Review Article

J Minim Invasive Surg 2015; 18(2): 31-38

Published online June 15, 2015

https://doi.org/10.7602/jmis.2015.18.2.31

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

Laparoscopic Total Gastrectomy for Gastric Cancer

Do Hyun Jung, M.D.1, Hyung-Ho Kim, M.D., Ph.D.1,2

Department of Surgery, 1Seoul National University Bundang Hospital, Seongnam, 2Seoul National University College of Medicine, Seoul, Korea

Received: April 20, 2015; Accepted: June 1, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Laparoscopic total gastrectomy (LTG) has been more widely performed in the last decade because of improvements in the techniques and safety of laparoscopic distal gastrectomy. However, due to its technical difficulty, there are still concerns regarding the safety of LTG. Meta-analyses have shown that LTG is technically feasible, safe, and may offer advantages over open total gastrectomy for treatment of gastric cancer. Various methods of performing esophagojejunostomy have been developed in an effort to decrease the rate of anastomosis-related complications, and have ultimately improved the safety and acceptance of LTG. However, there is still a lack of level-one evidence in support of LTG. Conduct of large-scale, randomized clinical trials will be needed in order to verify the safety and efficacy of LTG. Therefore, we reviewed the current status and some of the controversies surrounding LTG.

Keywords Laparoscopy, Gastrectomy, Stomach neoplasms

  1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4:146-148.
    Pubmed
  2. Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 2012;256:39-52.
    Pubmed CrossRef
  3. Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 2012;255:446-456.
    Pubmed CrossRef
  4. Jiang L, Yang KH, Guan QL, et al. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer:an update meta-analysis based on randomized controlled trials. Surg Endosc 2013;27:2466-2480.
    Pubmed CrossRef
  5. Kim HH, Han SU, Kim MC, et al. Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 2014;32:627-633.
    Pubmed CrossRef
  6. Kim HH, Han SU, Kim MC, et al. Prospective randomized controlled trial (phase III) to comparing laparoscopic distal gastrectomy with open distal gastrectomy for gastric adenocarcinoma (KLASS 01). J Korean Surg Soc 2013;84:123-130.
    Pubmed KoreaMed CrossRef
  7. Nakamura K, Katai H, Mizusawa J, et al. A phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric Cancer (JCOG0912). Jpn J Clin Oncol 2013;43:324-327.
    Pubmed CrossRef
  8. Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R. Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc 2013;27:1509-1520.
    Pubmed CrossRef
  9. Shen H, Shan C, Liu S, Qiu M. Laparoscopy-assisted versus open total gastrectomy for gastric cancer: a meta-analysis. J Laparoendosc Adv Surg Tech A 2013;23:832-840.
    Pubmed CrossRef
  10. Chen K, Xu XW, Zhang RC, Pan Y, Wu D, Mou YP. Systematic review and meta-analysis of laparoscopy-assisted and open total gastrectomy for gastric cancer. World J Gastroenterol 2013;19:5365-5376.
    Pubmed KoreaMed CrossRef
  11. Xiong JJ, Nunes QM, Huang W, et al. Laparoscopic vs open total gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol 2013;19:8114-8132.
    Pubmed KoreaMed CrossRef
  12. Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z. Laparoscopic versus open total gastrectomy for gastric cancer: an updated metaanalysis. PLoS One 2014;9:e88753.
    Pubmed KoreaMed CrossRef
  13. Wang W, Li Z, Tang J, Wang M, Wang B, Xu Z. Laparoscopic versus open total gastrectomy with D2 dissection for gastric cancer: a meta-analysis. J Cancer Res Clin Oncol 2013;139:17211734.
    Pubmed CrossRef
  14. Jeong GA, Cho GS, Kim HH, Lee HJ, Ryu SW, Song KY. Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery 2009;146:469-474.
    Pubmed CrossRef
  15. Lee SE, Ryu KW, Nam BH, et al. Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 2009;100:392-395.
    Pubmed CrossRef
  16. Kim MG, Kim BS, Kim TH, Kim KC, Yook JH, Kim BS. The effects of laparoscopic assisted total gastrectomy on surgical outcomes in the treatment of gastric cancer. J Korean Surg Soc 2011;80:245-250.
    Pubmed KoreaMed CrossRef
  17. Eom BW, Kim YW, Lee SE, et al. Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer:case-control study. Surg Endosc 2012;26:3273-3281.
    Pubmed CrossRef
  18. Jeong O, Jung MR, Kim GY, Kim HS, Ryu SY, Park YK. Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case-control study using propensity score matching method. J Am Coll Surg 2013;216:184-191.
    Pubmed CrossRef
  19. Lee JH, Ahn SH, Park do J, Kim HH, Lee HJ, Yang HK. Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg 2012;36:2394-2399.
    Pubmed CrossRef
  20. Lee MS, Lee JH, Park do J, Lee HJ, Kim HH, Yang HK. Comparison of short- and long-term outcomes of laparoscopicassisted total gastrectomy and open total gastrectomy in gastric cancer patients. Surg Endosc 2013;27:2598-2605.
