Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2021; 27(18): 2193-2204
Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2193
Totally laparoscopic total gastrectomy using the modified overlap method and conventional open total gastrectomy: A comparative study
Chang Seok Ko, Nam Ryong Choi, Byung Sik Kim, Jeong Hwan Yook, Min-Ju Kim, Beom Su Kim
Chang Seok Ko, Nam Ryong Choi, Byung Sik Kim, Jeong Hwan Yook, Beom Su Kim, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Min-Ju Kim, Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Ko CS, Choi NR, Kim BS, Yook JH and Kim BS performed the literature search, conception and design, drafting of the article; Kim MJ performed the analysis and interpretation; all authors were involved in the critical revision and final approval of the article.
Institutional review board statement: This study was approved by the Institutional Review Board of the Asan Medical Center (approval No. 2019-0702).
Informed consent statement: Patients were not required to give informed consent for the study because the clinical data were obtained retrospectively after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Beom Su Kim, MD, PhD, Professor, Surgeon, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: March 7, 2021
Revised: March 21, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: May 14, 2021
Research background

Although several methods of totally laparoscopic total gastrectomy (TLTG) have been reported, the best anastomosis technique of TLTG has not been conclusively established. Recently, we developed a modified overlap method for TLTG for overcoming these disadvantages of linear stapled method. This procedure requires less dissection around abdominal esophagus; therefore, it can create a secure esophagojejunal anastomosis with reduced tension as circular stapled method.

Research motivation

Whether is a more optimal anastomotic method of esophagojejunostomy in TLTG and open total gastrectomy (OTG) remains unclear. Especially, there was no report about comparing between TLTG with overlap method and OTG.

Research objectives

The aim of this study was to investigate the effectiveness and surgical outcomes including recurrence and survival of TLTG using the modified overlap method compared with OTG using the circular stapled method.

Research methods

We performed 151 TLTG with modified overlap method and 131 OTG for gastric cancer between March 2012 and December 2018 at Asan Medical Center. We evaluated surgical and oncological outcomes between the two groups using propensity score matching. In addition, we analyzed risk factors associated with postoperative complications for improvement of postoperative management of gastric cancer surgery.

Research results

The patients who underwent TLTG were discharged earlier than those who underwent OTG. Time to first flatus and soft diet were significantly shorter in TLTG group. Pain score at all postoperative period and administration of opioid were significantly lower after the TLTG. No statistically significant difference was found between the two groups in terms of early, late and esophagojejunostomy-related complications. Significant differences were observed not with respect to 5-year recurrence free survival and overall survival.

Research conclusions

TLTG with modified overlap method have favorable surgical and oncological outcomes compared with OTG. Furthermore, the surgeon should perform total gastrectomy cautiously and delicately especially with the patients with obese, high American Society of Anaesthesiologists score and old age.

Research perspectives

Based on our results, we confirmed that the TLTG with modified overlap method has several advantages over OTG. However, this study has certain limitations. It is a retrospective study performed by a single experienced surgeon at a high-volume center, and the number of enrolled patients is relatively small.