Laparoscopy-assisted Total Gastrectomy Research Articles

Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen.

The feasibility of using reduced-port laparoscopic total gastrectomy (RPLTG) for the treatment of gastric cancer remains unclear. This study aimed to address the potentially important advantages of this surgical technique. Between April 2002 and February 2014, 90 patients underwent laparoscopy-assisted total gastrectomies, performed by a single surgeon. Of these, 45 patients underwent RPLTG and 45 patients underwent conventional laparoscopy-assisted total gastrectomy (CLATG). Short-term outcomes were compared to evaluate the feasibility of RPLTG for gastric cancer. There were several significant differences between the RPLTG and CLATG groups in short-term outcomes: the mean total operation durations were significantly longer in the RPLTG group (319.0 min) than in the CLATG group (259.0 min). However, the mean volume of blood loss, the degree of lymph node dissection, and the number of dissected lymph nodes did not differ between the two groups. We have shown that RPLTG could be an acceptable and satisfactory procedure for the treatment of gastric cancer requiring total gastrectomy for surgeons sufficiently experienced in CLATG.

Laparoscopic-assisted Total Gastrectomy Versus Open Total Gastrectomy for Upper and Middle Gastric Cancer in Short-term and Long-term Outcomes

In recent years, laparoscopy-assisted distal gastrectomy has become the recognized procedure for treatment of early gastric cancer because of improved cosmesis and reduced postoperative pain. However, there are a few reports of laparoscopic-assisted total gastrectomy (LATG) performed for gastric cancer in the upper third or middle third stomach due to the difficulties of surgical techniques and the safety of oncologic short-term and long-term outcomes. Between January 2006 and December 2009, 84 patients with upper third or middle third gastric cancer underwent LATG or conventional open total gastrectomy (OTG). Of these patients, 34 patients underwent LATG and they were compared with patients who underwent OTG regarding short-term and long-term outcome. The proximal margins (P=0.343) and distal margins (P=0.685) did not differ between the LATG and OTG groups. Postoperative morbidity occurred in 8 (16.0%) OTG and 6 (17.6%) LATG cases and postoperative mortality occurred 2 (4.0%) and 0 (0.0%) cases of OTG and LATG, respectively. Recurrence occurred in 8 (16.0%) cases and 1 (2.9%) case in the OTG and LATG group, respectively (P=0.077). The 5-year survival rate in the OTG group was 77.5% and in the LATG was 93.2% with no significant difference (P=0.082). Our results confirm that LATG with extended lymphadenectomy for middle or upper early and locally advanced gastric cancer can achieve a radical oncologic resection equivalent to that of OTG. In addition, LATG is a feasible and safe procedure, and has several advantages over conventional OTG.

Hand-assisted Laparoscopic Total Gastrectomy With Regional Lymph Node Dissection for Advanced Gastric Cancer

Laparoscopic-assisted distal gastrectomy has been applied to the treatment of gastric cancer. However, there have been few reports on the laparoscopic-assisted total gastrectomy for advanced gastric cancer, mainly because of the difficulty of the procedure. Here, we report a series of cases where the hand-assisted laparoscopic total gastrectomies with regional lymph node dissection were performed successfully. The average operative time was 245 minutes. The mean blood loss was 110 mL. The number of dissected lymph nodes per patient was beyond 15 nodes satisfying a reliable evaluation of nodal status. All resection specimens had no residual tumor at the proximal or distal resection margins. The mean oral feeding was 3.6 days. The mean postoperative length of stay was 8.7 days. The hand-assisted laparoscopic D2 total gastrectomy for advanced gastric cancer is both technically feasible and safe.

