Laparoscopic Radical Total Gastrectomy Research Articles

Relationship between mode of esophagojejunostomy in laparoscopic radical total gastrectomy and complications

Relationship between mode of esophagojejunostomy in laparoscopic radical total gastrectomy and complications

Totally laparoscopic complete bursectomy and D2 lymphadenectomy in radical total gastrectomy: an outside bursa omentalis approach.

Bursectomy is regarded as a standard surgical procedure during gastrectomy for serosa-positive gastric cancer in Japanese gastric cancer treatment guidelines (Japanese Gastric Cancer Association in Gastric Cancer 14:113-123, 2011). As a consequence, bursectomy is widely performed in open gastrectomy. However, laparoscopic gastrectomy with bursectomy is rare. Based on our previous experience of laparoscopic bursectomy in distal gastrectomy (Zou et al. in Oncol Lett 10:99-102, 2015), herein, we described the technique of totally laparoscopic radical total gastrectomy with complete bursectomy using an outside bursa omentalis approach. Firstly, the transverse mesocolon and distal gastric membrane were separated from right to left, and the right gastroepiploica vessels were ligated at root with No. 6 lymph nodes (LNs) dissection followed by the pancreas membrane dissection from pancreas head to pancreas tail. Secondly, the anterior plane of transverse mesocolon was dissected from left to right starting from the lower pole of spleen, and the membrane of pancreas tail was separated to combine the pancreas anterior plane with No. 4s, 10, 11d and 2 LNs dissection. Thirdly, the lesser omental was dissected from right to left with No. 5 and 12a LNs dissection, and the duodenum was transected. Then, the No. 7, 8, 9 and 11p LNs were dissected followed by No. 1 LNs dissection. Finally, a Roux-en-Y esophagojejunostomy was carried out intracorporeally with a linear cutter. Thirty-two patients with advanced proximal gastric cancer underwent laparoscopic total gastrectomy with complete bursectomy using an approach outside bursa omentalis. One bowel obstruction and one pulmonary infection were recorded and cured with conservative measure. The mean operative time was 253.3±31.3min with a mean blood loss of 90.5±23.1ml. The mean length of stay was 10.6±2.6days. Laparoscopic radical total gastrectomy with complete bursectomy using an outside bursa omentalis approach is feasible and safe in experienced hands with favorable short outcome. Further studies were needed for its advanced application.

Totally laparoscopic spleen-preserving splenic hilum lymph nodes dissection in radical total gastrectomy: an omnibearing method

To investigate the feasibility and safety of laparoscopic spleen-preserving splenic hilum lymph nodes (LNs) dissection for advanced proximal gastric cancer using an omnibearing method. Between August 2013 and December 2014, 16 patients with advanced proximal gastric cancer treated in Guangdong Province Hospital of Chinese Medicine, were enrolled and subsequently underwent laparoscopic radical total gastrectomy (TG) with spleen-preserving splenic hilum LNs dissection. During dissecting Nos. 10 and 11 LNs, we divided them into two parts, namely LNs anterosuperior and posterior to the splenic vessel. The clinicopathological characteristics, intraoperative outcomes and postoperative courses were retrospectively collected and analyzed in the study. Laparoscopic surgery was successfully completed in all 16 patients without conversion to open surgery, and no perioperative death occurred. The mean operating time was 328.75±46.96min, and the mean estimated blood loss was 135.63±62.07ml. One patient experienced intraoperative bleeding due to the splenic vein injury which was successfully handled with laparoscopic vessel suturing, and one postoperative pulmonary infection was recorded. The mean time to first flatus was 3.56±1.03days with a mean 9.63±1.50days of postoperative hospital stay. The mean number of retrieved LNs was 28.31±5.99, in which LNs anterosuperior to splenic artery was 2.88±2.66 and LNs posterior was 1.38±1.75. Laparoscopic TG with spleen-preserving splenic hilum LNs dissection using an omnibearing method for advanced proximal gastric cancer was safe and technically feasible in experienced hands. Further studies in terms of its clinical significance are needed.