    Pubmed CrossRef
  21. Wada N, Kurokawa Y, Takiguchi S, et al. Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer. Gastric Cancer 2014;17:137-140.
    Pubmed CrossRef
  22. Bracale U, Marzano E, Nastro P, et al. Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 2010;24:24752479.
    Pubmed CrossRef
  23. Inaba K, Satoh S, Ishida Y, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 2010;211:e25-29.
    Pubmed CrossRef
  24. Nagai E, Ohuchida K, Nakata K, et al. Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: inverted T-shaped anastomosis using linear staplers. Surgery 2013;153:732-738.
    Pubmed CrossRef
  25. Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, Uyama I. Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 2009;144:1138-1142.
    Pubmed CrossRef
  26. Kim HS, Kim MG, Kim BS, Yook JH, Kim BS. Totally laparoscopic total gastrectomy using endoscopic linear stapler: early experiences at one institute. J Laparoendosc Adv Surg Tech A 2012;22:889-897.
    Pubmed CrossRef
  27. Kim HS, Kim BS, Lee IS, Lee S, Yook JH, Kim BS. Comparison of totally laparoscopic total gastrectomy and open total gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A 2013;23:323-331.
    Pubmed CrossRef
  28. Ebihara Y, Okushiba S, Kawarada Y, Kitashiro S, Katoh H. Outcome of functional end-to-end esophagojejunostomy in totally laparoscopic total gastrectomy. Langenbecks Arch Surg 2013;398:475-479.
    Pubmed KoreaMed CrossRef
  29. Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y. Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction:a long-term follow-up study. Ann Surg 2014;259:109116.
    Pubmed CrossRef
  30. Okabe H, Obama K, Kan T, Tanaka E, Itami A, Sakai Y. Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg 2010;211:e1-6.
    Pubmed CrossRef
  31. Li P, Huang CM, Zheng CH, et al. Laparoscopic spleen-preserving splenic hilar lymphadenectomy in 108 consecutive patients with upper gastric cancer. World J Gastroenterol 2014;20:11376-11383.
    Pubmed KoreaMed CrossRef
  32. Sano T, Yamamoto S, Sasako M. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma: Japan clinical oncology group study JCOG 0110-MF. Jpn J Clin Oncol 2002;32:363-364.
    Pubmed CrossRef
  33. Nakata K, Nagai E, Ohuchida K, Shimizu S, Tanaka M. Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes. Surg Endosc 2014. (in press)
  34. Nagai E, Nakata K, Ohuchida K, Miyasaka Y, Shimizu S, Tanaka M. Laparoscopic total gastrectomy for remnant gastric cancer:feasibility study. Surg Endosc 2014;28:289-296.
    Pubmed CrossRef
  35. Kwon IG, Cho I, Guner A, et al. Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery. Surg Endosc 2014;28:2452-2458.
    Pubmed CrossRef
  36. Son SY, Lee CM, Jung DH, et al. Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience. Gastric Cancer 2015;18:177-182.
    Pubmed CrossRef
  37. Jeong O, Ryu SY, Choi WY, Piao Z, Park YK. Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma. Ann Surg Oncol 2014;21:2994-3001.
    Pubmed CrossRef
  38. Jung DH, Son SY, Park YS, et al. The learning curve associated with laparoscopic total gastrectomy. Gastric Cancer 2014. (in press)
  39. Zhang X, Tanigawa N. Learning curve of laparoscopic surgery for gastric cancer, a laparoscopic distal gastrectomy-based analysis. Surg Endosc 2009;23:1259-1264.
    Pubmed CrossRef
  40. Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopyassisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 2005;11:7508-7511.
    Pubmed KoreaMed CrossRef
  41. Nunobe S, Hiki N, Tanimura S, Nohara K, Sano T, Yamaguchi T. The clinical safety of performing laparoscopic gastrectomy for gastric cancer by trainees after sufficient experience in assisting. World J Surg 2013;37:424-429.
    Pubmed CrossRef
  42. Tokunaga M, Hiki N, Fukunaga T, et al. Learning curve of laparoscopy-assisted gastrectomy using a standardized surgical technique and an established educational system. Scand J Surg 2011;100:8691.
  43. Kunisaki C, Makino H, Kimura J, et al. Application of reducedport laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen. Gastric Cancer 2014. (in press)
    Pubmed
  44. Kawamura H, Tanioka T, Kuji M, Tahara M, Takahashi M. The initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy. Gastric Cancer 2013;16:602-608.
    Pubmed CrossRef
  45. Ahn SH, Park do J, Son SY, Lee CM, Kim HH. Single-incision laparoscopic total gastrectomy with D1+beta lymph node dissection for proximal early gastric cancer. Gastric Cancer 2014;17:392-396.
    Pubmed CrossRef
  46. Ertem M, Ozveri E, Gok H, Ozben V. Single incision laparoscopic total gastrectomy and d2 lymph node dissection for gastric cancer using a four-access single port: the first experience. Case Rep Surg 2013;2013:504549.
    CrossRef

