Short-term outcomes of laparoscopic total gastrectomy for gastric cancer: a comparative study with laparoscopic distal gastrectomy at a high-volume center

Chen, Ke; Zhai, Shu-Ting; Pan, Junhai; Yu, Weihua; Pan, Yu; Chen, Qilong; Chen, Dingwei; Zhu, Yiping; Yan, Jing; Maher, Hendi; Wang, Xianfa

doi:10.1080/13645706.2017.1350718

Cited by 3 publications

(6 citation statements)

References 29 publications

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“…Gastrectomy with lymphadenectomy is the cornerstone of curative treatment for patients diagnosed with adenocarcinoma of the stomach [1] and, if deemed fit enough, patients will also receive perioperative chemotherapy [2]. Gastrectomy is associated with a high risk of postoperative complications (up to 40%) [3], of which pulmonary complications, anastomotic leakage, and wound complications occur most frequently [4][5][6][7][8][9]. These complications have a negative influence on postoperative outcomes, such as mortality, length of hospital stay, number of reoperations, and readmissions [10,11].…”

Section: Introductionmentioning

confidence: 99%

Identification of the clinically most relevant postoperative complications after gastrectomy: a population-based cohort study

et al. 2019

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Background Postoperative complications frequently occur after gastrectomy for gastric cancer and are associated with poor clinical outcomes, such as mortality and reoperations. The aim of study was to identify the clinically most relevantcomplications after gastrectomy, using the population-attributable fraction (PAF). Methods Between 2011 and 2017, all patients who underwent potentially curative gastrectomy for gastric adenocarcinoma were included from the Dutch Upper GI Cancer Audit. Postoperative outcomes (morbidity, mortality, recovery and hospitalization) were evaluated. The prevalence of postoperative complications (e.g., anastomotic leakage and pneumonia) and of the study outcomes were calculated. The adjusted relative risk and Confidence Interval (CI) for each complication-outcome pair were calculated. Subsequently, the PAF was calculated, which represents the percentage of a given outcome occurring in the population, caused by individual complications, taking both the relative risk and the frequency in which a complication occurs into account. Results In total, 2176 patients were analyzed. Anastomotic leakage and pulmonary complications had the greatest overall impact on postoperative mortality (PAF 29.2% [95% CI 19.3-39.1] and 21.6% [95% CI 10.5-32.7], respectively) and prolonged hospitalization (PAF 12.9% [95% CI 9.7-16.0] and 14.7% [95% CI 11.0-18.8], respectively). Anastomotic leakage had the greatest overall impact on re-interventions (PAF 25.1% [95% CI 20.5-29.7]) and reoperations (PAF 30.3% [95% CI 24.3-36.3]). Intra-abdominal abscesses had the largest impact on readmissions (PAF 7.0% [95% CI 3.2-10.9]). Other complications only had a small effect on these outcomes. Conclusion Surgical improvement programs should focus on preventing or managing anastomotic leakage and pulmonary complications, since these complications have the greatest overall impact on clinical outcomes after gastrectomy.

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Section: Introductionmentioning

confidence: 99%

Identification of the clinically most relevant postoperative complications after gastrectomy: a population-based cohort study

et al. 2019

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“…Thus, at present, perioperative mortality was reduced in specialized highvolume centers to 3% [20][21][22]. At the time of introduction of laparoscopic surgery of GC, a higher proportion of patients undergoing SG surgery has been reported [23]. Even though according to the latest research, SG are performed in the vast majority of the cases [13], however Gertsen et al…”

Section: Discussionmentioning

confidence: 99%

The role of subtotal and total gastrectomy in the treatment of gastric cancer

Palaj

Kečkéš

Waczulı́ková

et al. 2021

neo

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The optimal procedure for the lower third gastric adenocarcinoma is still an open question. We performed an analysis of the long-term survival of patients after subtotal (SG) or total gastrectomy (TG) on 164 enrolled patients. Bivariate and multivariable analyses were performed in order to identify characteristics associated with long-term survival. Survival was significantly affected by the number of positive lymph nodes (LN). Patients who have undergone TG had a higher number of total removed LN. The adjusted hazard ratio for the TG group suggests a partial superiority of TG over SG for patients with curative intent. Our data support the importance of extended LN dissection.