Laparoscopic Spleen-Preserving Splenic Hilar Lymphadenectomy Performed by Following the Perigastric Fascias and the Intrafascial Space for Advanced Upper-Third Gastric Cancer

BackgroundLaparoscopic spleen-preserving Splenic hilar lymphadenectomy (LSPL) is required in laparoscopy-assisted total gastrectomy for advanced proximal gastric cancer. However, it is considerably difficult and risk in clinical practice. Thus, we explore the application of LSPL performed by following the perigastric fascias and the intrafascial space in D2 radical gastrectomy for advanced upper-third gastric cancer.MethodsFrom July 2010 to December 2012, 109 patients with T2–3 upper-third gastric cancer underwent LSPL. Of these patients, 55 underwent classic LSPL (classic group), and the remaining 54 patients underwent LSPL performed by following the fascias and intrafascial space (fascia group). Clinicopathologic characteristics and intraoperative and postoperative variables were compared between the two groups.ResultsThere were no significant differences in clinicopathological characteristics between the two groups (P>0.05). All of the operations were successful without conversion to laparotomy. The operation time, mean splenic hilar lymph node (LN) dissection time, mean total blood loss and mean blood loss from splenic hilar LN dissection were significantly lower in the fascia group than in the classic group (P<0.05), whereas the times to first flatus, fluid diet and soft diet and the duration of hospital stay were similar in both groups. The mean number of harvested LNs (No. 10 and No. 11d) was slightly higher in the fascia group, but the difference was not significant. No significant difference in morbidity was found between the fascia group and the classic group (9.3% vs.10.9%, P>0.05). At a median follow-up of 12 months(range 5 to 35 months), none of the patients had died or experienced recurrent or metastatic disease.ConclusionLSPL performed by following the fascias and intrafascial space is an optimal and safe technique based on anatomical logic, and it reduces the difficulties associated with LSPL, making it easier to master and allowing its widespread adoption.

Feasibility and Nutritional Impact of Laparoscopy-assisted Subtotal Gastrectomy for Early Gastric Cancer in the Upper Stomach

Laparoscopy-assisted total gastrectomy (LATG) is commonly performed for early gastric cancer (EGC) in the upper stomach; however, the incidence of anastomotic complications remains high, and postoperative nutritional status is not satisfactory. This study aimed to evaluate the feasibility and nutritional impact of a novel surgical procedure, laparoscopy-assisted subtotal gastrectomy (LAsTG). This was a retrospective study of 167 patients with EGC in the upper stomach. Of these, 57 patients underwent LAsTG, while 110 patients underwent LATG. Postoperative change in body weight, and serum concentration of albumin (Alb) and total protein (TP) were compared between the LAsTG and LATG groups. Analysis of covariance (ANCOVA) was used to assess the influence of potential confounding factors. Frequency of anastomotic complications was significantly higher in the LATG group (16.3%) than in the LAsTG group (5.3%, P=0.040). Postoperative recovery of body weight at 12months after surgery was significantly better in the LAsTG group (89.8±1.4%) than in the LATG group (82.1±1.0%, P<0.001). By ANCOVA, adjusted mean differences of Alb and TP at 12months after surgery between the LAsTG and LATG groups were 0.226g/dl (95% CI 0.141-0.312; P<0.001) and 0.380g/dl (95% CI 0.265-0.495; P<0.001); thus, the surgical procedure was significantly associated with the postoperative Alb and TP levels. LAsTG could be a better choice than LATG for EGC in the upper stomach as a result of improvements in the incidence of anastomotic complications and postoperative nutritional status.

A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasion

Background Little is known about the feasibility and safety of laparoscopy-assisted total gastrectomy (LATG) with extended lymphadenectomy in patients with advanced gastric cancer (AGC). This study compared the technical feasibility, safety, and oncologic efficacy of LATG with open total gastrectomy (OTG) for AGC without serosa invasion. Methods From January 2009 to December 2011, 235 patients underwent LATG and 153 patients underwent OTG for AGC without serosa invasion. Age, gender, and depth of invasion (pT2 and pT3) were matched by propensity scoring, and 116 patients (58 LATG and 58 OTG) were selected for analysis. Their clinicopathologic characteristics, postoperative outcomes, and survival were compared. Results There was no significant difference in clinicopathologic characteristics between the two propensity-matched groups. Median number of lymph nodes per patient was 29, and the mean number of retrieved lymph nodes was similar in the LATG and OTG groups (30.8±10.2 vs. 29.0±8.3). Peri-operative characteristics, operation time, number of transfused units per patient, and time to resumption of activities were similar in the two groups; while blood loss, times to first flatus and resumption of soft diet, and post-operative stay were significantly lower in the LATG group (P &lt;0.05, respectively). Rates of post-operative complications (12.1% vs. 15.5%) and postoperative mortality (0% vs. 1.7%), as well as cumulative survival rates, were similar. Conclusions LATG with D2 lymphadenectomy is a safe and feasible procedure for AGC patients without serosa invasion. Prospective, multicenter, randomized trials are needed to confirm the efficacy of LATG in this patient population.

Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: a single-center comparative study

Although laparoscopic surgery is frequently performed for the treatment of gastric cancer, laparoscopic total gastrectomy is not widely performed because of its technical difficulty. Since December 2007 we have performed esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG) in more than 110 cases in our institution by using a circular stapler with a trans-orally inserted anvil. We performed a single-center comparative study to evaluate the safety and efficacy of esophagojejunostomy using a trans-orally inserted anvil in patients who underwent TLTG for the treatment of gastric cancer. In the present study, we examined 329 patients with gastric cancer who underwent esophagojejunostomy using a circular stapler after total gastrectomy. Data on the clinicopathological features, operative time, amount of intraoperative blood loss, and incidence of anastomosis-related complications among the surgical groups were obtained by reviewing the medical records, which were then analyzed. Approximately 67% of the patients were men, and the average patient age was 64.0 years (range 26-93 years). In addition, 166 (50.5%) and 163 (49.5%) patients underwent open and laparoscopic surgery, respectively. Leakage following esophagojejunostomy was noted in 7 (4.2%) of 166 patients who underwent total gastrectomy with open laparotomy, and 0 of 46 patients who underwent laparoscopic-assisted total gastrectomy (LATG). However, only 2 (1.7%) of 117 patients who underwent TLTG using a trans-orally inserted anvil exhibited leakage following esophagojejunostomy. Anastomotic stenosis of the esophagojejunostomy was observed in 5 (3.0%) of 166 patients who underwent total gastrectomy with open laparotomy, 2 (4.3%) of 46 patients who underwent LATG, and 2 (1.7%) of 117 patients who underwent TLTG using a trans-orally inserted anvil. We believe that esophagojejunostomy using a trans-orally inserted anvil after TLTG for gastric cancer is a safe and useful surgical procedure.

Combined neuroendocrine carcinoma and adenocarcinoma in the stomach: A case report.

Neuroendocrine carcinoma and adenocarcinoma existing in the stomach simultaneously is extremely rare. This report presents a 65-year-old male patient who was diagnosed with three types of malignant tumors in the stomach, neuroendocrine carcinoma (NEC), moderately differentiated adenocarcinoma and mucinous adenocarcinoma. In addition, the NEC and moderately differentiated adenocarcinoma existed in the same lesion and, therefore, was referred to as a mixed adenocarcinoma - NEC tumor. The patient underwent laparoscopic-assisted D2 radical total gastrectomy, Roux-en-Y esophagus-jejunum anastomosis and received FOLFOX chemotherapy for six cycles 3 weeks after surgery. Follow-up determined that the patient survived and was tumor-free 12 months after surgery. In conclusion, radical surgery combined with chemotherapy can effectively improve the prognosis of patients with these three specific tumor types simultaneously in the stomach.

Laparoscopy-assisted Total Gastrectomy: A Simplified Approach

Laparoscopy-assisted total gastrectomy (LATG), esophagojejunostomy is an effective but difficult procedure to perform. We describe a simple modification that substantially facilitates insertion of the anvil into the esophagus and avoids oral injuries and complications. After mobilization of the stomach and esophagus, a semicircumferential esophagotomy is made at the anterior esophageal wall. An OrVil anvil (Orvil, Covidien, Norwalk, CT, USA) is delivered laparoscopically and secured with a POLYSORB (Covidien) suture to the esophagus. The suture is advanced anteriorly so that the center rod penetrates the esophageal wall. The esophagus is transected with the stapler at this point. A circular-stapled esophagojejunostomy is then performed using the hemidouble stapling technique. Laparoscopy-assisted total gastrectomies were performed for 40 patients with gastric cancers (T1N0M0). All procedures were completed laparoscopically without any complications. The time required to place the anvil averaged 5 min compared with 9 min reported by others. There were no major complications or mortality in this series. The major advantage of this technique is that circular stapling is much easier than linear stapling, allowing surgeons without advanced surgical skills in LATG to perform the procedure effectively and safely.

