Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer

Abstract

Background The choice of surgical strategy for patients with proximal gastric cancer is controversial. The purpose of this study was to assess the feasibility, safety, and surgical and functional outcomes of laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG). Methods Between June 2003 and December 2009, 131 patients with proximal gastric cancer underwent LAPG (n = 50) or LATG (n = 81) at Seoul National University Bundang Hospital. We reviewed their medical and surgical records from our prospectively collected gastric cancer database. The clinicopathologic characteristics and shortterm, long-term, and functional outcomes were compared between the 2 groups. Results There were no significant differences in demographics, T-stage, N-stage, or survival between the 2 groups. The LAPG group had a shorter operative time and lower estimated blood loss than the LATG group. The early complication rates after the LAPG and LATG procedures were 24.0 and 17.3 %, respectively (p = 0.349). The incidence of reflux symptoms was significantly higher in the LAPG group (32.0 vs. 3.7 %, p \ 0.001). The parameters that reflected nutritional status were similar in the 2 groups. Conclusion LAPG is a feasible and acceptable method for treating proximal early gastric cancer in terms of surgical and oncologic safety. However, esophagogastrostomy after LAPG was associated with an increased risk of reflux symptoms. Antireflux procedures should be considered to prevent reflux symptoms after LAPG.

Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by Postgastrectomy Syndrome Assessment Scale (PGSAS-45): a nationwide multi-institutional study

“…In recent years, a tendency to increasing numbers of proximal gastric cancers has been reported, and early detection and potentially curative operations by PG for upper-third gastric cancers have been increasing [24,25]. For outcome measures with * higher score indicates better condition; for outcome measures without * higher score indicates worse condition If b is positive, the score of the outcome measure of the patients belonging to the category in brackets is higher in cases when the factor is a nominal scale, and the score of outcome measure of the patients with larger values is higher in cases when the factor is a numeral scale QOL comparison of PG and TG 413 In this study, the effect of tumor progression was removed by constraining patient selection to those with pathologic Stage IA/IB disease, and it is thought that accurate QOL comparison between operative procedures is possible under these circumstances.…”

A systematic review of laparoscopic total gastrectomy for gastric cancer

“…It is therefore difficult to assess the course of postoperative recovery in retrospective studies. In most studies, mortality was low and acceptable, with no significant differences between different patient groups [18][19][20][21][22][23][24].…”

“…Although ten LTGs were included in this study, this was not regarded as the first report, because of its small sample size and because the results were collected by a questionnaire. Since LTG was first reported as a technical note in 1999 [26], some further studies have been reported [18][19][20][21][22][23][24]. Of these, the highest number of publications has been from Japan (n = 50), followed by Korea (n = 42; see Fig.…”

“…Recently, laparoscopic total gastrectomy (LTG), also known as laparoscopy-assisted total gastrectomy and which is a more complex surgical procedure, has been more frequently used, and its outcomes are beginning to be reported [18][19][20][21]. Moreover, new techniques for LTG, in which intracorporeal esophagojejunostomy can be performed completely laparoscopically, have been developed in some high-volume centers, and some shortterm outcomes have been reported [22][23][24].…”

Laparoscopy-assisted resection of proximal gastric cancer: is less than all more or less complete, or is all more, nonetheless?

“…In this issue of Gastric Cancer, Ahn et al [1] present a series of 131 patients with early-stage proximal gastric cancer who underwent laparoscopic resection, either in the form of laparoscopy-assisted total gastrectomy (LATG) or that of laparoscopy-assisted proximal gastrectomy (LAPG). The comparison of these two minimally invasive techniques with assessment of multiple early and late measures of outcomes is intriguing, and although not being based on a randomized trial deserves careful recognition and analysis.…”