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Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy

Abstract

Objective

To validate the efficacy and safety of laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC).

Background

Laparoscopic distal gastrectomy (LDG) in the treatment of patients with local AGC is becoming increasingly popular, and there have been several multicenter randomized controlled trials focused on this treatment. However, few reports on the procedure of LTG for AGC exist.

Methods

The data of 976 patients who underwent LTG for AGC were retrieved from a prospectively constructed database of 2170 patients who underwent laparoscopic gastrectomy between 2007 and 2013. Surgical outcomes of LTG were investigated and compared with those of patients who underwent LDG.

Results

LTG was associated with significantly longer operation time, number of dissected lymph nodes, and time of resume soft diet compared with the LDG group. According to Clavien–Dindo classification, the morbidity and mortality rates of the LTG group were comparable to those of the LDG group. Multivariate analyses revealed that elderly patients, more comorbidities, and longer operation time were the significant independent risk factors for determining postoperative complications. The difference in overall survival rates between the two groups was statistically significant. However, a comparative analysis of overall survival showed no statistical significance for any of the stages of cancer between the LTG and LDG groups.

Conclusions

The study findings suggest that LTG is an oncologically safe procedure for AGC yields comparable surgical outcomes. A well-designed phase III trial can be carried out to provide valuable evidence for the oncologic safety of LTG for the treatment of AGC.

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Acknowledgments

We thank the Follow-up Office established by the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.

Author contributions

Lin JX and Huang CM conceived of the study, analyzed the data, and drafted the manuscript; Zheng CH, Li P, Xie JW, and Wang JB helped revise the manuscript critically for important intellectual content; Lu J, Chen QY, Lin M, and Tu RH helped collect data and design the study. All authors read and approved the final manuscript.

Author information

Correspondence to Chang-Ming Huang.

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Disclosures

This study supported by National Key Clinical Specialty Discipline Construction Program of China (No. [2012]649) and the Key Project of Science and Technology Plan of Fujian Province, China (No. 2-14Y0025). Jian-Xian Lin, Chang-Ming Huang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-bin Wang, Lu Jun, Qi-Yue Chen, Mi Lin, and Ruhong Tu have no conflicts of interest or financial ties to disclose.

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Lin, J., Huang, C., Zheng, C. et al. Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy. Surg Endosc 30, 1988–1998 (2016). https://doi.org/10.1007/s00464-015-4429-x

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Keywords

  • Stomach neoplasm
  • Laparoscopic total gastrectomy
  • Surgical outcomes
  • Clavien–Dindo classification