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Laparoscopic Surgery for Gastric Malignancy: Outcomes of a Minimally Invasive Oncologic Resection
Monica Young*, Alana Gebhart, Stephen D. Vu, Nojan Toomari, Brian R. Smith, Ninh T. Nguyen
Surgery, University of California Irvine Medical Center, Orange, CA
Introduction: Controversy remains over the safety and efficacy of laparoscopic gastric operations. The objective of this study was to evaluate the outcomes of patients who underwent laparoscopic gastrectomy and palliative bypass procedures.
Methods: 86 patients who underwent laparoscopic intervention for gastric malignancy between January 2001 and August 2013 were reviewed. 94% of patients underwent laparoscopic gastrectomy, while 6% were found to be unresectable and required a palliative bypass. Main outcome measures included operative findings, conversion rate, hospital stay, morbidity, mortality and pathology.
Results: Mean age was 68 years and 52% of patients were male. The majority of cases were performed for gastric adenocarcinoma (90%). Other indications included gastrointestinal stromal tumor (5.8%), dysplasia (1.2%), carcinoid (1.2%), and pancreatic cancer (1.2%). Eight patients (9.3%) underwent neoadjuvant therapy. Procedures performed included laparoscopic total gastrectomy (20%), subtotal gastrectomy (41%), distal gastrectomy (25%), proximal gastrectomy (5%), gastric wedge resection (3%) and palliative gastrojejunal bypass (6%). There were no conversions to laparotomy.
Eleven patients (13%) were monitored in the ICU postoperatively, with an overall mean ICU stay of 0.9 days. Median hospital stay was 4 days. There were no in-hospital or 30-day mortalities. Two intraoperative complications occurred in patients undergoing subtotal gastrectomy: ischemia of the Roux limb requiring resection and bleeding at the gastrojejunostomy anastomosis. The rate of major complications was 3.7% and minor complications was 9.9%. Anastomotic leak occurred in one patient following total gastrectomy (1.2%). Late complication rate was 11%, with stricture being the most common. Distribution of final pathology was: stage 0 (15%), stage I (47%), stage II (14%), stage III (10%) and stage IV (15%). Average number of lymph nodes resected was 19 ±12.3.
Conclusion: Laparoscopic gastrectomy is safe and associated with low morbidity and mortality. A minimally invasive approach can provide good oncologic resection with equivalent lymph node harvest to open gastrectomy.
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