Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center.

backgroundDespite the popularity of laparoscopic distal gastrectomy (LDG), laparoscopic total gastrectomy (LTG) remains a challenging procedure because of its technical difficulties and possible complications. In this study, the authors evaluated the short-term surgical outcomes and operative risks of LTG.

methodsThe records of 118 patients who underwent LTG for middle or upper gastric cancer were retrieved from a prospectively constructed database of 1,064 patients who underwent laparoscopic gastrectomy between 2007 and 2011. Surgical outcomes of LTG, such as operative results, postoperative courses, morbidities, and mortality, were investigated and compared with those of LDG patients.

resultsOf the 118 LTG patients, one underwent open conversion and three experienced an intraoperative complication. Mean operating time was 292 ± 88 min, and the mean total number of harvested lymph nodes was 41 ± 16. As compared with the LDG group, the LTG group had a significantly longer operation time (292 vs. 220 min, p < 0.001), and significantly more intraoperative blood loss (256 vs. 191 ml, p = 0.002). The overall morbidity rate after LTG was 22.9%, which was significantly higher than after LDG (12.7%, p = 0.002). There were two postoperative mortalities in the LTG group. The most common complications after LTG were anastomosis leakage (n = 9) and luminal bleeding (n = 9), which were followed by anastomosis stricture (n = 4) and abdominal infection (n = 3). Univariate and multivariate analysis revealed that old age [≥60 years, odds ratio (OR) = 2.55, 95% confidence interval (CI) = 0.95-6.84], intraoperative blood loss >200 ml (OR = 3.33, 95% CI = 1.14-9.70), and D2 lymphadenectomy (OR = 3.87, 95% CI = 1.30-11.55) were independent risk factors for postoperative complications after LTG.

conclusionsLTG is a feasible and acceptable procedure for treatment of middle or upper early gastric cancer. Further refinement of anastomosis techniques and considerable experience of laparoscopic gastrectomy are required for proper application of LTG in gastric carcinoma.