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“…The surgical details of the LTG have been previously described. [ 13 , 14 , 17 , 19 ] LPG was completed with dissection of the lymph nodes according to the Japanese Gastric Cancer Treatment Guidelines, [ 6 ] including dissection of the lymph nodes at station numbers 1, 2, 3a, 4a, 4sb, 7, 8a, 9, and 11p. The lymph nodes along the right gastric artery and infra-pyloric area were saved to preserve the blood supply to the remnant distal stomach.…”

Section: Methodsmentioning

confidence: 99%

“…The surgical details of the LTG have been previously described [13,14,17,19] . LPG was completed with dissection of the lymph nodes according to the Japanese Gastric Cancer Treatment Guidelines, [6] including dissection of the lymph nodes at station numbers 1, 2, 3a, 4a, 4sb, 7, 8a, 9, and 11p.…”

Section: Methodsmentioning

confidence: 99%

“…Minimally invasive surgery, characterized by laparoscopic interventions, has become the standard of care for many surgical procedures across different specialties and is referred to as one of the main directions of operative development in the twenty-first century [9] . We performed laparoscopic gastrectomy (LG) for the treatment of GC as early as 2004, [10] and achieved good surgical outcomes and accumulated rich experience [11–19] . Owing to the continuous debates of PG over TG and the fact that laparoscopic PG (LPG) is considered a relatively technically demanding procedure, we expanded LG to LPG with DTR in 2016 for proximal GC.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy for proximal gastric cancer with stage cT1–2

Wang

Chen

et al. 2021

Medicine

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This study aimed to evaluate the feasibility and nutritional benefits of laparoscopic proximal gastrectomy (LPG) with double-tract reconstruction (DTR) in comparison with laparoscopic total gastrectomy (LTG). The demographic, clinical, and pathological data and postoperative nutritional status of patients undergoing LPG with DTR (n = 21) or LTG (n = 26) at Sir Run Run Shaw Hospital between January 2016 and January 2019 were retrospectively reviewed and compared. The operative time in the LPG group was slightly longer than that in the LTG group; however, the difference was not statistically significant. Blood loss was not significantly different between groups. The mean number of retrieved lymph nodes was higher in the LTG group than in the LPG group ( P = .02). The time to first flatus, postoperative hospital stay, and postoperative complications were comparable between the groups. During the 3-year postoperative follow-up, a statistically significant decrease in hemoglobin level was observed in the LTG group. There were no differences between the two groups of patients before and after the operation regarding albumin levels. The mean vitamin B 12 level was higher in the LPG group than in the LTG group from 12 to 18 months postoperatively. LPG with DTR is an acceptable procedure for patients with upper gastric cancer. LPG with DTR has numerous potential advantages in preserving the physiological and nutritional functions of the remnant stomach and the conservation of the gastric reservoir.

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Short-term outcomes of laparoscopic total gastrectomy for gastric cancer: a comparative study with laparoscopic distal gastrectomy at a high-volume center

Abstract: The results of LTG were favorable even though are not inferior to those of LDG. LTG for gastric cancer is technically feasible and safe. However, because of the limits of this study, other high-quality studies are needed for further evaluation.

Cited by 3 publications

References 29 publications

Identification of the clinically most relevant postoperative complications after gastrectomy: a population-based cohort study

Identification of the clinically most relevant postoperative complications after gastrectomy: a population-based cohort study

The role of subtotal and total gastrectomy in the treatment of gastric cancer

Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy for proximal gastric cancer with stage cT1–2

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