Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced XXXX : a single-institution retrospective study.

@entity1 @entity5 @entity190 @entity260 @entity292 @entity356
BACKGROUND: D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced @entity356 (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC. METHODS: A single-institution retrospective study was conducted. Ninety-two consecutive AGC @entity1 who underwent radical TLTG were enrolled. The primary end point was morbidity. The @entity1 were observed for 3  years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS). RESULTS: Early and late morbidities (Clavien-Dindo grade >= 3) were 26.1 and 6.5  %, respectively. Operative time, estimated @entity190 , number of dissected lymph nodes, and postoperative hospital stay were 444 (278-694) min, 100 (0-2267) g, 48 (16-89), and 23 (9-136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9  %, respectively. Factors associated with @entity260 and 3yOS were operative time [OR 1.011 (1.006-1.017), p  <  0.01] and @entity5 recurrence within 3  years [HR 312.191 (1.126-86573.245], p  =  0.045], respectively. 3yRFS was associated with @entity5 size (>= 50  mm) [HR 10.325 (1.328-80.289), p  =  0.026], pathological N factor >= 2 [HR 3.188 (1.196-8.495), p  =  0.02], and postoperative pancreatic @entity292 combined with intra-abdominal abscesses Clavien-Dindo grade >= 2; [HR 3.670 (1.440-9.351), p  =  0.006]. CONCLUSIONS: TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.
