Summary of experience in the application of lymph node dissection and digestive tract reconstruction in total laparoscopic radical gastrectomy

Abstract

Objective \nTo evaluate the safety and feasibility of totally laparoscopic total gastrectomy(TLTG) in the radical surgery of proximal stomach cancer. \n \n \nMethods \nData of 81 patients undergoing TLTG surgery for proximal gastric cancer from Jan. 2018 to Jun. 2019 in Hangzhou First People′s Hospital Affiliated to Medical College of Zhejiang University were retrospectively analyzed. \n \n \nResults \n81 patients completed the TLTG, and no cases were transferred to laparotomy. The average operation time was (211±22.4) min, the average intraoperative blood loss was (78±27.2) ml, the average lymph node dissection was(26.3±3.8), the total positive lymph node rate was 29.6%(24/81), and the splenic hilar positive lymph node rate was 8.1%(3/37), the superior pancreatic region (No.7/8/9 lymph node) positive lymph node rate was 21.0%(17/81), the average postoperative exhaust time was(2.3±0.8)d, and the average postoperative hospital stay was (9.1±3.2)d. One patient developed anastomotic fistula after operation, which healed after conservative treatment with double cannula irrigation; 4 patients developed esophagojejunal anastomotic stenosis after operation, which improved after conservative treatment, and no complications were observed in the rest patients. \n \n \nConclusions \nTLTG is safe and feasible in radical surgery for proximal gastric cancer. \n \n \nKey words: \nTotally laparoscopic total gastrectomy;\xa0Complete laparoscopic surgery;\xa0Gastric cancer;\xa0Lymph node dissection around the common hepatic artery;\xa0Overlap anastomose