Recep AKTİMUR, Süleyman ÇETİNKÜNAR, Kadir YILDIRIM, Eylem ODABAŞI, Ömer ALICI, Adil NİGDELİOĞLU, NURAYDIN ÖZLEM

Initial experience with laparoscopic gastrectomy in a low-volume center

Amaç: Günümüzde minimal invazif cerrahi genel cerrahlar tarafından kompleks onkolojik prosedürler için bile kullanılır hale gelmiştir. Ancak, laparoskopik distal gastrektomi deneyiminin artmasına rağmen, teknik zorlukların onkolojik sonuçları etkileyebileceği endişesi ile az sayıda cerrah total gastrektomi için laparoskopik yöntemi tercih etmektedir. Yöntemler: Eylül 2013 ile Nisan 2014 arasında tek cerrah tarafından küratif amaçlı laparoskopik gastrektomi uygulanmış mide kanseri hastalarını retrospektif olarak değerlendirdik. 5 total gastrektomi + D2 (-No 10 ve 11d) ve 1 distal gastrektomi + D2 lenfadenektomi hastası, demografik özellikler, patolojik karakteristikler, morbidite ve hastane mortalitesi açısından değerlendirildi. Bulgular: Ortalama ameliyat süresi 255,8±37,2 dakika, ortalama kan kaybı 121.6±20.4 mL idi. Tüm hastalara R0 rezeksiyon uygulandı. Çıkartılan lenf nodu ortalaması 22,6±7,3, metastatik lenf nodu ortancası 16 (0-23) idi. 1 hastada 15ten az lenf nodu çıkartıldı. Komplikasyon oranı %33,3 (n=2) idi; laparoskopik distal gastrektomi uygulanan bir hastada aferent loop sendromu gelişti; laparoskopik total gastrektomi ve splenektomi uygulanan diğer bir hastada masif pulmoner emboli gelişti. Ortanca hastanede kalım süresi 10 (6-18) gündü. Sonuç: Laparoskopik cerrahi prosedürlerin uygulanmasında gelişen deneyim düzeyi ile birlikte, ileri gastrik kanser hastaları için, ileri laparoskopik işlemlerin az sayıda ve düşük yoğunlukta yapıldığı merkezlerde dahi laparoskopik total gastrektomi ilk düşünülecek tedavi seçeneği olabilir.

Düşük yoğunluklu bir merkezde ilk laparoskopik gastrektomi deneyimlerimiz

O bjective: Today, minimal invasive surgery has gained wide acceptance by general surgeons, even in complex oncological procedures. Despite the increased experi - ence on laparoscopic distal gastrectomy, limited number of surgeons prefer laparoscopic total gastrectomy for proximal or middle-third gastric cancer, due to the con - cern of technical diffculties which can alter the quality of oncological outcomes. Methods: We retrospectively analyzed gastric cancer patients who underwent curative intent laparoscopic gas - trectomy by single surgeon from October 2013 to April 2014. Five total gastrectomy + D2 (-No 10 and 11d) and 1 distal gastrectomy + D2 lymphadenectomy were ana- lyzed for patient demographics, pathological characteris - tics, morbidity and in-hospital mortality. Results: The mean operating time was 255,8±37.2 min - utes. The mean blood loss was 121.6±20.4 ml. In all patients, R0 resection were performed. The mean num - ber of harvested lymph nodes were 22.6±7.3. The me- dian number of metastatic lymph nodes was 16 (0-23). In one patient, less than 15 lymph nodes were retrieved. Complication rate was 33.3% (n=2). In one patient, who underwent laparoscopic distal gastrectomy, afferent loop syndrome developed. In another patient, who underwent total gastrectomy plus splenectomy a massive pulmoner embolism developed. The median hospital stay was 10 (6-18) days. Conclusion: With increased experience in advanced laparoscopic procedures, laparoscopic total gastrectomy may be considered as the frst line treatment approach for gastric cancer patient even in a low-volume center.

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