Exploration of digestive tract reconstruction with totally laparoscopic total gastrectomy for gastric cancer

Compared to that with laparoscopic assisted approach, intracorporeal anastomosis with totally laparoscopic radical total gastrectomy has the advantages of smaller incision, and better vision for operation, and may also be fit for patients with large size lesion, high-located lesions, or obesity. It remains controversial though several surgeons have reported the safety and feasibility of intracorporeal anastomosis with totally laparoscopic total gastrectomy. This review describes the recent technical advances in intracorporeal anastomoses with totally laparoscopic total gastrectomy, focusing on the reconstruction skills and indications. Current data on totally laparoscopic total gastric resection for gastric carcinoma revealed that all digestive tract reconstructions were performed with esophagus-jejunum Roux-en-Y anastomosis, and different reconstruction techniques of such Roux-en-Y anastomosis have certain advantages and disadvantages. Surgeons should make choice based on tumor location, esophageal diameter and personal skills in order to achieve maximal benefit to patients.

Difficulty and skill of digestive tract reconstruction after totally laparoscopic total gastrectomy

In recent years, with the standardization and promotion of laparoscopic techniques, the use of laparoscopic radical total gastrectomy is increasing. The main difficult points of this technique focus on digestive tract reconstruction after total gastrectomy. Esophagojejunal Roux-en-Y anastomosis is the first choice in laparoscopic reconstruction. There are two main methods for totally laparoscopic total gastrectomy (TLTG). One is esophagojejunal end-to-side anastomosis using circular stapler, and the other is esophagojejunal side-to-side anastomosis using linear staplers. TLTG has its advantages in digestive tract reconstruction including better visualization high safety and less trauma, which makes it a safe, convenient and effective method for reconstruction.

Short-term efficacy of esophagojejunostomy by delta-shaped anastomosis in totally laparoscopic radical total gastrectomy

Objective To investigate the short-term efficacy of esophagojejunostomy by delta-shaped anastomosis in totally laparoscopic radical total gastrectomy.Methods The clinical data of 5 patients with esophagogastric cancer and 2 with non-cardia gastric cancer who were admitted to the Ruijin Hospital of Shanghai Jiaotong University School of Medicine from July to October 2013 were retrospectively analyzed.All the 7 patients received totally laparoscopic radical total gastrectomy and esophagojejunostomy by delta-shaped anastomosis after preoperative evaluation.All the patients were followed by out-patient examination and phone call till November 2013.Results The operation was successfully carried out on all the 7 patients.The operation time was (234 ±23) minutes,and the time for delta-shaped anastomosis was (34 ± 7) minutes.The volume of intraoperative blood loss was (153 ±32)mL,and the number of lymph node harvest was 36 ±4.Seven staplers with 60 mm in length were applied.No anastomotic stricture was detected in the endoscopy for the first 3 patients after esophagojejunostomy.All the 7 patients recovered well,and the gastric tube was removed at postoperative day 1.The time for first flatus,liquid and semi-liquid food intake were (2.4 ± 0.5) days,(4.0 ± 0.6) days,(5.3 ± 0.5) days,respectively.No anastomotic bleeding,leakage,stricture or peritoneal infection was detected.No patients died perioperatively.Upper gastrointestinal imaging for the first 3 patients at postoperative day 5 showed unobstructed digestive tract.The numbers of patients in stage Ⅰ A,Ⅰ B,Ⅱ A,Ⅱ B were 3,2,1,1.The duration of postoperative hospital stay was (9.7 ± 1.4) days.The median time of follow-up was 3 months.The general condition of the patients was good,with no body weight loss,choking or substernal burning.Conclusions Esophagojejunostomy by deltashaped anastomosis in totally laparoscopic radical total gastrectomy is safe and feasible.The size of anastomosis is not restricted to the diameters of esophagus and jejunum,and the short-term efficacy is satisfactory. Key words: Adenocarcinoma of the esophagogastric junction; Gastric neoplasms; Laparoscopy; Esophagojejunostomy

Insertion of anvil into esophagus for anastomosis during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer

