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Mazzola et al. Mini-invasive Surg 2019;3:12 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.05

Original Article Open Access

Totally laparoscopic total gastrectomy: challenging
but feasible: a single center case series

Michele Mazzola, Monica Gualtierotti, Paolo De Martini, Camillo Leonardo Bertoglio, Lorenzo Morini,
Pietro Achilli, Andrea Zironda, Giovanni Ferrari

Division of Oncologic and Mini-invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy.
Correspondence to: Dr. Michele Mazzola, Division of Oncologic and Mini-invasive General Surgery, ASST Grande Ospedale
Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, Milan 20162, Italy. E-mail: michele.mazzola@ospedaleniguarda.it

How to cite this article: Mazzola M, Gualtierotti M, De Martini P, Bertoglio CL, Morini L, Achilli P, Zironda A, Ferrari G. Totally
laparoscopic total gastrectomy: challenging but feasible: a single center case. Mini-invasive Surg 2019;3:12.
http://dx.doi.org/10.20517/2574-1225.2019.05

Received: 20 Jan 2019 First Decision: 12 Feb 2019 Revised: 17 Feb 2019 Accepted: 4 Mar 2019 Published: 21 Apr 2019

Science Editor: Tetsu Fukunaga Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Abstract
Aim: To report the initial monocentric experience of totally laparoscopic total gastrectomy, assessing its feasibility and
safety, especially relating to the challenging step of esophago-jejunal (E-J) reconstruction.

Methods: All consecutive patients, underwent laparoscopic total gastrectomy for gastric cancer with curative intent,
between January 2017 and June 2018 at our institution, were considered. Data of the selected patients was retrieved
from a prospectively collected database. Short and long term outcomes were analyzed.

Results: Ten patients underwent totally laparoscopic total gastrectomy with D2 lymphadenectomy and 4 of these
had received preoperative chemotherapy; Two patients also received the lymphadenectomy of the station 10. E-J
reconstruction consisted of hemi-double stapling technique with transorally inserted anvil in 1 case, side-to-side overlap
anastomosis in 5 cases and end-to-side anastomosis in 4 cases. One patient experienced intraoperative complications
needing conversion to laparotomy. Seven patients experienced postoperative complications, three of these were severe
according to Dindo-Clavien classification. All the specimens had free proximal resection margins with R0 resection in all
the cases. Average postoperative length of hospital stay was 10 days and no patients died during hospitalization. Median
overall survival and disease-free survival were 15.5 and 12.5 months respectively.

Conclusion: Totally laparoscopic total gastrectomy is a feasible and safe option in the treatment of gastric cancer. The
choice about the type of E-J reconstruction should be based on the single patient’s features and on the dexterity of the
surgeon who should be able to perform more than one option for a tailored approach.

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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