Comparison of Totally Laparoscopic Total Gastrectomy and Laparoscopic-Assisted Total Gastrectomy Methods for the Surgical Treatment of Early Gastric Cancer Near the Gastroesophageal Junction

Abstract

Background: Several investigators have suggested methods for performing totally laparoscopic total gastrectomy (TLTG). However, even surgeons experienced in laparoscopic gastrectomy find it very hard to perform TLTG safely because it is a complex procedure. The aim of the present study was to evaluate the safety and efficacy of our TLTG method for the surgical treatment of early gastric cancer (EGC) located near the gastroesophageal junction (GEJ). Subjects and Methods: Between January 2010 and June 2011, 113 patients at a single institution underwent TLTG (n = 90) or laparoscopic-assisted total gastrectomy (LATG) (n = 23). Early surgical outcomes of the two techniques were compared to assess the effectiveness of TLTG for treating EGC near the GEJ. Results: The TLTG group included patients with higher body mass indexes (23.2 versus 22.2 kg/m(2), P = .037) and more overweight patients (22.2% versus 4.0%, P = .041) than the LATG group. Despite this, the two groups had similar early surgical outcomes, such as mean operation time, intraoperative events, postoperative complications, time to first flatus, time to starting a soft diet, pain scores, analgesic requirements, and lengths of hospital stay. Conclusions: The results of TLTG were favorable even though a high proportion of the subjects were overweight. TLTG for EGC near the GEJ could be the best way to improve early surgical outcomes of EGC in overweight patients provided it is performed by surgeons who are experienced in laparoscopic gastrectomy.