Article

Review Article

J Minim Invasive Surg 2015; 18(2): 31-38

Published online June 15, 2015 https://doi.org/10.7602/jmis.2015.18.2.31

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

Laparoscopic Total Gastrectomy for Gastric Cancer

Do Hyun Jung, M.D.1, Hyung-Ho Kim, M.D., Ph.D.1,2

Department of Surgery, 1Seoul National University Bundang Hospital, Seongnam, 2Seoul National University College of Medicine, Seoul, Korea

Received: April 20, 2015; Accepted: June 1, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Laparoscopic total gastrectomy (LTG) has been more widely performed in the last decade because of improvements in the techniques and safety of laparoscopic distal gastrectomy. However, due to its technical difficulty, there are still concerns regarding the safety of LTG. Meta-analyses have shown that LTG is technically feasible, safe, and may offer advantages over open total gastrectomy for treatment of gastric cancer. Various methods of performing esophagojejunostomy have been developed in an effort to decrease the rate of anastomosis-related complications, and have ultimately improved the safety and acceptance of LTG. However, there is still a lack of level-one evidence in support of LTG. Conduct of large-scale, randomized clinical trials will be needed in order to verify the safety and efficacy of LTG. Therefore, we reviewed the current status and some of the controversies surrounding LTG.

Keywords: Laparoscopy, Gastrectomy, Stomach neoplasms

References

  1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4:146-148.
    Pubmed
  2. Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 2012;256:39-52.
    Pubmed CrossRef
  3. Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 2012;255:446-456.
    Pubmed CrossRef
  4. Jiang L, Yang KH, Guan QL, et al. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer:an update meta-analysis based on randomized controlled trials. Surg Endosc 2013;27:2466-2480.
    Pubmed CrossRef
  5. Kim HH, Han SU, Kim MC, et al. Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 2014;32:627-633.
    Pubmed CrossRef
  6. Kim HH, Han SU, Kim MC, et al. Prospective randomized controlled trial (phase III) to comparing laparoscopic distal gastrectomy with open distal gastrectomy for gastric adenocarcinoma (KLASS 01). J Korean Surg Soc 2013;84:123-130.
    Pubmed KoreaMed CrossRef
  7. Nakamura K, Katai H, Mizusawa J, et al. A phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric Cancer (JCOG0912). Jpn J Clin Oncol 2013;43:324-327.
    Pubmed CrossRef
  8. Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R. Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc 2013;27:1509-1520.
    Pubmed CrossRef
  9. Shen H, Shan C, Liu S, Qiu M. Laparoscopy-assisted versus open total gastrectomy for gastric cancer: a meta-analysis. J Laparoendosc Adv Surg Tech A 2013;23:832-840.
    Pubmed CrossRef
  10. Chen K, Xu XW, Zhang RC, Pan Y, Wu D, Mou YP. Systematic review and meta-analysis of laparoscopy-assisted and open total gastrectomy for gastric cancer. World J Gastroenterol 2013;19:5365-5376.
    Pubmed KoreaMed CrossRef
  11. Xiong JJ, Nunes QM, Huang W, et al. Laparoscopic vs open total gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol 2013;19:8114-8132.
    Pubmed KoreaMed CrossRef
