Woo Jin Hyung1, Han-Kwang Yang2, Sang-Uk Han3, Young-Jun Lee4, Joong-Min Park5, Jin Jo Kim6, Oh Kyung Kwon7, Seong Ho Kong2, Hyoung-Il Kim1, Hyuk-Joon Lee2, Wook Kim8, Seung Wan Ryu9, Sung-Ho Jin10, Sung Jin Oh11, Keun Won Ryu12, Min-Chan Kim13, Hye-Seong Ahn14, Young Kyu Park15, Young-Ho Kim16, Sun-Hwi Hwang17, Jong Won Kim5, Gyu Seok Cho18. 1. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea. 2. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. 3. Department of Surgery, Ajou University School of Medicine, Suwon, South Korea. 4. Department of Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, South Korea. 5. Department of Surgery, Chung-Ang University College of Medicine, Seoul, South Korea. 6. Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, South Korea. 7. Department of Surgery, Kyungpook National University Medical Center, Daegu, South Korea. 8. Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea. 9. Department of Surgery, Keimyung University School of Medicine, Daegu, South Korea. 10. Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea. 11. Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. 12. Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea. 13. Department of Surgery, Dong-A University College of Medicine, Busan, South Korea. 14. Department of Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea. 15. Department of Surgery, Chonnam National University Hwasoon Hospital, Hwasun, South Korea. 16. Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea. 17. Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea. 18. Department of Surgery, Soonchunhyang University College of Medicine, 170-Jomaru-ro, Bucheon-si, Gyeonggi-do, South Korea. gschogs@schmc.ac.kr.
Abstract
BACKGROUND: With improved short-term surgical outcomes, laparoscopic distal gastrectomy has rapidly gained popularity. However, the safety and feasibility of laparoscopic total gastrectomy (LTG) has not yet been proven due to the difficulty of the technique. This single-arm prospective multi-center study was conducted to evaluate the use of LTG for clinical stage I gastric cancer. METHODS: Between October 2012 and January 2014, 170 patients with pathologically proven, clinical stage I gastric adenocarcinoma located at the proximal stomach were enrolled. Twenty-two experienced surgeons from 19 institutions participated in this clinical trial. The primary end point was the incidence of postoperative morbidity and mortality at postoperative 30 days. The severity of postoperative complications was categorized according to Clavien-Dindo classification, and the incidence of postoperative morbidity and mortality was compared with that in a historical control. RESULTS: Of the enrolled patients, 160 met criteria for inclusion in the full analysis set. Postoperative morbidity and mortality rates reached 20.6% (33/160) and 0.6% (1/160), respectively. Fifteen patients (9.4%) had grade III or higher complications, and three reoperations (1.9%) were performed. The incidence of morbidity after LTG in this trial did not significantly differ from that reported in a previous study for open total gastrectomy (18%). CONCLUSIONS: LTG performed by experienced surgeons showed acceptable postoperative morbidity and mortality for patients with clinical stage I gastric cancer.
BACKGROUND: With improved short-term surgical outcomes, laparoscopic distal gastrectomy has rapidly gained popularity. However, the safety and feasibility of laparoscopic total gastrectomy (LTG) has not yet been proven due to the difficulty of the technique. This single-arm prospective multi-center study was conducted to evaluate the use of LTG for clinical stage I gastric cancer. METHODS: Between October 2012 and January 2014, 170 patients with pathologically proven, clinical stage I gastric adenocarcinoma located at the proximal stomach were enrolled. Twenty-two experienced surgeons from 19 institutions participated in this clinical trial. The primary end point was the incidence of postoperative morbidity and mortality at postoperative 30 days. The severity of postoperative complications was categorized according to Clavien-Dindo classification, and the incidence of postoperative morbidity and mortality was compared with that in a historical control. RESULTS: Of the enrolled patients, 160 met criteria for inclusion in the full analysis set. Postoperative morbidity and mortality rates reached 20.6% (33/160) and 0.6% (1/160), respectively. Fifteen patients (9.4%) had grade III or higher complications, and three reoperations (1.9%) were performed. The incidence of morbidity after LTG in this trial did not significantly differ from that reported in a previous study for open total gastrectomy (18%). CONCLUSIONS: LTG performed by experienced surgeons showed acceptable postoperative morbidity and mortality for patients with clinical stage I gastric cancer.
Entities:
Keywords:
Gastric cancer; Laparoscopy; Total gastrectomy