Aamer Zaman Khan, D Lamanto, PMY Goh.
Laparoscopic Gastrectomy for Advanced Gastric Carcinoma (Early Experience).
Pak J Surg Jan ;17(3):11-4.

Laparoscopy for the treatment of gastric cancer has evolved in the last decade. Use of the laparoscopic approach in the management of gastric canceris still in the developmental phase. Here we present ourexperience with a small series of four cases that has shown this approach to have potential advantages in terms of postoperative pain, quicker mobilization, fewer wound problems, better cosmesis and safety in terms of oncological adequacy. Between Sept. 1997 and February 2000 we performed four cases of laparoscopic gastrectomy for gastric carcinoma. There were two male and two female patients with a mean age of 61.5 years. All the patients were staged pre-operatively with endoscopy, endoscopic ultrasound, and CT scan. At endoscopy a biopsy for histopathology from the tumor site was taken in all the cases. We performed one D2 total radical gastrectomy and free D2 subtotal distal gastrectomies using laparoscopic approach.

Mean operation time was 210 minutes. There were no intraopereative complications. All the four patients recovered uneventfully from surgery. One patient was in staged IIIa, one 11b and two patients in stage IIa of the disease. Histologically all the four were well-differentiated adenocarcinoma. Oral feeding was started on the third postoperative day for all the cases. Median post-operative stay was seven days. Two patients had post-operative chemotherapy. All four are alive for eight months to three years after the initial operation with no recurrences. Our series showed that moderately advanced cancers could produce good results in terms of safety and oncological adequacy. It holds the promise of quicker alimentation, less wound and respiratory complications and early return to normal daily activities. However, this needs to be substantiated by larger prospective randomized controlled trails at centers with particular expertise.

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