P-259 Laparoscopic gastrectomy: our technique, complications and long-term oncological results

Abstract

Introduction: Although laparoscopic gastrectomy (LGE) has become a standard treatment of early gastric cancer (GC) in Japan and South Korea, it doesn't have wide spread in otherWorld. We want to represent our experience in performing LGE with analysis of short postoperative and long oncological results. Methods: Since 2011 we have done 87 LGE with D1+ or D2 lymphadenectomy (according to Japanese Gastric Cancer Treatment Guidelines 2010 (version 3)). There were 64 total and 23 subtotal LGE among them. Distribution for stages was: IA - 2 (2.3%), IB - 7 (8.1%), IIA - 16 (18.4%), IIB - 43 (49.4%), IIIA - 8 (9.2%), IIIB - 6 (6.9%), IIIC - 5 (5.7%). Thus 79 (90.8%) of patients had advanced stage (cT3-4, N0-2) and 82 (94.3%) received perioperative chemotherapy. In 10 cases extended resections were done: splenectomy (4), colon resection (2), hepatic (3), distal pancreatic (1). We used 5-6 trocars and 5-6 cm laparotomy for specimen extraction. In 6 cases transvaginal route for specimen retrieval were used. Anastomoses after Roux-an-Y reconstruction were performed using circular staplers (37), linear (45) and intracorporeal manual suture (5) for BI-reconstruction after distal LG. Results: Mean age was 57.8 (37-78) years. Mean operating time - 245 (160-550) minutes for total LGE and 235 (155-420) - for subtotal. Mean intraoperative blood loss - 95 (50-1100) ml. Mean postoperative hospital stay - 7.9 (4-24) days. Mean number of resected lymph nodes - 24.3 (8-60). All patients had R0 resection margins. There were no conversions to laparotomy. 30-day postoperative complications were registered in 28 (32.2%) patients. Among them grade IIIB-IV complications (according to Clavien-Dindo, 2004 classification) were in 12 (13.8%). Anastomotic leaks occurred in 5 (5.7%). Reoperations were done in 8 (9.2%). Reasons for reoperation were: anastomotic leak (4), bleeding (3) and anastomotic stricture (1). Mortality rate was 2.3% (2 patients died). Long-term oncologic results were assessed in 72 cases. One-year overall survival rate was 80.1%, 2-year - 64.3%, 3-year - 62.7% and 4-year - 55.6%. One-year progression-free survival (PFS) rate was 64.4%. PFS rates for 2, 3 and 4-years were 53.6, 52.9 and 50.3% respectively. Conclusion: Laparoscopic gastrectomy is feasible and safe method for patients even with advanced stage of gastric cancer. It has acceptable postoperative and long-term oncological outcomes in compare with open procedure.