The Surgical Outcomes Of 83 Patients With Totally Laparoscopic Gastrectomy (TLG)

Objective:Totally laparoscopic gastrectomy(TLG)is an increasingly popular procedure in the field of minimally invasive gastrectomy surgery,and majority of researches have explored the clinical efficacy of TLG in the treatment of early gastric cancer(EGC),demonstrating a lot of controversy in aspects of safety,clinical efficacy and digestive reconstruction strategy of this procedure.Our aim was to analyze the surgical outcomes of TLG in the treatment of advanced gastric cancer(AGC),and to summarize our preliminary surgical experience.Methods:We collected the clinical data of 83 patients who were performed TLG by our team from June 2016 to October 2019,including preoperative data,intraoperative data,postoperative and pathological clinical data.Results:Eighty-three patients successfully underwent TLG in this research.Of them,sixty-nine patients underwent totally laparoscopic distal gastrectomy(TLDG)with Billroth ? reconstruction using the linear stapler and fourteen patients underwent totally laparoscopic total gastrectomy(TLTG)with Roux-en-Y reconstruction using intracorporeal hand-sewn method.In the group of TLDG,five cases(7.2%)were converted to open surgery.And two cases(2.8%)died of pulmonary embolism and liver failure within 30-days after surgery,respectively.In the group of TLTG,no cases were converted to laparotomy or postoperative deaths.The mean age of these two groups were 58.2±9.5 years and 58.9±9.3 years.The body mass index(BMI)were 21.4 ± 2.7kg/m2 and 21.1±2.2 kg/m2.The operation time for TLDG and for TLTG were 269.6±58.1min and 299.6±54.1min,and the blood loss were 243.7±372.8mland 265.4±163.8ml.The postoperative hospital stay were 11.2±2.9d and 12.4±4.4d.Postoperative complications were 5.6%and 7.1%,respectively.No complications related to anastomosis occurred in all patients.Conclusion:The TLDG and TLTG are safe and feasible procedures,resulting in promosing short-term outcomes.The intracorporeal hand-sewn method for esphagojejunostomy(EJS)is not only a safe and feasible way to perform for TLTG,but also can manifest merits in better surgical vision,wide operative space,low risk of anastomotic bleeding and less anastomotic tension.Furthermore,it can help the surgical team to get through the periods of learning curve in developing more complicated laparoscopic procedure,such as laparoscopic pancreaticoduodenectomy(LPD).