Eleven-year experience with 3000 cases of laparoscopic gastric cancer surgery in a single institution: analysis of postoperative morbidities and long-term oncologic outcomes

Abstract

Background: The present study summarizes the 11-year laparoscopic gastric cancer surgery experience of a single institution in South Korea and evaluates the current trends of laparoscopic gastric cancer surgery through our experience. Methods: A total of 3000 minimally invasive gastric cancer surgeries were performed at Seoul National University Bundang Hospital between May 2003 and January 2014. The types of laparoscopic gastrectomy used, surgical techniques, postoperative morbidities, and long-term oncologic outcomes were analyzed. Results: The proportion of challenging procedures such as laparoscopic total gastrectomy and laparoscopic gastrectomy for patients with advanced gastric cancer increased during the study period. The frequency of laparoscopic function-preserving gastrectomy for patients with early-stage cancer also increased. The overall rate of complications was 16.7 %; surgical and systemic complication rates were 11.8 and 6.2 %, respectively. There was one case of postoperative mortality due to delayed bleeding after discharge. Male gender, high BMI, long operating times, combined resection of other organs, and total and proximal gastrectomies were independent predictors of surgical morbidities; however, pathologic T-stage was not a predictable factor. Accumulated experience in laparoscopic surgery decreased the surgical complication rates of total and proximal gastrectomies more than it did in distal gastrectomy over time. The 5-year overall survival rates of patients in advanced stages and those who underwent laparoscopic total gastrectomy were comparable to those reported previously. Conclusions: Our results indicate the trends toward the expansion of laparoscopic approaches to technically demanding procedures and an increased use of laparoscopic function-preserving surgeries for patients with EGC with acceptable outcomes.