Laparoscopy-assisted Total Gastrectomy for Remnant Gastric Cancer

Surgical treatment is more difficult for remnant gastric cancer than for primary gastric cancer because of adhesions to adjacent organs. Severe adhesions between the remnant stomach and the left lobe of the liver make difficult to remove the remnant stomach. Laparoscopic gastrectomy has gradually gained acceptance for the treatment of primary gastric cancer because of the potential benefits of being less invasive and having a shorter recovery time but has generally been considered contraindicated in patients who have undergone open upper abdominal surgery. However, few reports have described laparoscopy-assisted total gastrectomy after open or laparoscopic gastrectomy. The benefits and feasibility of laparoscopic surgery for remnant gastric cancer remain unclear. We describe in detail the procedure of laparoscopy-assisted total gastrectomy for remnant gastric cancer and evaluate its safety and feasibility.

Laparoscopic management of hypertrophic hypersecretory gastropathy with protein loss: A case report

Hypertrophic hypersecretory gastropathy with protein loss (HHGP) is a rare form of acquired gastropathy characterized by giant gastric rugal folds and hypoalbuminemia. It is often misdiagnosed as Ménétrier's disease. We report the case of a 45-year-old man with HHGP who presented with nausea and anorexia. The patient had no underlying disease and was not on medication. Esophagogastroduodenoscopy and CT showed a thickening of the gastric folds in the stomach. As cancer cells were not detected on endoscopic biopsies, the patient was diagnosed with Ménétrier's disease. He was managed with a high-protein diet and annual follow-up by esophagogastroduodenoscopy. Five years after the diagnosis, the patient underwent laparoscopy-assisted total gastrectomy for refractory abdominal pain, diarrhea, and protein loss. A pathological diagnosis of HHGP was made and he was discharged without any surgical complications. The patient was relieved of anorexia, abdominal pain, and diarrhea. Laparoscopy-assisted total gastrectomy could be regarded as a treatment option for HHGP.

Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy.

OBJECTIVE:To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS) in patients undergoing laparoscopic assisted total gastrectomy.MATERIALS AND METHODS:This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22) patients received enhanced recovery programme (ERAS) management and rest twenty-five (n = 25) conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared.RESULTS:Postoperative hospital stay is shorter in ERAS group (78 ± 26 h) when compared to conventional group (140 ± 28 h). ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h). There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43) g/L vs. (73.07 ± 19.32) g/L, d3 (126.10 ± 18.62) g/L vs. (160.72 ± 26.18) g/L)].CONCLUSION:ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

腹腔鏡補助下胃全摘術を施行した胃限局性若年性ポリポーシスの1例

腹腔鏡補助下胃全摘術を施行した胃限局性若年性ポリポーシスの1例

A safe anastomotic technique of using the transorally inserted anvil (OrVil™) in Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy for proximal malignant tumors of the stomach

BackgroundTo explore the safety and feasibility of the transorally inserted anvil (OrVil™) in laparoscopy-assisted total gastrectomy for gastric cancer.MethodsFrom December 2010 to June 2011, a total of 28 patients underwent laparoscopy-assisted total gastrectomy with a Roux-en-Y-esophagojejunostomy anastomosis with OrVil™. Perioperative treatments, intraoperative data, postoperative complications and hospital length of stay were evaluated.ResultsThere were no conversions to the open gastrectomy. The mean operation time was 143 minutes and the mean blood loss was 70 ml. Patients resumed an oral liquid diet on postoperative days 4 to 5. Two patients (7%) who suffered postoperative aspiration pneumonia were cured by conservative treatment. The median hospital length of stay was 9.6 days (8 to 11 days), with no inhospital mortalities. The median follow-up time was 14.8 months (12 to 18 months), and postoperative endoscopic examination revealed no anastomosis stenosis in patients who had dysphagia.ConclusionThe use of the OrVil™ is technically feasible and relatively safe for Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy.

