Advantage of Completely Laparoscopic Gastrectomy With Linear Stapled Reconstruction A Long-term Follow-up Study

作者：Okabe Hiroshi^*; Obama Kazutaka; Tsunoda Shigeru; Tanaka Eiji; Sakai Yoshiharu

来源：Annals of Surgery, 2014, 259(1): 109-116.

DOI：10.1097/SLA.0b013e31828dfa5d

• functional end-to-end anastomosis
• gastric cancer
• intracorporeal reconstruction
• laparoscopic surgery
• linear stapler

Background: Completely laparoscopic gastrectomy with intracorporeal anastomosis was introduced to achieve safer anastomosis and smaller scars. Although several reports have shown the feasibility of linear-stapled anastomosis, there are no studies of a large number of patients assessing the long-term complications and functional outcomes.
Methods: This retrospective study included 345 patients who had intended to undergo completely laparoscopic distal or total gastrectomy with linear-stapled anastomosis between September 2005 and January 2012. This study evaluated both the short- and long-term complications, as well as the endoscopic findings, changes in body weight and serum albumin.
Results: Completely laparoscopic gastrectomy was successfully achieved in 342 patients (99.1%). Short-term complications occurred in 59 patients (17.3%). Reconstruction-related complications were observed in 19 patients (5.6%). Three patients with anastomotic leakage required reoperation. No patient experienced anastomotic stenosis over a mean follow-up period of 29.6 months. Two patients underwent an emergency operation for an internal hernia after total gastrectomy. Adhesive intestinal obstruction was observed in 5 patients (1.5%), but all were resolved without surgical intervention. Body weight loss at 2 years after distal and total gastrectomy was 7.2% and 13.9%, which were similar to previous reports of open surgery.
Conclusions: Completely laparoscopic gastrectomy with linear-stapled anastomosis is a feasible choice for gastric cancer patients with some potential long-term advantages such as less anastomotic stenosis and fewer adhesive intestinal obstructions.

• 出版日期2014-1