Total laparoscopic resection for advanced gastric cancer is safe and feasible in the Western population.

Abstract

There is debate surrounding the use of laparoscopic resection for advanced gastric cancer in the Western population. Here we aim to assess the feasibility and short-term outcomes of laparoscopic gastrectomy in consecutive patients in a Western population. From 2012 to 2014, retrospective review of 28 patients with clinically staged advanced gastric cancer (≥T3 or ≥N1) treated with laparoscopic resection. Sixty-one percentage of patients were male. Median age was 67 years (range 35-86). Median BMI was 26.5 (range 19.4-46.1). Resection types were proximal (n=2), distal (n=14), and total (n=12). Twenty-six (93%) patients underwent D2 lymphadenectomy. Four patients underwent conversion to open. Median blood loss was 125mL (range 30-300). Median LOS was 7days (range 4-16). Of postoperative complications, five were minor: arrhythmia (n=1), surgical site infection (n=3), in-hospital fall (n=1); and four were major (intra-abdominal abscess, stricture, PE, and anastomotic bleed). T stages were Tx (n=1), T2 (n=3), T3 (n=18), and T4 (n=6). N stages were N0 (n=4), N1 (n=8), N2 (n=1), and N3 (n=15). Median tumor size was 5.8cm (range 0-9.5). Median lymph node yield was 22 (range 6-53). All margins were negative. Median follow-up was 12.8months (range 2-27). Six patients have died of progressive disease. Following total laparoscopic resection for advanced gastric cancer, oncologic endpoints, postoperative course, and early cancer-specific follow-up are excellent. The results demonstrated here support the routine use of these techniques in the Western patient population.