Totally Laparoscopic Total Gastrectomy Using Endoscopic Linear Stapler: Early Experiences at One Institute

Background: Totally laparoscopic total gastrectomy (TLTG) for gastric cancer is still uncommon because of the technical difficulty of performing the esophagojejunostomy laparoscopically. We have developed a secure technique for intracorporeal esophagojejunostomy and successfully performed the TLTG method using an endoscopic linear stapler. Our experiences with this method are reported here. Subjects and Methods: Between July 2009 and May 2010, 124 patients with gastric cancer underwent TLTG using endoscopic linear staplers in one institution. The clinicopathological data and surgical outcomes of the first 70 cases and the subsequent 54 cases were reviewed retrospectively and compared because technical improvements were instituted after the 70th case. Results: The two groups differed significantly in terms of mean operation time (189.0 versus 148.3 minutes, P < .001), overall postoperative complication rate (37.1% versus 13.0%, P = .003), severe postoperative complication rate (15.7% versus 3.7%, P = .030), and intraoperative event rate (12.9% versus 1.9%, P = .042). Conclusions: The early period of performing TLTG using an endoscopic linear stapler was associated with a high morbidity rate. This improved significantly when key technical changes were introduced. However, surgeons who are inexperienced in laparoscopic gastrectomy should be careful when performing TLTG because it involves many complex processes. The account in this report of our experiences with TLTG may help surgeons to master this method faster and more safely.