Totally Laparoscopic Total Gastrectomy Using Endoscopic Linear Stapler: Early Experiences at One Institute

Kim, Hee Sung; Kim, Min; Kim, Beom Su; Yook, Jeoung Hwan; Kim, Byung Sik

doi:10.1089/lap.2012.0238

Cited by 27 publications

(12 citation statements)

References 20 publications

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“…Totally laparoscopic total gastrectomy (TLTG) using various types of intracorporeal anastomosis methods has been developed due to improvements in surgical devices and the accumulation of operative experience, but an optimal method for TLTG is yet to be established because of the technical challenges, especially for reconstruction of the esophagojejunostomy (EJ). Since 2008, TLTG using endoscopic linear staplers has been performed in our institute on more than 400 patients by expert surgeons with much experience of laparoscopic surgery, and we have developed a secure and effective technique for reconstructing the EJ[ 15 - 17 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience

Gong¹,

Kim²,

Kim³

2017

WJG

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AIMTo evaluate the safety and efficacy of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy (LATG) using a circular stapler in gastric cancer patients.METHODSWe retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed.RESULTSThe TLTG group had higher mean ages at the time of operation (57.78 ± 11.20 years and 55.69 ± 11.96 years, P = 0.020) and more histories of abdominal surgery (20.2% and 12.4%, P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions, combined operations, pain scores and administration of analgesics, and complications were similar between the two groups. However, compared with the LATG group, the TLTG group required a shorter operation time (149 min vs 170 min, P < 0.001), had lower postoperative hematocrit change (3.49% vs 4.04%, P = 0.002), less intraoperative events (3.1% vs 10.2%, P < 0.001), less intraoperative anastomosis events (2.4% vs 7.1%, P = 0.003), faster postoperative recovery such as median time to first flatus (3.30 d vs 3.60 d, P < 0.001), faster median commencement of soft diet (4.30 d vs 4.60 d, P < 0.001) and shorter length of postoperative hospital stay (6.75 d vs 7.02 d, P = 0.005).CONCLUSIONThe intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore, TLTG can be recommended as an appropriate procedure for gastric cancer.

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Section: Introductionmentioning

confidence: 99%

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience

Gong¹,

Kim²,

Kim³

2017

WJG

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“…Consequently, totally laparoscopic distal gastrectomy is increasingly employed and has a proven history of safety and feasibility[ 2 - 8 ]. However, although scholars have reported a variety of totally laparoscopic total gastrectomy (TLTG) methods[ 3 , 9 - 13 ], this technique has not been widely adopted because of the technological difficulty inherent in digestive reconstruction. Interest in improving the postoperative appearance and quality of life (QoL) in patients with gastric cancer has been increased.…”

Section: Introductionmentioning

confidence: 99%

Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

Huang¹,

Huang²,

Zheng³

et al. 2017

WJG

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AIMTo evaluate the short-term outcomes and quality of life (QoL) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-later-cut overlap method (IJOM) after totally laparoscopic total gastrectomy (TLTG).METHODSA total of 507 patients who underwent laparoscopic gastrectomy (D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG (group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy (LATG) (group A, n = 456). The short-term outcomes and QoL were compared between the two groups after 1:2 propensity-score matching (PSM). We used a questionnaire to assess QoL.RESULTSBefore matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups (P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A (P < 0.05). After matching, group T reported better QoL in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better QoL (“Have you felt pain” and “Have you had difficulty eating solid food”) (P < 0.05).CONCLUSIONThe IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving QoL after laparoscopic gastrectomy.

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“…[19][20][21][22][23][24][25][26][27][28][29] However, there were no differences in the surgical outcomes between extracorporeal and intracorporeal E-J stomy or between circular and linear stapling. The rate of E-J leakage ranged from 0% to 7.4% overall, from 1.5% to 7.4% for circular stapling, [14][15][16][17][18][19][20][21] and from 0% to 6% for linear stapling.…”

Section: Reconstruction Methodsmentioning

confidence: 86%

Laparoscopic Total Gastrectomy for Gastric Cancer

Jung

Kim

2015

J Minim Invasive Surg

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Laparoscopic total gastrectomy (LTG) has been more widely performed in the last decade because of improvements in the techniques and safety of laparoscopic distal gastrectomy. However, due to its technical difficulty, there are still concerns regarding the safety of LTG. Meta-analyses have shown that LTG is technically feasible, safe, and may offer advantages over open total gastrectomy for treatment of gastric cancer. Various methods of performing esophagojejunostomy have been developed in an effort to decrease the rate of anastomosis-related complications, and have ultimately improved the safety and acceptance of LTG. However, there is still a lack of level-one evidence in support of LTG. Conduct of large-scale, randomized clinical trials will be needed in order to verify the safety and efficacy of LTG. Therefore, we reviewed the current status and some of the controversies surrounding LTG.

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Totally Laparoscopic Total Gastrectomy Using Endoscopic Linear Stapler: Early Experiences at One Institute

Cited by 27 publications

References 20 publications

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience

Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

Laparoscopic Total Gastrectomy for Gastric Cancer

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