Critical factors that influence the early outcome of laparoscopic total gastrectomy

Yuichiro Kawamura, Seiji Satoh, Koichi Suda, Yoshinori Ishida, Seiichiro Kanaya, Ichiro Uyama

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Laparoscopic distal gastrectomy (LDG) is a routinely performed procedure. However, clinical expertise in laparoscopic total gastrectomy (LTG) is insufficient, and it is only performed at specialized institutions. This study aimed to identify critical factors associated with complications after laparoscopic gastrectomy (LG), particularly LTG. Methods: A large-scale database was used to identify critical factors influencing the early outcomes of LTG. Of 1248 patients with resectable gastric cancer who underwent LG, 259 underwent LTG. Predictive risk factors were determined by analyzing relationships between clinical characteristics and postoperative complications. Major complications after LTG were analyzed in detail. Results: Multivariate analysis of all LG procedures revealed LTG as a risk factor for complications. Morbidity in the LDG and LTG groups was 6.2 % (52 of 835 patients) and 22.4 % (58 of 259 patients), respectively. Major post-LTG complications included anastomotic leakages and pancreatic fistulae. The rate of anastomotic leakage was significantly higher in the LTG group (5.0 %) than in the LDG group (1.2 %); however, it showed a tendency to decrease in more recent cases. Pancreatic fistulae occurred frequently after LTG with D2 lymphadenectomy (LTG-D2), particularly in cases of concomitant pancreatosplenectomy. Obesity was also associated with pancreatic fistula formation after LTG with pancreatosplenectomy. Conclusions: Compared with LDG, LTG is a developing procedure. Advances in the surgical techniques associated with the LTG procedure will improve the short-term outcomes of esophagojejunostomy. With regard to LTG-D2, establishing optimal and safe #10 node dissection is one of the most urgent issues. Pancreatic fistula after LTG with pancreatosplenectomy must be investigated in the future.

Original languageEnglish
Pages (from-to)662-668
Number of pages7
JournalGastric Cancer
Volume18
Issue number3
DOIs
Publication statusPublished - 2014 Jun 7
Externally publishedYes

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Gastrectomy
Pancreatic Fistula
Anastomotic Leak

Keywords

  • Gastric cancer
  • Laparoscopic gastrectomy
  • Laparoscopic total gastrectomy
  • Short-term outcome

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research
  • Medicine(all)

Cite this

Kawamura, Y., Satoh, S., Suda, K., Ishida, Y., Kanaya, S., & Uyama, I. (2014). Critical factors that influence the early outcome of laparoscopic total gastrectomy. Gastric Cancer, 18(3), 662-668. https://doi.org/10.1007/s10120-014-0392-9

Critical factors that influence the early outcome of laparoscopic total gastrectomy. / Kawamura, Yuichiro; Satoh, Seiji; Suda, Koichi; Ishida, Yoshinori; Kanaya, Seiichiro; Uyama, Ichiro.

In: Gastric Cancer, Vol. 18, No. 3, 07.06.2014, p. 662-668.

Research output: Contribution to journalArticle

Kawamura, Y, Satoh, S, Suda, K, Ishida, Y, Kanaya, S & Uyama, I 2014, 'Critical factors that influence the early outcome of laparoscopic total gastrectomy', Gastric Cancer, vol. 18, no. 3, pp. 662-668. https://doi.org/10.1007/s10120-014-0392-9
Kawamura, Yuichiro ; Satoh, Seiji ; Suda, Koichi ; Ishida, Yoshinori ; Kanaya, Seiichiro ; Uyama, Ichiro. / Critical factors that influence the early outcome of laparoscopic total gastrectomy. In: Gastric Cancer. 2014 ; Vol. 18, No. 3. pp. 662-668.
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AU - Kanaya, Seiichiro

AU - Uyama, Ichiro

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AB - Background: Laparoscopic distal gastrectomy (LDG) is a routinely performed procedure. However, clinical expertise in laparoscopic total gastrectomy (LTG) is insufficient, and it is only performed at specialized institutions. This study aimed to identify critical factors associated with complications after laparoscopic gastrectomy (LG), particularly LTG. Methods: A large-scale database was used to identify critical factors influencing the early outcomes of LTG. Of 1248 patients with resectable gastric cancer who underwent LG, 259 underwent LTG. Predictive risk factors were determined by analyzing relationships between clinical characteristics and postoperative complications. Major complications after LTG were analyzed in detail. Results: Multivariate analysis of all LG procedures revealed LTG as a risk factor for complications. Morbidity in the LDG and LTG groups was 6.2 % (52 of 835 patients) and 22.4 % (58 of 259 patients), respectively. Major post-LTG complications included anastomotic leakages and pancreatic fistulae. The rate of anastomotic leakage was significantly higher in the LTG group (5.0 %) than in the LDG group (1.2 %); however, it showed a tendency to decrease in more recent cases. Pancreatic fistulae occurred frequently after LTG with D2 lymphadenectomy (LTG-D2), particularly in cases of concomitant pancreatosplenectomy. Obesity was also associated with pancreatic fistula formation after LTG with pancreatosplenectomy. Conclusions: Compared with LDG, LTG is a developing procedure. Advances in the surgical techniques associated with the LTG procedure will improve the short-term outcomes of esophagojejunostomy. With regard to LTG-D2, establishing optimal and safe #10 node dissection is one of the most urgent issues. Pancreatic fistula after LTG with pancreatosplenectomy must be investigated in the future.

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KW - Laparoscopic gastrectomy

KW - Laparoscopic total gastrectomy

KW - Short-term outcome

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