Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study

Masaya Nakauchi, Koichi Suda, Shinichi Kadoya, Kazuki Inaba, Yoshinori Ishida, Ichiro Uyama

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC. Methods: A single-institution retrospective study was conducted. Ninety-two consecutive AGC patients who underwent radical TLTG were enrolled. The primary end point was morbidity. The patients were observed for 3 years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS). Results: Early and late morbidities (Clavien–Dindo grade ≥3) were 26.1 and 6.5 %, respectively. Operative time, estimated blood loss, number of dissected lymph nodes, and postoperative hospital stay were 444 (278–694) min, 100 (0–2267) g, 48 (16–89), and 23 (9–136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9 %, respectively. Factors associated with postoperative complications and 3yOS were operative time [OR 1.011 (1.006–1.017), p < 0.01] and cancer recurrence within 3 years [HR 312.191 (1.126–86573.245], p = 0.045], respectively. 3yRFS was associated with tumor size (≥50 mm) [HR 10.325 (1.328–80.289), p = 0.026], pathological N factor ≥2 [HR 3.188 (1.196–8.495), p = 0.02], and postoperative pancreatic fistula combined with intra-abdominal abscesses Clavien–Dindo grade ≥2; [HR 3.670 (1.440–9.351), p = 0.006]. Conclusions: TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.

Original languageEnglish
Pages (from-to)4632-4639
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
Volume30
Issue number10
DOIs
Publication statusPublished - 2016 Oct 1
Externally publishedYes

Fingerprint

Gastrectomy
Stomach Neoplasms
Survival Rate
Retrospective Studies
Recurrence
Operative Time
Morbidity
Abdominal Abscess
Pancreatic Fistula
Splenectomy
Length of Stay
Neoplasms
Lymph Nodes
Safety
Mortality

Keywords

  • D2 total gastrectomy
  • Gastric cancer
  • Long-term outcomes
  • Pancreatic fistula
  • Single-institution retrospective study
  • Totally laparoscopic total gastrectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer : a single-institution retrospective study. / Nakauchi, Masaya; Suda, Koichi; Kadoya, Shinichi; Inaba, Kazuki; Ishida, Yoshinori; Uyama, Ichiro.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 30, No. 10, 01.10.2016, p. 4632-4639.

Research output: Contribution to journalArticle

Nakauchi, Masaya ; Suda, Koichi ; Kadoya, Shinichi ; Inaba, Kazuki ; Ishida, Yoshinori ; Uyama, Ichiro. / Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer : a single-institution retrospective study. In: Surgical Endoscopy and Other Interventional Techniques. 2016 ; Vol. 30, No. 10. pp. 4632-4639.
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abstract = "Background: D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC. Methods: A single-institution retrospective study was conducted. Ninety-two consecutive AGC patients who underwent radical TLTG were enrolled. The primary end point was morbidity. The patients were observed for 3 years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS). Results: Early and late morbidities (Clavien–Dindo grade ≥3) were 26.1 and 6.5 {\%}, respectively. Operative time, estimated blood loss, number of dissected lymph nodes, and postoperative hospital stay were 444 (278–694) min, 100 (0–2267) g, 48 (16–89), and 23 (9–136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9 {\%}, respectively. Factors associated with postoperative complications and 3yOS were operative time [OR 1.011 (1.006–1.017), p < 0.01] and cancer recurrence within 3 years [HR 312.191 (1.126–86573.245], p = 0.045], respectively. 3yRFS was associated with tumor size (≥50 mm) [HR 10.325 (1.328–80.289), p = 0.026], pathological N factor ≥2 [HR 3.188 (1.196–8.495), p = 0.02], and postoperative pancreatic fistula combined with intra-abdominal abscesses Clavien–Dindo grade ≥2; [HR 3.670 (1.440–9.351), p = 0.006]. Conclusions: TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.",
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T1 - Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer

T2 - a single-institution retrospective study

AU - Nakauchi, Masaya

AU - Suda, Koichi

AU - Kadoya, Shinichi

AU - Inaba, Kazuki

AU - Ishida, Yoshinori

AU - Uyama, Ichiro

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background: D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC. Methods: A single-institution retrospective study was conducted. Ninety-two consecutive AGC patients who underwent radical TLTG were enrolled. The primary end point was morbidity. The patients were observed for 3 years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS). Results: Early and late morbidities (Clavien–Dindo grade ≥3) were 26.1 and 6.5 %, respectively. Operative time, estimated blood loss, number of dissected lymph nodes, and postoperative hospital stay were 444 (278–694) min, 100 (0–2267) g, 48 (16–89), and 23 (9–136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9 %, respectively. Factors associated with postoperative complications and 3yOS were operative time [OR 1.011 (1.006–1.017), p < 0.01] and cancer recurrence within 3 years [HR 312.191 (1.126–86573.245], p = 0.045], respectively. 3yRFS was associated with tumor size (≥50 mm) [HR 10.325 (1.328–80.289), p = 0.026], pathological N factor ≥2 [HR 3.188 (1.196–8.495), p = 0.02], and postoperative pancreatic fistula combined with intra-abdominal abscesses Clavien–Dindo grade ≥2; [HR 3.670 (1.440–9.351), p = 0.006]. Conclusions: TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.

AB - Background: D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC. Methods: A single-institution retrospective study was conducted. Ninety-two consecutive AGC patients who underwent radical TLTG were enrolled. The primary end point was morbidity. The patients were observed for 3 years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS). Results: Early and late morbidities (Clavien–Dindo grade ≥3) were 26.1 and 6.5 %, respectively. Operative time, estimated blood loss, number of dissected lymph nodes, and postoperative hospital stay were 444 (278–694) min, 100 (0–2267) g, 48 (16–89), and 23 (9–136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9 %, respectively. Factors associated with postoperative complications and 3yOS were operative time [OR 1.011 (1.006–1.017), p < 0.01] and cancer recurrence within 3 years [HR 312.191 (1.126–86573.245], p = 0.045], respectively. 3yRFS was associated with tumor size (≥50 mm) [HR 10.325 (1.328–80.289), p = 0.026], pathological N factor ≥2 [HR 3.188 (1.196–8.495), p = 0.02], and postoperative pancreatic fistula combined with intra-abdominal abscesses Clavien–Dindo grade ≥2; [HR 3.670 (1.440–9.351), p = 0.006]. Conclusions: TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.

KW - D2 total gastrectomy

KW - Gastric cancer

KW - Long-term outcomes

KW - Pancreatic fistula

KW - Single-institution retrospective study

KW - Totally laparoscopic total gastrectomy

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