Gastrectomía total laparoscópica con linfadenectomía D2

Background:
Laparoscopic gastrectomy is gaining popularity in the last decades for treatment of gastric cancer. However, laparoscopic total gastrectomy (LTG) has not become as popular as laparoscopic distal gastrectomy because of the more difficult reconstruction technique. Anyway, this technically demanding procedure has largely demonstrated to be at least equal compare to conventional open gastrectomy (OG) in short and long-term studies.

Methods:
A 51 years-old woman was admitted to our clinic with epigastric pain. The upper digestive endoscopy showed an ulcer of 1 cm of diameter with irregular edges in body of stomach. Ulcer biopsy indicated a moderate differentiated signet ring cell adenocarcinoma. The ecoendoscopy revealed a neoformation in the gastric body that extends out of the muscular layer, with pathological lymphadenopathies (uT3N1). CT scan did not revealed distant metastasis. Scientific multidisciplinary committee decided neoadjuvant treatment with FLOT chemotherapy. Six weeks after chemotherapy was finished patient was operated.

Results:
A total laparoscopic gastrectomy with D2 lymphadenectomy was performed. Operation time was 200 minutes. The postoperative course was uneventful and patient was discharged home on 12 day post-op with normal digestive tolerance and an esophagogastric transit showed no anastomotic leak. The resected specimen showed a poor differentiated signet ring cell adenocarcinoma with 3 positive lymph nodes from 23 isolated (T2N2M0) and the margins had tumor-free.

Conclusion:
Nowadays, LTG is believed to be a safe and feasible surgical technique for experienced surgeons in gastric cancer and minimally invasive surgery, comparable to OG.