Is Laparoscopy-Assisted Total Gastrectomy Feasible for the Treatment of Gastric Cancer? A Case-Matched Study

Background: The aim of this study was to clarify the short- and long-term outcomes of laparoscopy-assisted total gastrectomy (LATG) for gastric cancer compared to conventional open total gastrectomy (COTG) with a case-control study. Methods: Between January 2002 and December 2010, a series of 264 patients with gastric cancer underwent R0 total gastrectomy (61 LATG patients and 203 COTG patients). Age, gender, and pathological stage were matched by propensity scoring, and 120 patients (60 LATG and 60 COTG) were selected for analysis. Results: There were no significant differences in the clinicopathological features between the two groups. Regarding postoperative outcomes, first flatus time was significantly shorter in the LATG group than in the COTG group (p < 0.001), while operation time was significantly longer in the LATG group than in the COTG group (p < 0.001). Postoperative complications occurred in 5 cases (8.3%) of the LATG group and in 11 cases (18.3%) of the COTG group (p = 0.178). There were two recurrences in the LATG group and three recurrences in the COTG group. There was no significant difference in the 5-year survival rate between the two groups (p = 0.667). Conclusions: LATG for gastric cancer may be both feasible and efficient compared to COTG for experienced laparoscopic surgeons. This study is valuable for a prospective randomized controlled trial of LATG for gastric cancer in a larger number of patients.

Familial juvenile polyposis syndrome with a novel SMAD4 germline mutation.

Juvenile polyposis syndrome (JPS) is a dominantly inherited disorder characterized by the development of numerous juvenile polyps (JPs) of the gastrointestinal tract, and associated with a mutation of the SMAD4 or BMPR1A gene. Here, we report a mother-daughter case of familial JPS. A 29-year-old female patient with severe iron deficiency anemia and hypoproteinemia had numerous polyps in the stomach and a few polyps in the ileum and colon that were detected endoscopically. Biopsy specimens from the gastric polyps were diagnosed as JPs. The patient underwent a laparoscopy-assisted total gastrectomy, and her anemia and hypoproteinemia improved. Her mother also had multiple JPs in the stomach, duodenum, jejunum, and colon. We then diagnosed them as having familial JPS. Moreover, germline mutation analysis of the 2 patients presented a novel pathogenic SMAD4 variant.

Laparoscopy-Assisted Versus Open Total Gastrectomy for Gastric Cancer: A Meta-analysis

It remains controversial whether laparoscopy-assisted total gastrectomy (LATG) is a safe or better alternative to open total gastrectomy (OTG) for the treatment of gastric cancer. We aimed to evaluate the safety and efficacy of LATG by pooling comparative studies of LATG and OTG in a meta-analysis. Original articles comparing LATG and OTG for gastric cancer, published in the English language since 1990, were searched for in PubMed, Embase, Medline, and the Cochrane Library. The outcome variables analyzed were number of harvested lymph nodes, postoperative complications, postoperative mortality, 5-year survival, operative time, blood loss, time of analgesic use, first flatus day, and postoperative hospital stay. Eight studies were considered suitable for the meta-analysis, for a total of 1161 patients (409 LATG and 752 OTG). Compared with OTG, LATG showed a similar number of lymph nodes harvested, morbidity, and postoperative mortality. There was also no difference in 5-year overall and disease-specific survival between groups, according to two enrolled studies where such data were available. LATG required longer operative times than OTG but also resulted in significantly less blood loss, earlier return of bowel function, less time of analgesics use, and shorter postoperative hospital stay. This meta-analysis suggests that LATG in the treatment of gastric cancer is similar in safety and efficacy to OTG. LATG has the advantages of less blood loss and faster postoperative recovery, at the expense of a longer operative time.

