The technique of laparoscopically assisted total gastrectomy with jejunal interposition for early gastric cancer

Mochiki, Erito; Kamimura, Hitoshi; Haga, Norihiro; Asao, Takayuki; Kuwano, Hiroyuki

doi:10.1007/s00464-001-8219-2

Cited by 50 publications

(34 citation statements)

References 10 publications

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“…In our experience, this procedure was associated with higher operating time and blood loss and longer hospital stay than the other laparoscopic procedures, but it was mostly performed for advanced GC cases with palliative intent. Finally, as occurred in our series, laparoscopic PG for EGC is still reported occasionally [16,19,21,22].…”

Section: Discussionmentioning

confidence: 80%

“…By contrast, TG is a technically demanding and time-consuming procedure, requiring a very skilled and experienced surgeon. From 1999 to 2003, only 36 (6.5%) TGs were reported in the literature, most being laparoscopic-assisted [14,[16][17][18]19,21]. In our experience, this procedure was associated with higher operating time and blood loss and longer hospital stay than the other laparoscopic procedures, but it was mostly performed for advanced GC cases with palliative intent.…”

Section: Discussionmentioning

confidence: 85%

See 1 more Smart Citation

Laparoscopic surgery for gastric cancer: preliminary experience

Carboni¹,

Lepiane²,

Santoro³

et al. 2005

Gastric Cancer

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 85%

Laparoscopic surgery for gastric cancer: preliminary experience

Carboni¹,

Lepiane²,

Santoro³

et al. 2005

Gastric Cancer

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“…As the minimal invasiveness and clinical usefulness of LADG became known, other types of laparoscopic surgery for gastric cancer were developed. Laparoscopic proximal gastrectomy (LAPG) [31,32] and total gastrectomy (LATG) [33], which are selected according to the EGC site, were developed in Japan. Also, laparoscopic pyloruspreserving gastrectomy [34,35] and laparoscopic gastrectomy with vagus nerve preservation [36] are performed as types of function-preserving gastrectomy.…”

Section: Ladgmentioning

confidence: 99%

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

2006

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surgery, including less invasiveness, less pain, earlier recovery, and better cosmesis [2]. Kitano et al. [3] first applied and described laparoscopy-assisted distal gastrectomy (LADG) as treatment for early gastric cancer (EGC) in 1994.With the development of various diagnostic modalities and the spread of mass screening, EGC now accounts for more than 50% of the total incidence of gastric cancer in Japan. The low frequency of lymph node metastasis in patients with EGC is well known; it reportedly occurs in 2%-5% of those with mucosal cancer and 11%-20% of those with submucosal cancer [4]. To allow for the treatment of EGC in patients without a risk of lymph node metastasis, laparoscopic wedge resection (LWR) with a lesion-lifting method was developed by Ohgami et al. [5] in 1992, and intragastric mucosal resection (IGMR) was developed by Ohashi [6] in the early 1990s. With the recent development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) [7], the use of LWR and IGMR seems to be decreasing, whereas the use of LADG with lymph node dissection has increased in patients with EGC with a risk of lymph node metastasis.The past 15 years have seen remarkable advances in laparoscopic surgical techniques and instruments, such as laparoscopic coagulating shears [8]. Extended lymph node dissection (D2) and total gastrectomy can now be performed laparoscopically [9,10]. However, LADG remains controversial as a standard surgery for gastric cancer because there are few studies evaluating the technical difficulty, advantages, and oncological feasibility of LADG.Here, we review reports, in the English-language literature, of LADG with lymph node dissection as treatment for cancer, to clarify the current status of this technique and related problems. AbstractSince 1991, laparoscopic surgery has been adopted for the treatment of gastric cancer, and it has been performed worldwide, especially in Japan and Korea. We reviewed the English-language literature to clarify the current status of and problems associated with laparoscopic gastrectomy with lymph node dissection as treatment for gastric cancer. In Japan, early-stage gastric cancer (T1/T2, N0) is considered the only indication for laparoscopic gastrectomy. As yet, there is little high-level evidence based on long-term outcome supporting laparoscopic gastrectomy for cancer, but reports have provided level 3 evidence that the procedure is technically safe, and that it yields better short-term outcomes than open surgery; that is, recovery is faster, hospital stay is shorter, there is less pain, and cosmesis is better. However, investigation into the oncological outcome of laparoscopic gastrectomy as treatment for cancer is lacking. To establish laparoscopic surgery as a standard treatment for gastric cancer, multicenter randomized controlled trials to compare the short-and longterm outcomes of laparoscopic surgery versus open surgery are necessary.

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“…B. Gastrektomie mit D2-Lymphadenektomie, Präparatebergung, Rekonstruktion) laparoskopisch sicher durchgeführt werden können [1,4,9,78,95].Vorteile der MIC zeigten sich sowohl intraoperativ (vergleichbare Operationsdauer, weniger Blutverlust) als auch postoperativ (niedrige Morbidität, rasche Rekonvaleszenz, zügiger Kostaufbau). Die vorläufigen Resultate bezüglich der onkologischen Radikalität zeigten der konventionellen Chirurgie vergleichbare Resektionsausmaße bzw.…”

Section: Intraoperative Tumorzellverschleppungunclassified

Grenzen der laparoskopischen Viszeralchirurgie in der Onkologie

Bruch

Schwandner

Keller

2003

Chirurg

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Controversial discussion focuses on the application of laparoscopic curative resection for cancer due to oncologic radicality,tumor cell dissemination, and port site metastases. Considering the limitations of laparoscopic surgery, it is necessary to objectively evaluate whether laparoscopic surgery is associated with an improved quality of curative treatment. Therefore, controlled studies comparing the results of laparoscopic vs conventional cancer surgery are mandatory. To date, comparable findings on short-term outcome of laparoscopy with open resection can only be shown for colorectal cancer. However, long-term data including recurrence and survival are still missing as randomized studies (phase IIIb) are still to be completed. Consequently, laparoscopic curative resection should only be performed within controlled trials. In terms of the upper GI tract, minimally invasive surgery has proven to be technically feasible in expert centers including limited resections for early gastric cancer, left pancreatectomies, or hepatic resections for malignancy. Finally, laparoscopy has gained acceptance in the field of diagnosis (e.g., staging laparoscopy, laparoscopic ultrasound) and palliative treatment (e.g. gastroenterostomy, thermoablation) without the need for controlled studies.

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The technique of laparoscopically assisted total gastrectomy with jejunal interposition for early gastric cancer

Abstract: We successfully performed laparoscopically assisted total gastrectomies in a relatively short period of time. When patients are carefully selected, the laparoscopic procedure can be curative and minimally invasive as a treatment for early gastric cancer.

Cited by 50 publications

References 10 publications

Laparoscopic surgery for gastric cancer: preliminary experience

Laparoscopic surgery for gastric cancer: preliminary experience

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

Grenzen der laparoskopischen Viszeralchirurgie in der Onkologie

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