MC, Kim KH, Kim HH, Jung GJ (2005) Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 91:90–94

    Article  PubMed  Google Scholar 

  15. Kitano S, Shiraishi N, Uyama I, Suqihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncological outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72

    Article  PubMed  Google Scholar 

  16. Lang H, Piso P, Stukenborg C, Raab R, Jahne 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 

  17. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Crose N, Gennari L (1997) Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial. Ann Surg 226:613–620

    Article  PubMed  CAS  Google Scholar 

  18. 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 

  19. 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 

  20. 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 24:2475–2479

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. M.-S. Lee, J.-H. Lee, D. J. Park, H.-J. Lee, H.-H. Kim, and H.-K. Yang have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hyung-Ho Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, MS., Lee, JH., Park, D.J. et al. Comparison of short- and long-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in gastric cancer patients. Surg Endosc 27, 2598–2605 (2013). https://doi.org/10.1007/s00464-013-2796-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-2796-8

Keywords

Navigation