Safety of intracorporeal circular stapling esophagojejunostomy using trans-orally inserted anvil (OrVil™) following laparoscopic total or proximal gastrectomy - comparison with extracorporeal anastomosis

BackgroundThere have been several attempts to develop a unique and easier way to perform esophagojejunostomy during laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy. The OrVil™ system (Covidien, Mansfield, MA, USA) is one of those methods, but its technical and oncologic feasibility have not been proven and need to be observed.MethodsAmong 87 patients who underwent laparoscopy-assisted total gastrectomy (LATG; 79 cases) and laparoscopy-assisted proximal gastrectomy with double tract anastomosis (LAPG_DT; 8 cases) from April 2004, 47 patients underwent the conventional extracorporeal method (Group I; 2004–2008) were compared with 40 patients treated with the intracorporeal OrVil™ system (Group II; 2009–2012).ResultsThere was no significant difference in clinicopathologic characteristics between the two groups except tumor location; more cardia lesions were involved in group II (p = 0.012). The mean time for esophagojejunostomy (E-J), defined as the time from anvil insertion to closure of the jejunal entry site has no significant difference (Group I vs II: 22.2 ± 3.2 min vs 18.6 ± 3.5 min, p = 0.623). In terms of anastomotic complication, there was no significant difference in E-J leakage and stricture. E-J leakage occurred in 2 out of 47 (4.3%) cases in group I and 2 out of 40 (5%) in group II (p = 0.628); half of them were treated conservatively in each group and the others underwent reoperation. E-J stricture occurred in 2 (4.3%) cases in group I and 1 (2.5%) in group II (p = 0.561), which required postoperative gastrofiberscopic balloon dilatation.ConclusionsEsophagojejunostomy using the OrVil™ system was a feasible and safe technique compared with the conventional extracorporeal method through mini-laparotomy in terms of anastomotic complications. Moreover, it can help to reduce surgeon’s stress regarding esophagojejunostomy because it needs no purse-string procedure and serves a secure operation view laparoscopically.

Present features and future vision of laparoscopy-assisted total gastrectomy (LATG)

Present features and future vision of laparoscopy-assisted total gastrectomy (LATG)

Laparoscopy-Assisted vs. Open Total Gastrectomy for Advanced Gastric Cancer: Long-Term Outcomes and Technical Aspects of a Case–Control Study

Background and ObjectivesAn increasing number of studies comparing laparoscopy-assisted distal gastrectomy and conventional open distal gastrectomy have been reported; the technical feasibility and clinical efficacy have been confirmed. However, few data are available to compare laparoscopy-assisted total gastrectomy (LATG) and open techniques for the treatment of advanced gastric cancer (AGC). The aim of this study is to compare the oncologic efficacy and long-term outcomes of LATG vs. open total gastrectomy (OTG) for AGC and to provide our experiences regarding these surgical difficulties as well. MethodsUsing data from a clinical database of all operations performed in our department by a special surgical team, we retrospectively analysed data from 117 cases of LATG and matched OTG performed between January 2004 and December 2010. This analysis was a case–control study in which patients in the two groups were matched according to tumour location, age, gender, BMI and TNM stage via a propensity score matching method. Patient clinical characteristics, lymph node retrieval, early postoperative complications, recurrence and long-term outcomes were compared. ResultsThe demographics, preoperative data and characteristics of the tumour were similar in both groups. No significant differences were found in the LATG group compared with the OTG group with regard to the number of retrieved lymph nodes or distance from the proximal margin. Operating time was longer in the LATG group than in the OTG group (292.8±49.5 vs. 242.1 ± 47.4, p < 0.05). Significant differences were found between LATG and OTG with regard to blood loss, postoperative hospitalisation and times of analgesic injection. The early postoperative complication rates in the LATG group were significantly lower than in the OTG group (11.1 vs. 16.3 %, p < 0.05). Operative mortality was zero in both groups. During a median follow-up of 61.2 (range, 6–84) months, the overall 5-year survival rates in the LATG group and OTG group were 49.3 and 46.5 %, respectively; there was no significant difference between the two groups (p = 0.756). ConclusionOur results suggest that LATG is technically feasible for advanced gastric cancer patients and can yield good short- and long-term oncologic outcomes as compared with conventional OTG.