Totally Laparoscopic Distal Gastrectomy with D(2) Lymphadenectomy and Billroth II Gastrojejunostomy for Gastric Cancer: Short- and Medium-term Results of 139 Consecutive Cases from a Single Institution

Objective: The goal of this study was to investigate the feasibility, safety, and associated 3-year survival outcomes of the totally laparoscopic distal gastrectomy (TLDG) for the treatment of gastric cancer. Methods: Herein, we analyzed the clinical data from 139 consecutive patients with gastric cancer who received TLDG at our institution from March of 2007 to March of 2013. Results: TLDG was successfully carried out in 139 patients; no cases were converted to open surgery. The mean operation time was 228.6 ± 51.0 minutes, mean blood loss was 131.2 ± 85.2 mL, and mean number of dissected lymph nodes was 31.1 ± 9.0. The average time to flatus, time to fluid diet, and length of hospital stay were 3.6 ± 1.1 days, 4.8 ± 1.6 days, and 9.8 ± 4.0 days, respectively. The postoperative morbidity was 10.1%. A total of 135 patients were followed for a subsequent 1-73 months (median, 24.0 months). The 3-year disease-free survival (DFS) and overall survival (OS) rates were 82.3% and 82.9%, respectively. When divided by stage, the 3-year DFS for stage I, II, and III were 100%, 86.2%, and 48.8%, respectively; and the 3-year OS for stage I, II, and III were 98.0%, 92.3%, and 51.6%, respectively. Conclusions: In this preliminary report, TLDG was found to be a safe, feasible, and efficacious procedure for the treatment of gastric cancer with encouraging 3-year overall and stage-by-stage survival rates.