Open Versus Hand-assisted Laparoscopic Total Gastric Resection With D2 Lymph Node Dissection for Adenocarcinoma: A...

A case-control study was conducted to investigate the feasibility and safety of hand-assisted laparoscopic total gastrectomy (HALTG) with D2 lymphadenectomy for gastric cancer as opposed to traditional open total gastrectomy (OTG).

One hundred fifty-four patients suffering cardia, upper, middle, or whole gastric cancer operated in our department from February 2009 to February 2012 were divided into 2 groups: the open total gastrectomy group (the OTG group) and the hand-assisted laparoscopic total gastrectomy group (the HALTG group). Operative time, estimated blood loss, number of lymph node retrieval, time to the first flatus, and postoperative hospital stay were compared between the 2 groups.

HALTG was associated with significantly less operative blood loss, shorter time to the first flatus and shorter postoperative hospital stay, but longer operative time, compared with OTG. There were no significant differences in tumor size, retrieved lymph nodes, American Joint Committee on Cancer/Union International Control Cancer staging and tumor location between the 2 groups. Negative resection margins were obtained in all patients who had undergone a hand-assisted laparoscopic gastrectomy (100%) and in all but 2 patients in the open group (97.6%). The overall observed 5-year survival rate was 56.5% in the HALTG group and 51.8% in the OTG group (P=0.0001, log-rank test).

HALTG is a safe, feasible, and oncologically sound procedure and has advantages over ODG.