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Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional and oncological outcomes

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Abstract

Background

Higher morbidity in total gastrectomy than in distal gastrectomy has been reported, but laparoscopic subtotal gastrectomy (LsTG) has been reported to be safe and feasible in early gastric cancer (GC). We determined the surgical, nutritional and oncological outcomes of LsTG for advanced gastric cancer (AGC).

Methods

Of the 816 consecutive patients with GC who underwent radical gastrectomy at our institution between 2008 and 2012, 253 who underwent curative laparoscopic gastrectomy (LG) for AGC were enrolled. LsTG was indicated for patients with upper stomach third tumors, who hoped to avoid total gastrectomy, <4 cm to the esophagogastric junction and a 2-cm proximal margin with cut end negative in frozen section, whereas laparoscopic conventional distal gastrectomy (LcDG) and laparoscopic total gastrectomy (LTG) were performed otherwise. Surgical outcomes and postoperative nutritional status were primarily assessed.

Results

Of 253 patients, the morbidity (Clavien–Dindo classification grade ≥ III) was 17.0% (43 patients). The 3-year overall survival and 3-year recurrence-free survival rates were 80.2 and 73.5%, respectively. LcDG, LsTG and LTG were performed in 121, 27 and 105 patients, individually. Morbidity was strongly associated with LTG (P = 0.001). Postoperative loss of body weight was significantly greater after LTG in comparison with LcDG or LsTG (P < 0.001). No difference in morbidity and postoperative loss of body weight were observed between LcDG and LsTG group.

Conclusions

LG for AGC was feasible and safe surgically and oncologically. LsTG for AGC may be safer than LTG from surgical and postoperative nutritional point of view.

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Abbreviations

GC:

Gastric cancer

JCGC:

Japanese classification of gastric cancer

CD:

Clavien–Dindo classification

LG:

Laparoscopic gastrectomy

3yOS:

3-Year overall survival

3yRFS:

3-Year recurrence-free survival

LN:

Lymph node

LcDG:

Laparoscopic conventional distal gastrectomy

LsTG:

Laparoscopic subtotal gastrectomy

LTG:

Laparoscopic total gastrectomy

LDG:

Laparoscopic distal gastrectomy

BW:

Body weight

NAC:

Neoadjuvant chemotherapy

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Acknowledgements

The authors are indebted to Maruzen Co., Ltd. (Tokyo, Japan) for their review of the present manuscript as native English speakers and to StaGen Co., Ltd. (Tokyo, Japan) for their review of statistical analyses as medical statisticians.

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Authors and Affiliations

  1. Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Masaya Nakauchi, Koichi Suda, Kenichi Nakamura, Susumu Shibasaki, Kenji Kikuchi, Tetsuya Nakamura, Shinichi Kadoya, Yoshinori Ishida, Kazuki Inaba, Keizo Taniguchi & Ichiro Uyama

  2. Cancer Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Koichi Suda

  3. Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, 213-8507, Japan

    Keizo Taniguchi

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  1. Masaya Nakauchi
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Correspondence to Koichi Suda.

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Masaya Nakauchi, Koichi Suda, Kenichi Nakamura, Susumu Shibasaki, Kenji Kikuchi, Tetsuya Nakamura, Shinichi Kadoya, Kazuki Inaba, Yoshinori Ishida, Keizo Taniguchi and Ichiro Uyama have no conflict of interest or financial ties to disclose.

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Nakauchi, M., Suda, K., Nakamura, K. et al. Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional and oncological outcomes. Surg Endosc 31, 4631–4640 (2017). https://doi.org/10.1007/s00464-017-5526-9

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