Objective To investigate the clinical value of a new anvil inserting method for esophagogastrostomy or esophagojejunostomy during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer.Methods The clinical data of 21 patients with gastric cancer who received laparoscopic radical proximal gastrectomy or radical total gastrectomy at the Southwest Hospital from March 2010 to February 2011 were retrospectively analyzed.Five trocars were inserted through the abdominal wall of the patients.After perigastric lymphadenectomy and mobilization of esophagus,an incision was made on the esophagus above the tumor,and then the anvil with drawn wire attached was inserted into the esophagus.An endo-cutter was applied to cut the esophagus adjacent to the incision left the drawn wire untouched,and then the stem of the anvil was pulled out by the drawn wire for laparoscopic anastomosis. Results The operations were successfully accomplished under the laparoscope with no conversion to open surgery.Fifteen patients received laparoscopic radical total gastrectomy and 6 received laparoscopic radical proximal gastrectomy. The mean operation time,volume of blood loss,time to off-bed activity,passage of flatus and postoperative duration of hospital stay were (257 ± 38) minutes,( 119 ± 32) ml,(2.5 ± 0.5 ) days,( 3.7 ± 0.8 ) days and (7.5 ± 2.6) days,respectively.No perioperative mortality,anastomotic bleeding or anastomotic fistula was detected.One patient was complicated with pulmonary infection + pleural effusion and was cured by conservative treatment; 1 was complicated with anastomotic stenosis which was alleviated by gastroscopic balloon dilation; 1 was complicated by incisional infection and was cured by medical treatment after drainage.No cancer cells were detected at the anastomotic ring or resection margin of the specimen.There were 4 patients with well-differentiated adenoma,8 with moderate-differentiated adenoma and 9 with poor-differentiated mucinous adenoma.There were 5 patients in stage Ⅰ,10 in stage Ⅱ and 6 in stage Ⅲ (UICC staging).Twenty-one patients were followed up for a mean period of (11 ±4) months (range,6-17 months ),no tumor recurrence or metastasis was detected. Conclusions The new technique for anvil insertion is safe,effective and easy for manipulation and learn.It offers a new approach for laparoscopic digestive tract reconstruction. Key words: Gastric neoplasms; Laparoscopy; Gastrectomy; Esophagogastrostomy; Esophagojejunostomy

Videolaparoscopic total and subtotal gastrectomy with extended lymph node dissection for gastric cancer

Background Laparoscopic surgery has been used in the treatment of early gastric cancer with low mortality and morbidity and improvement in patient’s quality of life. The purpose of the current study was to determine if these advantages persist after radical laparoscopic treatment of more advanced gastric cancer. Methods A retrospective review of 44 patients after laparoscopic surgery for gastric cancer was performed. Results Tumor stage was IA in 8 patients, IB in 12, II in 9, IIIA in 6, IIIB in 1, and IV in 8. Eight total and 36 subtotal R0 gastrectomies were performed (12 D 1 and 32 D 2). The mean number of dissected lymph nodes was 38.1 ± 21.5. Conversion rate was 7%. Operative mortality and morbidity were 7% and 12%, respectively. Three-year survival was 75%. Conclusions Laparoscopic radical total or subtotal gastrectomy with extended lymphadenectomy for gastric cancer is a feasible, safe, and oncologically effective procedure.

Modern Treatment of Early Gastric Cancer: Comparison between Laparoscope Assisted vs Hand-Assisted Laparoscopic Distal Gastrectomy vs Open Distal Gastrectomy

Recently detection of early gastric cancer (EGC) has been increasing and the treatment strategies for gastric cancer have been changing. The purpose of this study was to compare clinical outcomes between laparoscopically assisted (LADG) and hand-assisted laparoscopic gastrectomy (HALDG) and open distal gastrectomy for early gastric cancer. This review is directed toward providing gastric surgeons with recent advances in the treatment of EGC. We investigated the English language literature for the past 12 years through computer searches which focused on : 1) Patient demographics, 2) Operation time, 3) Intra-operative blood loss, 4) Depth of invasion, 5) CBC, 6)Weight loss, 7) Analgesic requirement, 8)Time NPO, 9) Length of hospital stay, 10) Tumor stage, 11) Lymph node (LN) dissection, 12) Position of LN resected, 13) Complications. Improved operative techniques and surgical instrumentation have facilitated the development of minimally invasive gastric cancer surgery. The short-term benefits of laparoscopic gastrectomy included less surgical trauma, less pain, rapid return of gastrointestinal function, and shorter hospital stay, with no change in operative outcome. Laparoscopic gastrectomy was better accepted by the patients as a good procedure and promptly brought the patients back to their previous lifestyle and activities of daily living. But the advantages of HALDG for gastric cancer, extended lymph node dissection and intracorporeal anastomosis are feasible and easier with the presence of the internal hand. The hand-assisted laparoscopic (HALDG) method reported the best results in lymph node dissection.This method is an alternative to total laparoscopic radical gastrectomy. LADG and HALDG, when compared with conventional open gastrectomy, have several advantages. When performed by a skilled surgeon, LADG and HALDG are safe and useful techniques for patients with early-stage gastric cancer. Their appropriateness for gastric cancer surgery require further study.