Laparoscopic and open gastrectomies in Lithuania: long term follow up

Abstract

Introduction. Over 20 years passed since the first laparoscopic total gastrectomy was performed for cancer. While laparoscopic distal gastrectomy earned its place for Stage I gastric cancer in Japan (grade B recommendation), total gastrectomy remains in need of solid evidence (grade C recommendation) [1]. Despite being the pioneer in laparoscopic surgery, Europe did not have similar surgical experience compared to East Asia due to decreased exposure to gastric cancer. However, several studies on minimally invasive gastrectomy for gastric cancer have been conducted in Europe [2,3]. Baltic countries stand in between East and West in terms of gastric cancer incidence: incidence rate per 100,000 is 10.6 in United Kingdom, 26.3 in Lithuania and 85.3 in Japan [4]. Laparoscopic gastric surgery in Lithuania was started in 2000s in Kaunas and Klaipėda. Recent metaanalysis provided insight to current situation: of the 18 studies that were included, 17 were nonrandomized and only 1 was randomized controlled trial [5]. However, some of the European studies did not analyse total gastrectomy as a distinct entity combining both distal and total gastrectomies; moreover, most of them do not provide data on full five-year follow up for each patient. Therefore, a case-control study was designed to evaluate laparoscopic (LTG) versus open total gastrectomy (OTG), comparing short-term surgical and long-term oncologic outcomes. Methods. 34 patients with stage T1-2 gastric cancer underwent total gastrectomy from October 2004 to July 2009 in Klaipėda Republican Hospital and the Hospital of Lithuanian University of Health Sciences. 17 patients having a laparoscopic approach were retrospectively compared to a homogenous group of patients, paired for age, stage of disease and comorbidities. Patients operated after 2010 were excluded in order to obtain full five-year survival data from National Cancer Registry. [...].