Laparoscopic Completion Total Gastrectomy as a Standardized Procedure for Gastric Stump Cancer: A Case Control Study

Abstract

Objective Complete gastrectomy for gastric stump cancer (GSC) can be challenging due to severe adhesions; therefore, advanced techniques are required when being performed by laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy (LCTG) for the treatment of GSC. Methods Patient records from January 2010 to October 2018 were retrospectively evaluated. The patients were classified into two groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data between the groups. Results Twenty open and 17 LCTGs were performed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 vs. 182.5 min; p = 0.026), lower blood loss (14 vs. 105 mL; p < 0.001), and shorter period to the first flatus passage (2 vs. 3 days; p < 0.001) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the two groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathological findings revealed that the laparoscopic group had a smaller tumor size (not pathological T category) and fewer metastatic lymph nodes than the open group leading to an earlier distribution of the pathological stage in the laparoscopic group. Conclusions LCTG for the treatment of GSC was safely conducted with fewer complications and mortalities than previously reported results. Advanced technologies and sophistication of laparoscopic skills may further yield minimal invasiveness with better short-term outcome.

Laparoscopic completion gastrectomy: A single‐institution case series and systematic review of the literature

“…Eleven studies sought to compare the outcomes of laparoscopy versus laparotomy, while two studies compared the outcomes of laparoscopy versus robotic‐assisted laparoscopy (Figure 1). Since the index report of laparoscopic completion by Yamada et al in 2015, there were 596 reported cases (including our study) of planned laparoscopic completion gastrectomy 4–6,11–30 . The mean age of patients was 68.3 years and interval to completion was 21.8 years.…”

“…Since the index report of laparoscopic completion by Yamada et al in 2015, there were 596 reported cases (including our study) of planned laparoscopic completion gastrectomy. [4][5][6][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The mean age of patients was 68.3 years and interval to completion was 21.8 years. There were 146 (38.6%) cases with prior benign gastric disease, while 232 had prior malignant disease.…”

“…Although robot‐assisted laparoscopy is associated with higher costs and longer operative duration due to the need for manual robotic arm adjustment and calibration, surgeons from other institutions have found that the robotic approach can allow for more precise and safer adhesiolysis and lymphadenectomy 6,13 . This is due to several factors such as the greater range of motion of the robotic arms, tremor‐free forceps manipulations and improvements in surgical field visualization 27 . An interesting limitation of the robotic system reported by Li et al (2021) was that once installed, the robotic arms have a limited range of activity and as such, it is difficult to examine the entire abdomen when performing cytoreductive surgery 29 .…”

“…6,13 This is due to several factors such as the greater range of motion of the robotic arms, tremor-free forceps manipulations and improvements in surgical field visualization. 27 An interesting limitation of the robotic system reported by Li et al (2021) was that once installed, the robotic arms have a limited range of activity and as such, it is difficult to examine the entire abdomen when performing cytoreductive surgery. 29 This could potentially compromise the oncological documentation of tumor burden and can only be circumvented by changing the patient's position, a very inconvenient process.…”