Laparoscopic total gastrectomy (LTG) has drawn increasing attention over the years. Although LTG has shown surgical benefits compared to open TG (OTG) in early stage gastric cancer (GC), little is known about the surgical and oncological outcomes of LTG for advanced GC following neoadjuvant therapy (NAT).

To compare the long- and short-term outcomes of advanced GC patients who underwent LTG vs OTG following NAT.

Advanced GC patients who underwent TG following NAT between April 2011 and May 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences were enrolled and stratified into two groups: LTG and OTG. Propensity score matching analysis was performed at a 1:1 ratio to overcome possible bias.

In total, 185 patients were enrolled (LTG: 78; OTG: 109). Of these, 138 were paired after propensity score matching. After adjustment for propensity score matching, baseline parameters were similar between the two groups. Compared to OTG, LTG was associated with a significantly shorter length of hospital stay (P = 0.012). The rates of R0 resection, lymph node harvest, and postoperative morbidity did not significantly differ between the two groups. Overall survival (OS) outcomes were comparable between the two groups. Pathological T and N stages were found to be independent risk factors for OS.

LTG can be a feasible method for advanced GC patients following NAT, as it appears to be associated with better short- and comparable long-term outcomes compared to OTG.

• Gastric cancer
• Laparoscopic total gastrectomy
• Open total gastrectomy
• Neoadjuvant therapy
• Propensity score matching

• Gastric cancer
• Laparoscopic surgery
• Propensity score matching

• Gastric cancer
• Laparoscopic-assisted total gastrectomy
• Oncological efficacy
• Open total gastrectomy
• Propensity score matching
• Surgical safety

• Female
• Follow-Up Studies
• Gastrectomy/mortality
• Humans
• Laparoscopy/mortality
• Length of Stay/statistics & numerical data
• Lymph Node Excision/mortality
• Male
• Middle Aged
• Propensity Score
• Retrospective Studies
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Rate
• Treatment Outcome

• 81872022 National Natural Science Foundation of China
• 81672439 National Natural Science Foundation of China
• 82073357 National Natural Science Foundation of China
• 7162039 Beijing Natural Science Foundation
• CFH 2018-2-2153 Capital's Funds for Health Improvement and Research
• Capital’s Funds for Health Improvement and Research

• adenocarcinoma of the esophagogastric junction
• anti-reflux anastomosis
• proximal gastrectomy

• Bodyweight
• Gastric cancer
• Hemoglobin
• Laparoscopic distal gastrectomy
• Remnant stomach

• Adult
• Aged
• Aged, 80 and over
• Female
• Gastrectomy/methods
• Gastric Stump/surgery
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Stomach Neoplasms/surgery
• Treatment Outcome

Laparoscopic total gastrectomy (LTG) is increasingly performed in patients with gastric cancer. However, the usage of intracorporeal esophagojejunostomy (IEJ) following LTG is limited, as the safety and efficacy remain unclear. The present meta-analysis aimed to evaluate the feasibility and safety of IEJ following LTG.

Studies published from January 1994 to January 2017 comparing the outcomes of IEJ and extracorporeal esophagojejunostomy (EEJ) following LTG were reviewed and collected from the PubMed, EBSCO, Cochrane Library, Embase, and China National Knowledge Internet (CNKI). Operative results, postoperative recovery, and postoperative complications were compared and analyzed. The weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI) were calculated using the Review Manager 5.3.

Seven nonrandomized studies with 785 patients were included. Compared with EEJ, IEJ has less blood loss (WMD: −13.52 ml; 95% CI: −24.82–−2.22; P = 0.02), earlier time to first oral intake (WMD: −0.49 day; 95% CI: −0.83–−0.14; P < 0.01), and shorter length of hospitalization (WMD: −0.62 day; 95% CI: −1.08–−0.16; P < 0.01). There was no significant difference between IEJ and EEJ regarding the operation time, anastomotic time, number of retrieved lymph nodes, time to first flatus, anastomosis leakage rate, anastomosis stenosis rate, and proximal resections (all P > 0.05).

Compared with EEJ, IEJ has better cosmesis, milder surgical trauma, and a faster postoperative recovery. IEJ can be performed as safely as EEJ. IEJ should be encouraged to surgeons with sufficient expertise.

