Resultados a corto plazo de la gastrectomía casi total (95% gastrectomy) laparoscópica / Short-term results of near-total (95%) laparoscopic gastrectomy

INTRODUCCIÓN: La gastrectomía total es una cirugía con importante morbimortalidad perioperatoria que es considerada el tratamiento de elección en el cáncer gástrico proximal. Descrita por primera vez en 1980, nuestro grupo describió y estandarizó la gastrectomía 95% totalmente laparoscópica en 2014. Esta técnica pretende disminuir las complicaciones de la gastrectomía total sin descuidar la radicalidad oncológica de la misma. Se presentan los primeros resultados de una cohorte de casos consecutivos tras 4 años realizando la técnica en 2 centros hospitalarios. MÉTODOS: Se ha llevado a cabo un estudio prospectivo observacional en 67 pacientes con gastrectomía 95% laparoscópica realizadas entre 2014 y 2017. El objetivo principal ha sido la detección de complicaciones (Clavien Dindo > IIIa), centrándose en la fuga anastomótica como la más importante. Objetivo secundario fue valorar la calidad de la cirugía oncológica. RESULTADOS: Se incluyeron 67 pacientes consecutivos en los que se realizó gastrectomía 95% totalmente laparoscópica. No existió ningún caso de fuga anastomótica, 2 pacientes (2,98%) presentaron una o más complicaciones Clavien Dindo ≥ IIIa. La estancia total fue de 6 (3-13) días. Se realizó resección radical R0 en todos los pacientes. CONCLUSIONES: La gastrectomía 95% permite en pacientes seleccionados cumplir los estándares oncológicos de resección en el cáncer gástrico proximal de manera reproductible y segura, disminuyendo los riesgos perioperatorios como la fuga anastomótica. Se trata de un estudio prospectivo observacional no comparativo, por lo que son necesarios más estudios para valorar la estandarización de la técnica

INTRODUCTION: Total gastrectomy is a surgery with significant perioperative morbidity and mortality, being considered the treatment of choice in proximal gastric cancer. First described in 1980, our group reported and standardized totally laparoscopic 95% gastrectomy in 2014. This technique aims to reduce the complications of total gastrectomy while maintaining oncological radicality. We present the initial results from a cohort of consecutive cases after performing the technique for 4 years at 2 hospital centers. METHODS: A prospective observational study was carried out in 67 patients with laparoscopic 95% gastrectomy between 2014 and 2017. The main objective has been to detect complications (Clavien Dindo> IIIa), focusing on anastomotic leaks as the most important. The secondary objective was to assess the quality of oncological surgery. RESULTS: Sixty-seven consecutive patients were included, in whom 95% totally laparoscopic gastrectomy was performed. There was no case of anastomotic leak. Two patients (2.98%) had one or more Clavien Dindo complications equal to or greater than IIIa. The total hospital stay was 6 (3-13) days. R0 radical resection was performed in all patients. CONCLUSIONS: 95% gastrectomy allows selected patients to meet the oncological standards of resection in proximal gastric cancer in a reproducible and safe manner, reducing perioperative risks such as anastomotic leakage. It is a non-comparative observational prospective study, so more studies are needed to assess the standardization of the technique

Short-term results of near-total (95%) laparoscopic gastrectomy. / Resultados a corto plazo de la gastrectomía casi total (95%gastrectomy) laparoscópica.

INTRODUCTION: Total gastrectomy is a surgery with significant perioperative morbidity and mortality, being considered the treatment of choice in proximal gastric cancer. First described in 1980, our group reported and standardized totally laparoscopic 95% gastrectomy in 2014. This technique aims to reduce the complications of total gastrectomy while maintaining oncological radicality. We present the initial results from a cohort of consecutive cases after performing the technique for 4 years at 2 hospital centers. METHODS: A prospective observational study was carried out in 67 patients with laparoscopic 95% gastrectomy between 2014 and 2017. The main objective has been to detect complications (Clavien Dindo> IIIa), focusing on anastomotic leaks as the most important. The secondary objective was to assess the quality of oncological surgery. RESULTS: Sixty-seven consecutive patients were included, in whom 95% totally laparoscopic gastrectomy was performed. There was no case of anastomotic leak. Two patients (2.98%) had one or more Clavien Dindo complications equal to or greater than IIIa. The total hospital stay was 6 (3-13) days. R0 radical resection was performed in all patients. CONCLUSIONS: 95% gastrectomy allows selected patients to meet the oncological standards of resection in proximal gastric cancer in a reproducible and safe manner, reducing perioperative risks such as anastomotic leakage. It is a non-comparative observational prospective study, so more studies are needed to assess the standardization of the technique.