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Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study

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Abstract

Background

D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC.

Methods

A single-institution retrospective study was conducted. Ninety-two consecutive AGC patients who underwent radical TLTG were enrolled. The primary end point was morbidity. The patients were observed for 3 years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS).

Results

Early and late morbidities (Clavien–Dindo grade ≥3) were 26.1 and 6.5 %, respectively. Operative time, estimated blood loss, number of dissected lymph nodes, and postoperative hospital stay were 444 (278–694) min, 100 (0–2267) g, 48 (16–89), and 23 (9–136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9 %, respectively. Factors associated with postoperative complications and 3yOS were operative time [OR 1.011 (1.006–1.017), p < 0.01] and cancer recurrence within 3 years [HR 312.191 (1.126–86573.245], p = 0.045], respectively. 3yRFS was associated with tumor size (≥50 mm) [HR 10.325 (1.328–80.289), p = 0.026], pathological N factor ≥2 [HR 3.188 (1.196–8.495), p = 0.02], and postoperative pancreatic fistula combined with intra-abdominal abscesses Clavien–Dindo grade ≥2; [HR 3.670 (1.440–9.351), p = 0.006].

Conclusions

TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.

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Abbreviations

TLTG:

Totally laparoscopic total gastrectomy

AGC:

Advanced gastric cancer

EGC:

Early gastric cancer

LG:

Laparoscopic gastrectomy

LN:

Lymph node

SHLN:

Splenic hilar lymph node

3yOS:

Three-year overall survival rates

3yRFS:

Three-year recurrence-free survival rates

D2-10:

D2 lymphadenectomy with preservation of station 10 lymph nodes and spleen

D2-S:

Spleen-preserving D2 lymphadenectomy

D2 + S:

D2 lymphadenectomy combined with splenectomy

D2 + PS:

D2 lymphadenectomy combined with distal pancreaticosplenectomy

NAC:

Neoadjuvant chemotherapy

BMI:

Body mass index

ASA-PS:

American Society of Anesthesiologists Physical Status

JCGC:

Japanese Classification of Gastric Carcinoma

CD:

Clavien–Dindo classification

HR:

Hazard ratio

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Acknowledgments

The authors are indebted to Maruzen CO., LTD. (Tokyo, Japan) for their native English speaker’s review of this manuscript.

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This work was not supported by any grants or funding.

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Correspondence to Koichi Suda.

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Masaya Nakauchi, Koichi Suda, Shinichi Kadoya, Kazuki Inaba, Yoshinori Ishida, and Ichiro Uyama have no conflicts of interest or financial ties to disclose.

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Nakauchi, M., Suda, K., Kadoya, S. et al. Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study. Surg Endosc 30, 4632–4639 (2016). https://doi.org/10.1007/s00464-015-4726-4

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