• Gastric Neoplasms
• Intracorporeal Esophagojejunostomy
• Laparoscopy
• Total Gastrectomy

• laparoscopy-assisted total gastrectomy
• prognosis
• propensity score matching
• stomach neoplasms

Anastomotic leakage after total gastrectomy occurs despite improvements in surgical techniques and patient management. Although many cases of dehiscence can be managed non-operatively, major leakage requires a second surgery and can potentially lead to death. Therefore, accurate and immediate diagnosis and treatment are essential.

In this report, we describe a 66-year-old Japanese man who was diagnosed with a complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy with oral contrast radiography using Gastrografin^®. The severe complication was successfully treated by re-anastomosis after two emergency drainage surgeries. After the second surgery, the esophageal end formed a fistula with the jejunum, but balloon dilation failed to open the fistula. Therefore, oral ingestion and conservative treatment were considered unsuitable, and we performed esophagojejunal re-anastomosis 7 months after the first surgery. At a follow-up examination 2 years after re-anastomosis, the patient weighed 47 kg, and his ingestion had recovered to 80% of that before surgery.

Complete separation of an esophagojejunal anastomosis is a rare but severe complication of total gastrectomy. Therefore, we consider that once separation is diagnosed, aggressive and urgent re-operation and effective drainage are useful. Moreover, it is necessary to take great care to minimize the operative morbidity associated with esophagojejunal anastomosis.

• Anastomotic leakage
• Esophagojejunal anastomosis
• Laparoscopic total gastrectomy

• Anastomotic leak
• Anastomotic stricture
• CDH1 mutation
• Esophagojejunostomy
• Gastric adenocarcinoma
• Hereditary diffuse gastric cancer
• Total gastrectomy

To present the feasibility and safety of Roux-en-Y esophagojejunostomy using hemi-double-stapling technique after laparoscopic total gastrectomy.

We reviewed the outcomes from 58 consecutive patients with gastric cancer who underwent laparoscopic total gastrectomy. The clinicopathological characteristics including postoperative complications were examined.

The mean age and body mass index were 57.3 ± 9.7 years and 23.7 ± 2.6 kg/m², respectively. The mean overall total operation was 199.8 ± 57.0 minutes. Intraoperative blood loss was 81.6 ± 56.3 mL and there was no open conversion. The patients' hospital stay was a mean 9.6 ± 2 days. The mean proximal margin of the specimens was 2.7 ± 1.8 cm. There were 3 cases (5.1%) of anastomosis leakage, but all were controlled successfully by endoscopic stent.

The circular HDST technique is simple and reliable without any significant demerits with respect to safety concerns or difficulty of operation.

• Feasibility
• Gastric cancer
• Hemi-double-stapling technique
• Intracorporeal esophagojejunostomy
• Laparoscopic total gastrectomy

The use of laparoscopy for the treatment of gastric cancer suffered some resistance among surgeons around the world, gaining strength in the past decade. However, its oncological safety and technical feasibility remain controversial.

To describe the results from the clinical and anatomopathological point of view in the comparative evaluation between the surgical videolaparoscopic and laparotomic treatments of total gastrectomy with linphadenectomy at D2, resection R0.

Retrospective analyses and comparison data from patients submitted to total gastrectomy with D2 linphadenectomy at a sole institution. The data of 111 patients showed that 64 (57,7%) have been submitted to laparotomic gastrectomy and 47 (42,3%) to gastrectomy entirely performed through videolaparoscopy. All variables related to the surgery, post-operative follow-up and anatomopathologic findings have been evaluated.

Among the studied variables, videolaparoscopy has shown a shorter surgical time and a more premature period for the introduction of oral and enteral nourishment than the open surgery. As to the amount of dissected limph nodes, there has been a significant difference towards laparotomy with p=0,014, but the average dissected limph nodes in both groups exceed 25 nodes as recommended by the JAGC. Was not found a significant difference between the studied groups as to age, ASA, type of surgery, need for blood transfusion, stage of the disease, Bormann classification, degree of differentiation, damage of the margins, further complications and death.

