Laparoscopic Gastrectomy for Advanced Gastric Cancer

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic gastrectomy (LG) application for advanced gastric cancer remains debated due to limited oncological and surgical outcome data.
• Multicenter prospective cohort studies are crucial for evaluating novel surgical techniques in complex oncological cases.

Purpose of the Study:

• To assess the feasibility and safety of laparoscopic gastrectomy (LG) for advanced gastric cancer.
• To determine the incidence of severe postoperative complications following LG in a multicenter setting.

Main Methods:

• A prospective cohort study involving 98 patients with clinical stage II or III gastric cancer across 8 institutions.
• Primary endpoint: incidence of severe postoperative complications (Clavien-Dindo grade Ⅲa or higher).
• Analysis included different types of LG: distal (LDG), proximal (LPG), and total (LTG).

Main Results:

• The R0 resection rate was 90.8%, with 3.1% conversion to open surgery.
• Overall and severe postoperative complication rates were 17.3% and 9.2%, comparable to open surgery benchmarks.
• Laparoscopic total gastrectomy (LTG) showed a higher incidence of severe complications (28.6%) and anastomotic leakage (9.5%) compared to LDG and LPG.

Conclusions:

• Laparoscopic gastrectomy (LG) is a feasible option for advanced gastric cancer when performed by experienced surgeons, with acceptable complication rates.
• Laparoscopic total gastrectomy (LTG) requires heightened vigilance due to a statistically significant higher risk of severe postoperative complications.