Shuhei Komatsu1,2, Toshiyuki Kosuga1, Takeshi Kubota1, Kazuma Okamoto1, Hirotaka Konishi1, Atsushi Shiozaki1, Hitoshi Fujiwara1, Daisuke Ichikawa3, Eigo Otsuji1. 1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. 2. Department of Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital 15-749 Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan. 3. First Department of Surgery, Faculty of Medicine, University of Yamanashi 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan.
Abstract
BACKGROUND: The aim of this study was to compare the short- and long-term outcomes of laparoscopic total gastrectomy (LTG) with those of open total gastrectomy (OTG) for the upper part of clinical Stage I gastric cancer. METHODS: Between 2000 and 2015, 122 and 96 consecutive gastric cancer patients who had undergone curative LTG and OTG with lymphadenectomy were enrolled in the study. We performed the simple intracorporeal techniqueof esophagojejunostomy using a circular stapler in LTG. This technique comprised of laparoscopic trans-abdominal anvil insertion into the esophagus, which was assisted by lifting up the nasogastric tube connected to the anvil head. RESULTS: By the Clavien-Dindo classification defined as grade II or high, the rate of postoperative complications was 14.8% (14/112: Grade II (7), IIIa (4), and IIIb (3)) in LTG and 15.6% (15/96) in OTG. There was no anastomotic leakage (0% (0/122)) and only 3.3% (4/122) of anastomotic stenosis in LTG. There was no significant difference in the short-term outcomes between both groups in all enrolled and propensity score-matched patients (LTG vs. OTG: 15.4% (10/65) vs. 16.9% (11/65)). Regarding the long-term outcomes, there was no significant difference in overall survival between both groups in all enrolled (P = 0.190) and propensity score-matched patients (P = 0.643). CONCLUSIONS: LTG for the upper part of clinical Stage I gastric cancer is a safe and reliable procedure and could have similar short- and long-term outcomes as OTG. AJTR
BACKGROUND: The aim of this study was to compare the short- and long-term outcomes of laparoscopic total gastrectomy (LTG) with those of open total gastrectomy (OTG) for the upper part of clinical Stage I gastric cancer. METHODS: Between 2000 and 2015, 122 and 96 consecutive gastric cancerpatients who had undergone curative LTG and OTG with lymphadenectomy were enrolled in the study. We performed the simple intracorporeal techniqueof esophagojejunostomy using a circular stapler in LTG. This technique comprised of laparoscopic trans-abdominal anvil insertion into the esophagus, which was assisted by lifting up the nasogastric tube connected to the anvil head. RESULTS: By the Clavien-Dindo classification defined as grade II or high, the rate of postoperative complications was 14.8% (14/112: Grade II (7), IIIa (4), and IIIb (3)) in LTG and 15.6% (15/96) in OTG. There was no anastomotic leakage (0% (0/122)) and only 3.3% (4/122) of anastomotic stenosis in LTG. There was no significant difference in the short-term outcomes between both groups in all enrolled and propensity score-matched patients (LTG vs. OTG: 15.4% (10/65) vs. 16.9% (11/65)). Regarding the long-term outcomes, there was no significant difference in overall survival between both groups in all enrolled (P = 0.190) and propensity score-matched patients (P = 0.643). CONCLUSIONS:LTG for the upper part of clinical Stage I gastric cancer is a safe and reliable procedure and could have similar short- and long-term outcomes as OTG. AJTR