Abstract: cancer stomach is the fifth killer cancer worldwide. Radical gastrectomy for tumor resection is the gold
standard for potential cure of resectable gastric cancer. Recent advances in laparoscopy especially high resolution of
imaging and energy dissection/vessel sealing devices have allowed laparoscopy to have a role in gastrectomy even
radical ones that necessitate lymph nodes dissection. This gives advantages of minimal invasiveness but shouldn’t
be on expense of safety and oncologic efficiency of the resection. Several recent studies have discussed the role of
laparoscopy in radical gastric resection for cancer. Still further studies are needed in this field.
Objective: retrospective comparison between laparoscopic and open radical gastrectomy for resectable gastric
cancer, regarding oncologic efficiency (safety margin, number of LNs, tumor free survival, and overall survival) and
safety (operative blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and
operative and early postoperative mortality) for patients operated upon in the Surgery Department, Assuit University
Hospital. Patients and methods: This retrospective study involved 47 consecutive patients who had radical
gastrectomy for gastric adenocarcinoma. All patients were admitted to the Surgery Department Assuit university
Hospital between January 1st, 2014 and December 31st 2016. Patients were divided into 2 groups. Group A; included
patients who had totally laparoscopic radical gastrectomy (No 13) and group B; included patients who had open
radical gastrectomy (No 34). The two groups were compared regarding pathologic safety margin from the excised
tumor, number of LNs, tumor free survival, and overall survival. Also, they were compared regarding operative
blood loss, viscus or organ injury, anastomotic leakage, wound infection, incisional hernia, and operative and early
postoperative mortality, and postoperative hospital stay. Results: in group A (n= 13) all operations were completed
laparoscopicaly. There were 7 females and 6 males. Mean age was 49 years old (range 38-59). The clinical TNM
stages were stage II in 8 patients (8/13) and stage III in 5 (5/13). Negative safety margin was achieved in 10 (10/13)
patients, while margin was close (<1 cm) in 3 (3/13) patients. A mean of 19 LNs was harvested (range 11-26).
During the follow up period 10-34 months (mean 19) the tumor recurred in 5 patients with a mean tumor free
survival of 15 months (range 8-24 months). One year survival was 11/13. Mean operative time was 250 minutes
(180-320). Mean blood loss was 230 mL. Postoperative leakage occurred in 2 patients where the leakage trickled out
through the tubal drains. In the two patients no operative intervention was needed. No other operative complications
had occurred, nor wound infection or incisional hernia. No operative or early postoperative mortality had occurred.
In group B (n=34), there were 19 females and 15 males. Mean age was 58 years (range 37-71). The clinical TNM
stages were stage II in 19 patients (18/34) and III in 16 (16/34). Negative safety margin was achieved in 29 (29/34)
patients, while margin was close (<1 cm) in 5 (5/34) patients. A mean of 26 lymph nodes was harvested. During the
follow up period (12-31, mean 20 months) the tumor recurred in 9 patients with a mean tumor free survival of 14
months (range 10-24 months). One year survival was 30/34. Mean operative time was 160 minutes. Mean blood loss
was 540 mL. No postoperative leakage had occurred. Total number of postoperative complications was 14, and
occurred in 6 (6/34) patients. Postoperative bleeding through the drain that stopped spontaneously occurred in 3
patients. Wound infection occurred in 4 patients and incisional hernia occurred in 7 patients. No operative or early
postoperative mortality had occurred. Conclusions: the absence of mortality or major complications that necessitate
surgical intervention together with the accepted oncologic results regarding safety margin, number of LNs removed,
and tumor free survival indicate that totally laparoscopic radical gastrectomy is not only feasible and safe, but it is
also oncologically efficient. However, still larger randomized controlled studies are needed for more solid
conclusions.