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KMID : 0914820070070040206
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Journal of the Korean Gastric Cancer Association
2007 Volume.7 No. 4 p.206 ~ p.212
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Laparoscopy Assisted Total Gastrectomy with Lymph Node Dissection－77 Consecutive Cases
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Lee Joong-Ho
Song Jye-Won
Oh Sung-Jin
Kim Sung-Soo
Choi Won-Hyuk
Cheong Jae-Ho
Hyung Woo-Jin
Choi Seung-Ho
Noh Sung-Hoon
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Abstract
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Purpose: The number of laparoscopy assisted distal gastrectomies (LADG) is gradually increasing for the treatment of early gastric cancer (EGC) patients as a surgical modality for improving quality of life. However, there are few
reports on laparoscopy-assisted total gastrectomy (LATG), mainly because this procedure is performed relatively infrequently, and the procedure is more complicated than LADG. This study was performed to evaluate the technical
feasibility, safety, and surgical results of LATG with lymphadenectomy through a review of our experience.
Materials and Methods: From July 2003 to June 2007, 77 LATG with Roux-en-Y esophagojejunostomy were performed for patients with a preoperative diagnosis of EGC. The clinicopathological features and surgical outcomes were analyzed.
Results: There were 49 males and 28 females in the study with a mean age of 61 years (range 30∼85 years).
The mean operation time was 210 minutes (range 100∼400 minutes) and the operation time was gradually decreased
as the case numbers increased. There were 13 operative morbidities (16.9%) and no operative mortalities. The restoration of bowel motility was noted at 3.2 postoperative days; a soft diet was started at 4.4 postoperative days and the duration of hospital stay was 10 days. There were 20 mucosal lesions, 32 submucosal lesions, 15 proper muscle lesions, 7 ubserosal lesions and 3 serosal lesions. A total of 20 patients were treated by D2 lymph node dissection, 55 patients were treated by D1+β lymph node dissection, and two patients were treated by D1 +α lymph node dissection. The mean number of retrieved lymph nodes was 42 (range 11∼86). Lymph node metastases were noted in 12 patients.
Conclusions: This study indicated LATG could be applied safely and effectively for patients with EGC. However, a prospective study comparing laparoscopy-assisted versus open gastrectomy for short-term and long-term surgical outcome is needed.
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KEYWORD
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Gastric cancer, Laparoscopy assisted total gastrectomy, Lymph node dissection
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