  12. Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z. Laparoscopic versus open total gastrectomy for gastric cancer: an updated metaanalysis. PLoS One 2014;9:e88753.
    Pubmed KoreaMed CrossRef
  13. Wang W, Li Z, Tang J, Wang M, Wang B, Xu Z. Laparoscopic versus open total gastrectomy with D2 dissection for gastric cancer: a meta-analysis. J Cancer Res Clin Oncol 2013;139:17211734.
    Pubmed CrossRef
  14. Jeong GA, Cho GS, Kim HH, Lee HJ, Ryu SW, Song KY. Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery 2009;146:469-474.
    Pubmed CrossRef
  15. Lee SE, Ryu KW, Nam BH, et al. Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 2009;100:392-395.
    Pubmed CrossRef
  16. Kim MG, Kim BS, Kim TH, Kim KC, Yook JH, Kim BS. The effects of laparoscopic assisted total gastrectomy on surgical outcomes in the treatment of gastric cancer. J Korean Surg Soc 2011;80:245-250.
    Pubmed KoreaMed CrossRef
  17. Eom BW, Kim YW, Lee SE, et al. Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer:case-control study. Surg Endosc 2012;26:3273-3281.
    Pubmed CrossRef
  18. Jeong O, Jung MR, Kim GY, Kim HS, Ryu SY, Park YK. Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case-control study using propensity score matching method. J Am Coll Surg 2013;216:184-191.
    Pubmed CrossRef
  19. Lee JH, Ahn SH, Park do J, Kim HH, Lee HJ, Yang HK. Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg 2012;36:2394-2399.
    Pubmed CrossRef
  20. Lee MS, Lee JH, Park do J, Lee HJ, Kim HH, Yang HK. Comparison of short- and long-term outcomes of laparoscopicassisted total gastrectomy and open total gastrectomy in gastric cancer patients. Surg Endosc 2013;27:2598-2605.
    Pubmed CrossRef
  21. Wada N, Kurokawa Y, Takiguchi S, et al. Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer. Gastric Cancer 2014;17:137-140.
    Pubmed CrossRef
  22. Bracale U, Marzano E, Nastro P, et al. Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 2010;24:24752479.
    Pubmed CrossRef
  23. Inaba K, Satoh S, Ishida Y, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 2010;211:e25-29.
    Pubmed CrossRef
  24. Nagai E, Ohuchida K, Nakata K, et al. Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: inverted T-shaped anastomosis using linear staplers. Surgery 2013;153:732-738.
    Pubmed CrossRef
  25. Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, Uyama I. Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 2009;144:1138-1142.
    Pubmed CrossRef
  26. Kim HS, Kim MG, Kim BS, Yook JH, Kim BS. Totally laparoscopic total gastrectomy using endoscopic linear stapler: early experiences at one institute. J Laparoendosc Adv Surg Tech A 2012;22:889-897.
    Pubmed CrossRef
  27. Kim HS, Kim BS, Lee IS, Lee S, Yook JH, Kim BS. Comparison of totally laparoscopic total gastrectomy and open total gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A 2013;23:323-331.
    Pubmed CrossRef
  28. Ebihara Y, Okushiba S, Kawarada Y, Kitashiro S, Katoh H. Outcome of functional end-to-end esophagojejunostomy in totally laparoscopic total gastrectomy. Langenbecks Arch Surg 2013;398:475-479.
    Pubmed KoreaMed CrossRef
  29. Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y. Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction:a long-term follow-up study. Ann Surg 2014;259:109116.
