To validate the efficacy and safety of laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC).
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.
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.
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.
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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90
Orditura M, Galizia G, Sforza V et al (2014) Treatment of gastric cancer. World J Gastroenterol 20(7):1635–1649
Kitano S, Iso Y, Moriyama M et al (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(2):146–148
Han HS, Kim YW, Yi NJ et al (2003) Laparoscopy-assisted D2 subtotal gastrectomy in early gastric cancer. Surg Laparosc Endosc Percutan Tech 13(6):361–365
Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19(2):168–173
Lee JH, Yom CK, Han HS (2009) Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 23(8):1759–1763
Hur H, Jeon HM, Kim W (2008) Laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for T2b advanced gastric cancers: three years’ experience. J Surg Oncol 98(7):515–519
Kawamura H, Homma S, Yokota R et al (2008) Inspection of safety and accuracy of D2 lymph node dissection in laparoscopy-assisted distal gastrectomy. World J Surg 32(11):2366–2370
Tanimura S, Higashino M, Fukunaga Y et al (2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22(5):1161–1164
Kim KH, Kim MC, Jung GJ et al (2012) Long-term outcomes and feasibility with laparoscopy-assisted gastrectomy for gastric cancer. J Gastric Cancer 12(1):18–25
Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma-2nd English edition. Gastric Cancer 1:10–24
Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2):101–112
Huang CM, Chen QY, Lin JX et al (2014) Huang’s three-step maneuver for laparoscopic spleen-preserving no. 10 lymph node dissection for advanced proximal gastric cancer. Chin J Cancer Res 26(2):208–210
Hu YF, Yu J, Zhang C et al (2010) Development and implementation of a clinical data mining system for gastric cancer surgery (in Chinese). Chin J Gastrointest Surg 13:510–515
Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111(5):518–526
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Japan Clinical Oncology Group. Postoperative Complication Criteria according to Clavien–Dindo Classification ver. 2.0. http://www.jcog.jp/doctor/tool/Clavien_Dindo.html
Sobin LH, Gospodarowicz MK, Wittekind C (2010) International Union Against Cancer (UICC) TNM classification of malignant tumours, 7th edn. Wiley-Liss, New York
Kubo A, Corley DA (2002) Marked regional variation in adenocarcinomas of the esophagus and the gastric cardia in the United States. Cancer 95(10):2096–2102
Lin JX, Huang CM, Zheng CH et al (2013) Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China. World J Surg Oncol 11:4
Nam BH, Kim YW, Reim D et al (2013) Laparoscopy assisted versus open distal gastrectomy with D2 lymph node dissection for advanced gastric cancer: design and rationale of a phase II randomized controlled multicenter trial (COACT 1001). J Gastric Cancer 13(3):164–171
Kunisaki C, Makino H, Yamamoto N et al (2008) Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer. Surg Laparosc Endosc Percutan Tech 18(3):236–241
Wang JB, Huang CM, Zheng CH et al (2010) Efficiency of laparoscopic D2 radical gastrectomy in gastric cancer: experiences of 218 patients (in Chinese). Chin J Gastrointest Surg 48(7):502–505
Huang CM, Lin JX, Zheng CH et al (2012) Clinical efficacy analysis of laparoscopy-assisted radical gastrectomy for 1380 patients with gastric cancer (in Chinese). Chin J Gastrointest Surg 15(12):1265–1268
DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244(6):931–939
Mazeh H, Samet Y, Abu-Wasel B et al (2009) Application of a novel severity grading system for surgical complications after colorectal resection. J Am Coll Surg 208(3):355–361
Lee JH, Park do J, Kim HH et al (2012) Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien–Dindo classification. Surg Endosc 26(5):1287–1295
Miki Y, Tokunaga M, Tanizawa Y et al (2014) Perioperative risk assessment for gastrectomy by surgical Apgar score. Ann Surg Oncol 21(8):2601–2607
Jeong O, Ryu SY, Choi WY et al (2014) Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma. Ann Surg Oncol 21(9):2994–3001
Kim W, Song KY, Lee HJ et al (2008) The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 248(5):793–799
Cho GS, Kim W, Kim HH et al (2009) Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly. Br J Surg 96(12):1437–1442
Hsieh CH (2003) Laparoscopic cholecystectomy for patients with chronic obstructive pulmonary disease. J Laparoendosc Adv Surg Tech A 13(1):5–9
Galizia G, Prizio G, Lieto E et al (2001) Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study. Surg Endosc 15(5):477–483
Uemura N, Nomura M, Inoue S et al (2002) Changes in hemodynamics and autonomic nervous activity in patients undergoing laparoscopic cholecystectomy: differences between the pneumoperitoneum and abdominal wall-lifting method. Endoscopy 34(8):643–650
Pak KH, Hyung WJ, Son T et al (2012) Long-term oncologic outcomes of 714 consecutive laparoscopic gastrectomies for gastric cancer: results from the 7-year experience of a single institute. Surg Endosc 26(1):130–136
Bo T, Peiwu Y, Feng Q et al (2013) Laparoscopy-assisted vs. open total gastrectomy for advanced gastric cancer: long-term outcomes and technical aspects of a case–control study. J Gastrointest Surg 17(7):1202–1208
Hwang SI, Kim HO, Yoo CH et al (2009) Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23(6):1252–1258
Shuang J, Qi S, Zheng J et al (2011) A case–control study of laparoscopy-assisted and open distal gastrectomy for advanced gastric cancer. J Gastrointest Surg 15(1):57–62
Park do J, Han SU, Hyung WJ et al (2012) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc 26(6):1548–1553
Ahn HS, Lee HJ, Hahn S et al (2010) Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer 116(24):5592–5598
Dikken JL, van de Velde CJ, Gönen M et al (2012) The New American Joint Committee on Cancer/International Union Against Cancer staging system for adenocarcinoma of the stomach: increased complexity without clear improvement in predictive accuracy. Ann Surg Oncol 19(8):2443–2451
We thank the Follow-up Office established by the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
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.
This study supported by National Key Clinical Specialty Discipline Construction Program of China (No. 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.
About this article
Cite this article
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
- Stomach neoplasm
- Laparoscopic total gastrectomy
- Surgical outcomes
- Clavien–Dindo classification