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Is laparoscopic total gastrectomy a safe operation? A review of various anastomotic techniques and their outcomes

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Abstract

Laparoscopic distal gastrectomy is an accepted option for gastric cancer surgery; however, laparoscopic total gastrectomy (LTG) is not widely performed. There is concern about the safety of the operation due to the difficulty of extracorporeal reconstruction through a mini-laparotomy. Efforts have been made to establish an intracorporeal anastomotic technique for esophagojejunostomy. This article reviews the current techniques available for laparoscopic esophagojejunostomy and their surgical outcomes. Several different techniques using either circular or linear staplers have been reported; however, the apparent superiority of any particular method has not been confirmed. The incidence of anastomosis-related complications varied among studies, but different techniques all successfully achieved excellent outcomes. The overall complication rate of LTG was similar to that of open total gastrectomy, suggesting that LTG is a safe and feasible option. However, the feasibility of LTG with D2 lymph node dissection for advanced upper gastric cancer needs to be confirmed in further studies, because most of the patients included in the LTG studies were diagnosed with early stages of disease.

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Acknowledgments

We would like to thank Shigeyuki Sakaguchi for his support in the production of the illustrations. In addition, we thank Takahiro Kinoshita, Shinsuke Usui, Takeshi Omori, Souya Nunobe, Naoki Hiki, Kazuki Inaba, Ichiro Uyama and Seiichiro Kanaya for their permission to use illustrations from their work.

Conflict of interest

The authors declare no conflicts of interest in association with this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Hiroshi Okabe, Shigeru Tsunoda, Eiji Tanaka, Shigeo Hisamori, Hironori Kawada & Yoshiharu Sakai

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  1. Hiroshi Okabe
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  2. Shigeru Tsunoda
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  3. Eiji Tanaka
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  4. Shigeo Hisamori
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Correspondence to Hiroshi Okabe.

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Okabe, H., Tsunoda, S., Tanaka, E. et al. Is laparoscopic total gastrectomy a safe operation? A review of various anastomotic techniques and their outcomes. Surg Today 45, 549–558 (2015). https://doi.org/10.1007/s00595-014-0901-9

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  • DOI: https://doi.org/10.1007/s00595-014-0901-9

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