    Pubmed CrossRef
  30. Okabe H, Obama K, Kan T, Tanaka E, Itami A, Sakai Y. Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg 2010;211:e1-6.
    Pubmed CrossRef
  31. Li P, Huang CM, Zheng CH, et al. Laparoscopic spleen-preserving splenic hilar lymphadenectomy in 108 consecutive patients with upper gastric cancer. World J Gastroenterol 2014;20:11376-11383.
    Pubmed KoreaMed CrossRef
  32. Sano T, Yamamoto S, Sasako M. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma: Japan clinical oncology group study JCOG 0110-MF. Jpn J Clin Oncol 2002;32:363-364.
    Pubmed CrossRef
  33. Nakata K, Nagai E, Ohuchida K, Shimizu S, Tanaka M. Technical feasibility of laparoscopic total gastrectomy with splenectomy for gastric cancer: clinical short-term and long-term outcomes. Surg Endosc 2014. (in press)
  34. Nagai E, Nakata K, Ohuchida K, Miyasaka Y, Shimizu S, Tanaka M. Laparoscopic total gastrectomy for remnant gastric cancer:feasibility study. Surg Endosc 2014;28:289-296.
    Pubmed CrossRef
  35. Kwon IG, Cho I, Guner A, et al. Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery. Surg Endosc 2014;28:2452-2458.
    Pubmed CrossRef
  36. Son SY, Lee CM, Jung DH, et al. Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience. Gastric Cancer 2015;18:177-182.
    Pubmed CrossRef
  37. Jeong O, Ryu SY, Choi WY, Piao Z, Park YK. Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma. Ann Surg Oncol 2014;21:2994-3001.
    Pubmed CrossRef
  38. Jung DH, Son SY, Park YS, et al. The learning curve associated with laparoscopic total gastrectomy. Gastric Cancer 2014. (in press)
  39. Zhang X, Tanigawa N. Learning curve of laparoscopic surgery for gastric cancer, a laparoscopic distal gastrectomy-based analysis. Surg Endosc 2009;23:1259-1264.
    Pubmed CrossRef
  40. Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopyassisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 2005;11:7508-7511.
    Pubmed KoreaMed CrossRef
  41. Nunobe S, Hiki N, Tanimura S, Nohara K, Sano T, Yamaguchi T. The clinical safety of performing laparoscopic gastrectomy for gastric cancer by trainees after sufficient experience in assisting. World J Surg 2013;37:424-429.
    Pubmed CrossRef
  42. Tokunaga M, Hiki N, Fukunaga T, et al. Learning curve of laparoscopy-assisted gastrectomy using a standardized surgical technique and an established educational system. Scand J Surg 2011;100:8691.
  43. Kunisaki C, Makino H, Kimura J, et al. Application of reducedport laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen. Gastric Cancer 2014. (in press)
    Pubmed
  44. Kawamura H, Tanioka T, Kuji M, Tahara M, Takahashi M. The initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy. Gastric Cancer 2013;16:602-608.
    Pubmed CrossRef
  45. Ahn SH, Park do J, Son SY, Lee CM, Kim HH. Single-incision laparoscopic total gastrectomy with D1+beta lymph node dissection for proximal early gastric cancer. Gastric Cancer 2014;17:392-396.
    Pubmed CrossRef
  46. Ertem M, Ozveri E, Gok H, Ozben V. Single incision laparoscopic total gastrectomy and d2 lymph node dissection for gastric cancer using a four-access single port: the first experience. Case Rep Surg 2013;2013:504549.
    CrossRef

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