Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8553
Peer-review started: October 7, 2017
First decision: October 25, 2017
Revised: November 14, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: December 28, 2017
Processing time: 81 Days and 23.7 Hours
In Korea and Japan, the incidence of upper and middle body gastric cancer has increased as a result of improved nationwide surveillance. Furthermore, the indication of laparoscopic gastrectomy has also extended. Therefore, the demand for minimally invasive surgery for upper body gastric cancer has grown, and there is more need for new therapeutic methods and modalities.
Intracorporeal anastomosis and extracorporeal anastomosis in laparoscopic total gastrectomy has developed due to improvements in surgical devices and the accumulation of operative experience, but an optimal method for laparoscopic total gastrectomy has yet to be established due to the difficulties of esophagojejunostomy.
We aimed to evaluate the surgical safety and efficacy of intracorporeal anastomosis using linear stapler for treating gastric cancer of the upper third of the stomach by comparing its outcomes with those of extracorporeal anastomosis using circular stapler.
From August 2008 to August 2014, 687 consecutive patients who underwent total gastrectomy (266 laparoscopic-assisted total gastrectomy (LATG) patients and 421 totally laparoscopic total gastrectomy (TLTG) patients) were reviewed retrospectively. Data obtained from medical records included patient age, sex, body mass index, American Society of Anesthesiologist score, history of abdominal surgery, operative time, pre- and postoperative hematocrit, time to first flatus, day of commencement of soft diet, pain score by visual analogue scale, number of analgesics administered, intra- and postoperative transfusion, intraoperative events, postoperative hospital stay, tumor size, number of retrieved lymph nodes, resection margins and cancer stage according to the American Joint Committee on Cancer - International Union for Cancer Control 7th edition.
The TLTG group had higher mean age at time of operation, and more histories of abdominal surgery. However, the TLTG group required a shorter operation time, lower postoperative hematocrit change, less intraoperative events, less intraoperative anastomosis events, and permitted faster postoperative recovery, such as median time to first flatus, median commencement of soft diet and length of postoperative hospital stay.
TLTG may be considered a feasible procedure, as compared to LATG. Because TLTG provides a wider view than TLTG, reconstruction in TLTG carried out with a linear stapler is easy, rapid and requires no hand-sewn reinforcement procedure, and TLTG does not need additional mini-laparotomy. Furthermore, TLTG had superior surgical outcomes in terms of operation time, postoperative hematocrit change, intraoperative events and postoperative recovery.
Based on our results, we can consider TLTG as a feasible and straightforward procedure. But this study has certain limitations. It is a retrospective study from a single institution, and although the pathologic results in the LATG and TLTG groups were similar, data on long-term outcomes are still needed to compare the oncological adequacy of these two methods.