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Evaluation of the Safety and Feasibility of Laparoscopic Total Gastrectomy in Clinical Stage I Gastric Cancer Patients

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Abstract

Background

This retrospective study was designed to assess the feasibility of laparoscopic total gastrectomy (LTG) in clinical stage I gastric cancer patients, and validate the appropriateness of the widespread adoption of LTG for experienced open surgeons.

Methods

Eighty-eight patients with clinical stage I gastric cancer underwent LTG in our hospitals (n = 55) and affiliated hospitals (n = 33). Esophagojejunostomy was performed intracoporeally using a circular stapler with an incision in the left upper abdomen. We investigated the patients’ clinicopathologic factor, and evaluated the effect of hospital volume on short-term outcomes.

Results

Fixed insertion of the anvil head was successfully achieved in all patients (lift-up method in 58 patients and transoral method in 28 patients), although 2 patients were converted to open surgery. The approach using a circular stapler through a small incision from the upper left quadrant of the abdomen facilitated a good laparoscopic visual field for the plane of the esophagojejunostomy. Fourteen patients developed Clavien–Dindo classification grade II or more postoperative complications, and the overall operative morbidity rate was 15.9 %. No anastomotic leakage was encountered in this series. No significant difference was observed in clinical outcomes between patients in the high- and low-volume hospital groups.

Conclusions

Laparoscopic total gastrectomy can be performed safely on clinical stage I gastric cancer patients by surgeons with sufficient experience in open gastrectomy and therefore represents a feasible procedure that is not clinically impacted by hospital volume.

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Acknowledgments

We would like to thank all our colleagues for giving us the opportunity to teach laparoscopic total gastrectomy procedures. Our colleagues are listed below. Kyoto Kizugawa Hospital: Drs. T Obayashi and K Deguchi, and T Daido; Midorigaoka Hospital: Drs. H Tamai and T Imanishi; Kyoto Kujo Hospital: Drs. K Suchi and K Kitagawa; Ayabe City Hospital: Dr. K Inoue; Rakusai Newtown Hospital: Drs. K Imura and N Yamaoka; Kyoto First Red Cross Hospital: Dr. Y Itokawa; Saiseikai Shiga Hospital: Drs. M Masuyama and K Fukuda; Second Okamoto Hospital: Dr. A Iwamoto; Nara City Hospital: Dr. H Nagata; Panasonic Hospital: Dr. N Tani.

Conflict of interest

None to be declared.

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan

    Daisuke Ichikawa, Shuhei Komatsu, Takeshi Kubota, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara & Eigo Otsuji

Authors
  1. Daisuke Ichikawa
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  2. Shuhei Komatsu
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  3. Takeshi Kubota
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  4. Kazuma Okamoto
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  5. Hirotaka Konishi
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  6. Atsushi Shiozaki
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  7. Hitoshi Fujiwara
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  8. Eigo Otsuji
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Corresponding author

Correspondence to Daisuke Ichikawa.

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Ichikawa, D., Komatsu, S., Kubota, T. et al. Evaluation of the Safety and Feasibility of Laparoscopic Total Gastrectomy in Clinical Stage I Gastric Cancer Patients. World J Surg 39, 1782–1788 (2015). https://doi.org/10.1007/s00268-015-3008-6

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