Laparoscopic gastrectomy with d 2 lymphadenectomy: an intial medical college experience from an endemic zone of gastriccancers. (2013-2019)

Objectives: The aim of the present study was to assess the technical feasibility and oncologicalsafety of laparoscopic gastrectomy with D2 dissection. Material and Methods: This prospective observational study was conducted at Govt. Medical College Srinagar since June 2013 to June 2019. The Kashmiri population comprises of endemic zone for gastric cancers due to their cultural and environmental influences. The study sample of patients were explained the various available modalities of treatment with their potential benefits and risks and also about the possibility of conversion to open surgery in case of any technical difficulties. This study was approved by the ethical committee of our medical college. Allthe patients included in the study were pathologically proven adenocarcinoma of the stomach. Results: Most of our patients were in the age range of 50 to 70 years and 34 (72.34%) patients were Males. In most of these patients the site of tumor was distal third 30 (63.82%), followed by diffuse involvement 06 (12.76%), and upper third 07 (14.89%) and middle third 04 (8.51%). The diagnostic laparoscopy was done in all patients. Laparoscopic partial gastrectomy with Gastrojujunostomy with D2 lymphadenectomy was performed in 26 (55.31%). Laparoscopic total Gastrectomy with Esophago-jejunostomy with D2 lymphadenectomy in 17 (36.17%), Laparoscopic gastrojejunostomy in 3(6.38%) and Laparoscopic feeding jujunostomy in 1 (2.01%) were performed.The median operative time was 150 min (range 130-180) in Partial Gastrectomy and 210 min (range 200–250) in total Gastrectomy, the median estimated blood loss was 110 ml (range 90-130) in partial Gastrectomy and 150 ml (range 100–200) in total Gastrectomy. There were no major intra operative and post operative complications. Wound infection developed in 3 (6.38 %) patients, one (2.12 %) patient developed duodenal stump leak and one (2.12%) patient was convertedinto open and 2 (4.2%) patients developed intra abdominal sepsis. The median number of lymph nodes retrieved was 20 (10-32). A positive proximal margin was detected in 2 patients (4.65%) The median time to start oral fluid was 4 days (3-7) days in partial Gastrectomy and 7 days (5-9) in total Gastrectomy. The median hospital stay was 5 days (4-7 days) in partial Gastrectomy and 7 days (range 5–10 days) in total Gastrectomy.There was no motality in our study sample. Conclusion: Laparoscopic gastrectomy is safe and feasible, and it can be performed by experienced surgeons to achieveoptimal oncological short-term outcomes.