Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy.

Background And Objective: Only a few surgeons with much experience of laparoscopic surgery perform laparoscopy-assisted total gastrectomy (LATG), because of its technical difficulty and concern about subsequent complications. The aim of this study was to evaluate the technical feasibility and safety of LATG as compared with laparoscopy-assisted distal gastrectomy (LADG) in gastric cancer.

Methods: From January 2002 to December 2007, LADG was performed in 473 patients and LATG in 67 patients at the Korean National Cancer Center. Surgical procedures and short-term surgical outcomes of LATG were analyzed.

Results: D2 lymph node dissection was performed in 35 LATG (52.2%) cases and in 274 LADG (57.9%) cases (P = 0.378). Mean blood losses during operation were 156.8 +/- 158.0 ml and 190.7 +/- 176.2 ml, respectively (P = 0.114). The open conversion rate for LATG was higher than LADG without significance (4.3% vs. 1.7%, P = 0.153). Complications occurred in 18 LATG cases (26.9%) and 38 LADG cases (8.0%) (P < 0.001). The most common postoperative complication of LATG was anastomotic stricture after esophagojejunostomy.

Conclusions: LATG is a technically feasible procedure as compared with LADG. However, its postoperative complication rate is higher than that of LADG, especially that of anastomotic stricture. A more effective anastomotic method during LATG is required to prevent stricture.