Comparison of laparoscopic total gastrectomy and laparotomic total gastrectomy for gastric cancer

Abstract

BackgroundThe use of laparoscopy for the treatment of gastric cancer suffered some resistance among surgeons around the world, gaining strength in the past decade. However, its oncological safety and technical feasibility remain controversial. AimTo describe the results from the clinical and anatomopathological point of view in the comparative evaluation between the surgical videolaparoscopic and laparotomic treatments of total gastrectomy with linphadenectomy at D2, resection R0.MethodRetrospective analyses and comparison data from patients submitted to total gastrectomy with D2 linphadenectomy at a sole institution. The data of 111 patients showed that 64 (57,7%) have been submitted to laparotomic gastrectomy and 47 (42,3%) to gastrectomy entirely performed through videolaparoscopy. All variables related to the surgery, post-operative follow-up and anatomopathologic findings have been evaluated.ResultsAmong the studied variables, videolaparoscopy has shown a shorter surgical time and a more premature period for the introduction of oral and enteral nourishment than the open surgery. As to the amount of dissected limph nodes, there has been a significant difference towards laparotomy with p=0,014, but the average dissected limph nodes in both groups exceed 25 nodes as recommended by the JAGC. Was not found a significant difference between the studied groups as to age, ASA, type of surgery, need for blood transfusion, stage of the disease, Bormann classification, degree of differentiation, damage of the margins, further complications and death. ConclusionsThe total gastrectomy with D2 lymphadenectomy performed by laparoscopy presented the same benefits known of laparotomy and with the advantages already established of minimally invasive surgery. It was done with less surgical time, less time for re-introduction of the oral and enteral diets and lower hospitalization time compared to laparotomy, without increasing postoperative complications.

Laparoscopic Subtotal/Total Gastrectomy (LS/TG) Versus Open Subtotal/Total Gastrectomy (OS/TG) For Gastric Cancer: Literature Review to Activate the Laparoscopic Procedure Gastric Cancer Resection in Secondary Care Hospital

“…There were no significant differences in hospital mortality. DFS in LTG was similar to that in OTG (HR, 0.62; 95% CI, 0.30, 1.27; P= 0.191) (Fig.2-3) [1][2][3][12][13][14][15][16][17][18][19][20].…”

“…The total gastrectomy with D2 lymphadenectomy performed by laparoscopy presented the same known benefits as laparotomy and with the already established advantages of minimally invasive surgery. It was performed with less surgical time, less time for reintroduction of the oral and enteral diets and less hospitalization time compared to laparotomy, without increasing postoperative complications [12]. groups in order to identify the potential confounders.…”

“…In addition to this, they also showed better LND, faster oral intake, reduced pain, earlier hospital discharge, the same M/M and similar anastomotic leakage or stenosis, and similar LTS-DFS-OS compared to OG. As far as port site some Author has reported negative results [10][11][12][13][14] while other authors have noticed that the time is shorter and closer to open technique when a dedicated laparoscopic team perform at least 50 LG [4,5]. Recently, Haverkamp et al meta-analysis have showed the superiority of LG vs OG but oncological outcomes are still being debated [2,11].…”

Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies

“…The full texts were available for the remaining 31 articles, and 1 publication was added because it was included as a reference in the report of another meta-analysis. Finally, 15 CCSs [7, 9–22] met the inclusion criteria for this meta-analysis, and all were published between 2008 and 2015. The quality assessment of these CCSs is shown in Table 1.…”

Minimally invasive surgery for gastric cancer in Brazil: current status and perspectives—a report from the Brazilian Laparoscopic Oncologic Gastrectomy Group (BLOGG)

“…From the Barretos group, Lacerda, Bertulucci and Oliveira, published in 2014 their technique, including an interesting homemade reverse anvil method for the esophagojejunal circular anastomosis; in all cases the anastomosis was completely intracorporeal (6).…”