Introduction
Minimally invasive gastrectomy with D2 lymphadenectomy has been shown to be non inferior to an equivalent open procedure.1,2 Some series demonstrate benefits in postoperative complications and length of stay with the laparoscopic approach.3 We present our experience of laparoscopic D2 gastrectomy for gastric adenocarcinoma for a single AANZGOSA trained surgeon.
Methods
All patients that underwent laparoscopic D2 gastrectomy for gastric adenocarcinoma by a single surgeon at Te Whatu Ora - Waitemata between June 2021 and June 2024 were identified. Exclusions included: GIST, sarcoma, CDH1, Menetrier's and gastric polyposis. Primary outcomes included: anastomotic leak, 30-day mortality and minimum standard lymph node (LN) yield (>15).
Results
Of 35 eligible patients, 26 satisfied selection criteria. 15/26 (58%) patients were male. Median age was 67.5 years. Cohort ethnicity was as follows: eight European, nine Maori and Pasifika and nine Asian. 11/26 underwent total gastrectomy. 16/26 patients had neoadjuvant chemotherapy. 7/26 had T4 disease. 10/26 had nodal disease. There were no anastomotic leaks, conversions to open or 30-day mortalities. Median length of stay was six days. 1/26 required return to theatre within 30-days (CT suspicion for internal hernia, normal diagnostic laparoscopy). 25/26 had the minimum standard LN yield. There was an average of 33 LN per specimen. 1/26 had a positive proximal margin (intraoperative frozen section was negative).
Conclusion
Laparoscopic D2 gastrectomy for malignancy can be performed safely and effectively with comparable outcomes to the open approach.