Laparoscopic Completion Total Gastrectomy for Remnant Gastric Cancer Compared to Laparoscopic Total Gastrectomy in Short- and Medium-Term Results

Introduction: The incidence of remnant gastric cancer is increasing in recent years. The advantages of minimally invasive surgery for gastric cancer are well established. However, laparoscopic completion total gastrectomy for remnant gastric cancer harbors difficulties due to adhesions, changed configuration of the anatomical organs, and changes on the lymphatic flow. We aim to investigate the feasibility, safety, and the short-term outcomes of laparoscopic completion total gastrectomy compared to laparoscopic total gastrectomy. Materials and Methods: All patients who underwent total gastrectomy from January 2018 to December 2021 at Shamir Medical Center were included in the study. Patients were divided into two groups-completion gastrectomy and total gastrectomy. The groups were compared for demographics, operative, and clinical outcomes. Results: Overall, 22 patients were included in the study. Eight were completion gastrectomy following subtotal gastrectomy for malignancy and 14 were primary total gastrectomy. All operations were performed by minimal invasive surgery technique. Average age was 64 years, with no differences in gender. Two major intraoperative complications were noted in completion group (25% versus 0%, P=.12). Both length of surgery (3:03 versus 3:40, P=.049) and length of stay (7 days versus 9 days, P=.5) were shorter in completion group. There were fewer postoperative complications (12.5% versus 28.5%, P=.61). Average number of harvested lymph nodes was significantly lower in completion group (10 versus 33, P=.002). Conclusion: Laparoscopic completion total gastrectomy for remnant gastric cancer is safe and feasible having comparable oncological surrogate's parameters and recurrence profile. Clinical Registration number: 0015-22-ASF.