The total gastrectomy with D2 lymphadenectomy performed by laparoscopy presented the same benefits known of laparotomy and with the advantages already established of minimally invasive surgery. It was done with less surgical time, less time for re-introduction of the oral and enteral diets and lower hospitalization time compared to laparotomy, without increasing postoperative complications.

AIM: To investigate the anastomotic complications of esophagojejunostomy (EJS) after laparoscopic total gastrectomy (LTG), we reviewed retrospective studies.

METHODS: A literature search was conducted in PubMed for studies published from January 1, 1994 through January 31, 2015. The search terms included “laparoscopic,”“total gastrectomy,” and “gastric cancer.” First, we selected 16 non-randomized controlled trials (RCTs) comparing LTG with open total gastrectomy (OTG) and conducted an updated meta-analysis of anastomotic complications after total gastrectomy. The Newcastle-Ottawa scoring system (NOS) was used to assess the quality of the non-RCTs included in this study. Next, we reviewed anastomotic complications in 46 case studies of LTG to compare the various procedures for EJS.

RESULTS: The overall incidence of anastomotic leakage associated with EJS was 3.0% (30 of 984 patients) among LTG procedures and 2.1% (31 of 1500 patients) among OTG procedures in the 16 non-RCTs. The incidence of anastomotic leakage did not differ significantly between LTG and OTG (odds OR = 1.42, 95%CI: 0.86-2.33, P = 0.17, I² = 0%). Anastomotic stenosis related to EJS was reported in 72 (2.9%) of 2484 patients, and the incidence was 3.2% among LTG procedures and 2.7% among OTG procedures. The incidence of anastomotic stenosis related to EJS was slightly, but not significantly, higher in LTG than in OTG (OR = 1.55, 95%CI: 0.94-2.54, P = 0.08, I² = 0%). The various procedures for LTG were classified into six categories in the review of case studies of LTG. The incidence of EJS leakage was similar (1.1% to 3.2%), although the incidence of EJS stenosis was relatively high when the OrVil^TM device was used (8.8%) compared with other procedures (1.0% to 3.6%).

CONCLUSION: The incidence of anastomotic complications associated with EJS was not different between LTG and OTG. Anastomotic stenosis was relatively common when the OrVil^TM device was used.

• Gastric cancer
• Laparoscopic
• Gastrectomy
• Anastomosis
• Complication

• Anastomotic Leak/diagnosis
• Anastomotic Leak/epidemiology
• Chi-Square Distribution
• Constriction, Pathologic
• Esophagostomy/adverse effects
• Esophagostomy/instrumentation
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Humans
• Incidence
• Jejunostomy/adverse effects
• Jejunostomy/instrumentation
• Laparoscopy/adverse effects
• Odds Ratio
• Risk Factors
• Stomach Neoplasms/surgery
• Treatment Outcome

AIM: To systematically review the surgical outcomes of totally laparoscopic gastrectomy (TLG) vs open gastrectomy (OG) for gastric cancer.

METHODS: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted. All original studies comparing TLG with OG were included for critical appraisal. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.

RESULTS: One RCT and 13 observational studies involving 1532 patients were included (721 TLG and 811 OG). TLG was associated with longer operation time [weighted mean difference (WMD) = 58.04 min, 95%CI: 37.77-78.32, P < 0.001], less blood loss [WMD = -167.57 min, 95%CI: -208.79-(-126.34), P < 0.001], shorter hospital stay [WMD = -3.75 d, 95%CI: -4.88-(-2.63), P < 0.001] and fewer postoperative complications (RR = 0.71, 95%CI: 0.58-0.86, P < 0.001). The number of harvested lymph nodes, surgical margin, mortality and cancer recurrence rate were similar between the two groups.

CONCLUSION: TLG may be a technically safe, feasible and favorable approach in terms of better cosmesis, less blood loss and faster recovery compared with OG.

• Gastric cancer
• Gastrectomy
• Intracorporeal anastomosis
• Laparoscopy
• Meta-analysis
• Survival

• Blood Loss, Surgical/prevention & control
• Chi-Square Distribution
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastrectomy/mortality
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Laparoscopy/mortality
• Neoplasm Recurrence, Local
• Odds Ratio
• Postoperative Complications/etiology
• Risk Assessment
• Risk Factors
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Time Factors
• Treatment Outcome