Minimally Invasive Therapy. 2012; Early Online, 1–8 ORIGINAL ARTICLE Laparoscopic total gastrectomy in gastric cancer: Our experience in 92 cases FRANCESCO CORCIONE, FELICE PIROZZI, DIEGO CUCCURULLO, PIERLUIGI ANGELINI, VINCENZO CIMMINO & ANNA SETTEMBRE General Surgery Department, Laparoscopic and Robotic Surgery Center, Highly Specialized and of National Importance Hospital “V. Monaldi”, Naples, Italy Abstract Introduction: Laparoscopic total gastrectomy (LTG) is seldom used for gastric cancer because the complex vascularization and lymphatic drainage makes lymphadenectomy and esophagojejunal anastomosis difficult and requires special skills. Our aim was to demonstrate the feasibility and accuracy of LTG in gastric cancer with D2 lymphadenectomy. Material and methods: Eighty-eight LTG and four laparoscopic remnant gastrectomies (LRGs) were performed over >12 years. The median patient age was 64 years, and the male/female ratio was 1.49/1. Eighty-seven patients had a D2 and only five patients had a D1 lymphadenectomy. We propose the retrospective analysis of intra- and perioperative mortality and morbidity. Results: In only four of 96 cases approached by laparoscopy, a conversion to laparotomy was needed. There were two (2.17%) perioperative deaths in 92 procedures and few complications. Histological data show 79 advanced gastric cancers (AGC), 11 early gastric cancers (EGC), and two gastric diffused lymphomas. The five-year Kaplan-Meier overall survival in patients with EGC and AGC was 100% and 58%, respectively. Conclusions: The results demonstrate the feasibility of an oncologically correct minimally invasive total gastrectomy. We would like to promote comparisons among different institutions to achieve better standardization of indications and techniques for a laparoscopic approach to gastric cancer. Key words: Laparoscopic gastric surgery, gastric cancer, laparoscopic lymphadenectomy Introduction Interest in laparoscopic treatment of gastric cancer has increased substantially, but still few centers are dedi- cated to this approach especially because the particularly varied vascularization and lymphatic drainage of the stomach requires a high degree of technical ability and experience in advanced laparoscopy in order to perform a correct oncologic surgery. Laparoscopy for advanced gastric cancer (AGC) requires appropriate training with resections for benign gastric ulcers and gastrointestinal stromal tumors (GIST) followed by early neoplasms (1). For early gastric cancer (EGC), after Kitano’s preliminary report in 1995 (2), numerous series have documented the oncologic validity of the laparoscopic method. Tanimura (3) has the largest series of laparoscopic gastrectomies, which consisted of 612 patients operated for neoplasms with staging up to T2N1, and reported, in 175 cases of AGC, a survival rate that overlaps that of his open group. Furthermore, in proximally located neoplasm where total gastrectomy is indicated, many surgeons still view the laparoscopic method as complex because of the difficulties posed by D2 lymphadenectomy and esophagojejunal anasto- mosis. We believe that our retrospective analysis of 88 laparoscopic total gastrectomies (LTG) and four laparoscopic remnant gastectomies (LRG) for cancer contribute to an increasing awareness of the feasibility and advantages of laparoscopy at specialized centers. Material and methods From January 1999 to June 2011, 88 LTGs and four LRGs for cancer were performed at our center. Also Correspondence: F. Corcione, General Surgery Department, Laparoscopic and Robotic Surgery Center. Highly Specialized and of National Importance Hospital “V. Monaldi”, Naples, Italy. E-mail: francesco.corcione@ospedalemonaldi.it ISSN 1364-5706 print/ISSN 1365-2931 online Ó 2012 Informa Healthcare DOI: 10.3109/13645706.2012.743919 Minim Invasive Ther Allied Technol Downloaded from informahealthcare.com by Antonio Sciuto on 06/04/13 For personal use only.