Laparoscopic surgery for gastric cancer: preliminary experience

Laparoscopic surgery for gastric cancer (GC) was introduced in the past decade because it was considered less invasive than open surgery, resulting in less postoperative pain, faster recovery, and improved quality of life. Several studies have demonstrated the safety and feasibility of this procedure. We analyzed our preliminary experience with this procedure.

From November 2003 to December 2004, 20 patients affected by gastric adenocarcinoma were operated on with a totally laparoscopic or laparoscopic-assisted approach. This series included 10 women and 10 men, aged from 34 to 75 years. Procedures consisted of eight total gastrectomies, three subtotal Billroth I and seven Billroth II gastrectomies, one proximal gastrectomy, and one wedge resection. According to the TNM classification, we observed five patients at stage Ia, four at stage Ib, three at stage II, one at stage IIIa, two at stage IIIb, and five at stage IV.

In all patients the procedures were completed without any conversion. Operative time ranged from 150 to 300 min. The number of dissected lymph nodes ranged from 23 to 47. No mortality was observed. Overall morbidity rate was 10% (two cases), with one enteric fistula and one esophagojejunal anastomotic leakage associated with pancreatitis. Excluding these two patients, postoperative stay was between 12 and 20 days.

Even though accompanied by a difficult learning curve, safety and feasibility are widely demonstrated, but a skilled and experienced surgeon is required. Accurate selection of patients is mandatory and curative resection is achievable in cases where GC is not advanced.