Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer

Figure 1 Selected resection lines based on the tumor’s location. A: Lesser curvature; B: Middle.

Figure 2 In a tumor located in the lesser curvature of the stomach, a liner stapler was used to make a curved transection line 3 cm from the lateral edge of the tumor.

Figure 3 The stomach was resected while the fundus and cardia were retained and used to form a larger proximal remnant stomach than subtotal gastrectomy.

Figure 4 Mean preoperative and postoperative levels of albumin, total protein, prealbumin, red blood cell counts, hemoglobin, C-reaction protein, and ferrous iron in patients undergoing laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy. ^aP < 0.05; ^bP < 0.01. On the first day postoperatively, these nutritional indices did not significantly differ between the groups. However, at 12 mo post-surgery, albumin, total protein, hemoglobin, and red blood cell levels were significantly higher in the laparoscopic-assisted tailored subtotal gastrectomy group than in the laparoscopic assisted total gastrectomy group (P < 0.05). No significant differences in ferrous iron, prealbumin, or C-reaction protein levels were found between the two groups (P > 0.05) (Table 4). TP: Total protein; PALB: Prealbumin; ALB: Albumin; Fe: Ferrous iron; CRP: C-reaction protein; HGB: Hemoglobin; RBC: Red blood cell; LaTG: Laparoscopic assisted total gastrectomy; LaTSG: Laparoscopic-assisted tailored subtotal gastrectomy.

Figure 5 Overall survival curves of patients in the laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy groups. Overall survival was better in the laparoscopic-assisted tailored subtotal gastrectomy (LaTSG) group than in the laparoscopic assisted total gastrectomy (LaTG) group. Subgroup analysis showed that compared to LaTG, LaTSG improved the survival of patients with stage III cancer, but not for other stages (stages I and II). LaTSG: Laparoscopic-assisted tailored subtotal gastrectomy; LaTG: Laparoscopic assisted total gastrectomy.

Figure 6 Disease-free survival curves of patients in the laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy groups. Disease-free survival rate was better in the laparoscopic-assisted tailored subtotal gastrectomy (LaTSG) group than in the laparoscopic assisted total gastrectomy (LaTG) group. Subgroup analysis showed that compared to LaTG, LaTSG improved the disease free survival of patients with stage III cancer, but not for other stages. LaTSG: Laparoscopic-assisted tailored subtotal gastrectomy; LaTG: Laparoscopic assisted total gastrectomy.