Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6837
Peer-review started: June 29, 2020
First decision: August 8, 2020
Revised: August 21, 2020
Accepted: September 18, 2020
Article in press: September 18, 2020
Published online: November 21, 2020
Consensus on the optimal surgical treatment strategy for advanced gastric cancer located in the middle of the stomach is yet to be established. Most patients ultimately undergo total gastrectomy (TG).
TG is associated with reduced nutritional status, and higher rates of postoperative complications. We modified the laparoscopic subtotal gastrectomy procedure to treat advanced middle-third gastric cancer.
This study aimed to evaluate short-term postoperative patient outcomes, nutritional status, and long-term oncological outcomes to assess the safety and efficacy of laparoscopic-assisted tailored subtotal gastrectomy (LaTSG) compared to those of laparoscopic-assisted total gastrectomy (LaTG).
This study retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third gastric cancer who underwent LaTSG (47 cases) or LaTG (45 cases) at Department of Pancreatic Stomach Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College between 2013 and 2017.
The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group (4.2% vs 17.8%, P < 0.05). At postoperative 12 mo, albumin, prealbumin, total protein, hemoglobin levels, and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group (P < 0.05). Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group (0% vs 11.1%, P < 0.05). Kaplan–Meier analysis showed a significant improvement in the overall survival (OS) and disease free survival (DFS) in the LaTSG group.
LaTSG is a safer procedure than LaTG in terms of both short and long-term outcomes. The long-term survival of patients who undergo LaTSG is better than that of patients who undergo LaTG.
Further randomized control trials and more enrolled patients are needed to help validate our findings.