Total and Subtotal D2 Laparoscopic Gastrectomy

Abstract

Laparoscopic distal gastrectomy with D2 lymph node dissection has been recently introduced as a treatment option for distal gastric cancer. Oncologic outcome measures of laparoscopic partial gastrectomy are comparable to those of the conventional open gastrectomy, and the postoperative course is improved in several retrospective and randomized controlled studies.

However, widespread diffusion of this technique is limited by the complexity of D2 lymphadenectomy.

Proximal gastric cancer is treated by total gastrectomy in association with an extended lymph node dissection of splenic, celiac, and paracardial stations. The role of laparoscopic total gastrectomy is still a matter of debate because of technical difficulties (specific node dissection and esophago-jejunal anastomosis) and little evidence on oncologic outcomes of this procedure.

The history of laparoscopic gastrectomies starts in 1991 with the first distal resection with Billroth I reconstruction reported by Kitano, while Goh in 1992 published the first Billroth II for benign ulcer.

The first laparoscopic Billroth II distal gastrectomy for cancer was performed in 1993 by Azagra who also performed the first laparoscopic total gastrectomy.