Gastrectomy for Distal Gastric Cancer: Transitioning from an Open to a Minimally Invasive Surgical Practice. A Single Surgeon Experience.

BACKGROUND: Surgical resection is the only curative option for gastric carcinoma (GC). Minimally invasive techniques are gaining popularity.

OBJECTIVES: To present a single-surgeon's experience in transitioning from an open to a minimally invasive approach, focusing on surgical and oncological outcomes.

METHODS: We conducted a retrospective analysis including distal gastrectomy patients 2012-2020 operated by a single surgeon. Two cohorts were compared: open (ODG) and laparoscopic distal gastrectomy (LDG).

RESULTS: Overall, 173 patients were referred for gastrectomy during the study years. We excluded 80 patients because they presented with non-GC tumors, underwent proximal or total gastrectomy, or underwent palliative surgery. Neoadjuvant treatment was administered to 62 patients (33.3%). Billroth 1 was the preferred method of reconstruction (n=77, 82.8%), followed by Roux-en-Y (n=12, 13%). Fifty-one patients (54.8%) underwent LDG, 42 (45.2%) underwent ODG. The LDG group had significantly shorter lengths of stay (6 days, interquartile range [IQR] 1-3 5-8 vs. 5 days, IQR 1-3 4-6, P = 0.001, respectively), earlier return to oral feeding (1 day, IQR 1-3 1-3 vs. 2 days, IQR 1-3 1-3.2, P < 0.001), and earlier removal of drains (4 days, IQR 1-3 3-5.2 vs. 5 days, IQR 1-3 3.5-6.7, P < 0.001). Overall lymph node yield was 30 (IQR 1-3 24-39) and was similar among groups (P = 0.647).

CONCLUSIONS: Laparoscopic techniques for resection of distal GC are feasible and safe, leading to good perioperative outcomes and adequate lymph node yield.