J Gastric Cancer.  2015 Sep;15(3):159-166. 10.5230/jgc.2015.15.3.159.

Short-Term Outcomes of Laparoscopic Total Gastrectomy Performed by a Single Surgeon Experienced in Open Gastrectomy: Review of Initial Experience

• Song JH
• Choi YY
• An JY
• Kim DW
• Hyung WJ
• Noh SH

• KMID: 2372201
• DOI: http://doi.org/10.5230/jgc.2015.15.3.159

Abstract

PURPOSE
Laparoscopic total gastrectomy (LTG) is more complicated than laparoscopic distal gastrectomy, especially during a surgeon's initial experience with the technique. In this study, we evaluated the short-term outcomes of and learning curve for LTG during the initial cases of a single surgeon compared with those of open total gastrectomy (OTG).
MATERIALS AND METHODS
Between 2009 and 2013, 134 OTG and 74 LTG procedures were performed by a single surgeon who was experienced with OTG but new to performing LTG. Clinical characteristics, operative parameters, and short-term postoperative outcomes were compared between groups.
RESULTS
Advanced gastric cancer and D2 lymph node dissection were more common in the OTG than LTG group. Although the operation time was significantly longer for LTG than for OTG (175.7+/-43.1 minutes vs. 217.5+/-63.4 minutes), LTG seems to be slightly superior or similar to OTG in terms of postoperative recovery measures. The operation time moving average of 15 cases in the LTG group decreased gradually, and the curve flattened at 54 cases. The postoperative complication rate was similar for the two groups (11.9% vs. 13.5%). No anastomotic or stump leaks occurred.
CONCLUSIONS
Although LTG is technically difficult and operation time is longer for surgeons experienced in open surgery, it can be performed safely, even during a surgeon's early experience with the technique. Considering the benefits of minimally invasive surgery, LTG is recommended for early gastric cancer.

Keyword

Stomach neoplasms; Laparoscopy; Total gastrectomy; Learning curve

MeSH Terms

Gastrectomy*
Laparoscopy
Learning Curve
Lymph Node Excision
Minimally Invasive Surgical Procedures
Postoperative Complications
Stomach Neoplasms
Surgeons

Figure

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  Fig. 1 Trocar locations and extracorporeal procedures for laparoscopic total gastrectomy. (A) Trocar placement. (B) Small bowel extraction through a mini-laparotomy in the lower left quadrant of the abdomen. (C) Jejunojejunostomy (JJ) approximately 50 cm distal to the esophagojejunostomy site. (D) Circular stapler insertion into the jejunum to create the esophagojejunostomy. (E) Circular stapler with jejunum insertion into the intra-abdominal cavity for the esophagojejunostomy.

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  Fig. 2 Mean visual analog scale (VAS) scores (A) and white blood cell (WBC) counts (B) after laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG). POD = postoperative day.

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  Fig. 3 Operation time and learning curves for laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG). (A) Changes in operation time with the accumulation of case experiences. (B) A graph of the consecutive 15 cases showing its sequential average through the moving average method.

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