J Korean Surg Soc.  2011 Apr;80(4):245-250. 10.4174/jkss.2011.80.4.245.

The effects of laparoscopic assisted total gastrectomy on surgical outcomes in the treatment of gastric cancer

• Kim MG
• Kim BS
• Kim TH
• Kim KC
• Yook JH
• Kim BS

• KMID: 1820014
• DOI: http://doi.org/10.4174/jkss.2011.80.4.245

Abstract

PURPOSE
To evaluate the effectiveness of laparoscopic assisted total gastrectomy (LATG), we compared its early surgical outcomes with those of conventional open total gastrectomy (OTG) in patients who were diagnosed as having early gastric cancer preoperatively.
METHODS
We retrospectively analyzed early surgical outcomes in 190 consecutive patients who underwent total gastrectomy for early gastric cancer between January 2009 to April 2010. The patients were divided into those who underwent LATG and those who underwent OTG. Their early surgical outcomes were analyzed to evaluate the effectiveness of LATG.
RESULTS
There was no significant difference in postoperative complication rates (P = 0.291). But in the analysis of other early surgical outcomes, we found that LATG could improve time to first flatus (P < 0.001), time to commencement of soft diet (P = 0.034), administration of analgesics (P = 0.024), pain score (Numeric Rating Scale), and hospital discharge (P = 0.045).
CONCLUSION
Although LATG didn't show better results for postoperative complications than those of OTG, LATG contributes to the improvement of early surgical outcomes, including bowel movement, pain score and hospital discharge. Therefore, we suggest that LATG could be a method to improve early surgical outcomes in patients who need total gastrectomy.

Keyword

Early gastric cancer; Laparoscopic assisted total gastrectomy; Open total gastrectomy

MeSH Terms

Analgesics
Diet
Flatulence
Gastrectomy
Humans
Postoperative Complications
Retrospective Studies
Stomach Neoplasms
Analgesics

Figure

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  Fig. 1 Trocar placement for laparoscopic assisted total gastrectomy. Op, operator; F.A, first assistant; Sc, scopist; S.N, Scrub nurse; 5 mm, 5 mm port; 12 mm, 12 mm port.

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  Fig. 2 Rolling up the straight needle in the abdomen.

Reference

1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994. 4:146–148.

2. Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS. The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg. 2008. 248:793–799.

3. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008. 248:721–727.

4. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005. 19:168–173.

5. Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC. Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006. 202:874–880.

6. Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, et al. Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol. 2008. 15:1625–1631.

7. Asao T, Hosouchi Y, Nakabayashi T, Haga N, Mochiki E, Kuwano H. Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer. Br J Surg. 2001. 88:128–132.

8. Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, et al. Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol. 2009. 100:392–395.

9. Mochiki E, Toyomasu Y, Ogata K, Andoh H, Ohno T, Aihara R, et al. Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc. 2008. 22:1997–2002.

10. Sakuramoto S, Kikuchi S, Futawatari N, Katada N, Moriya H, Hirai K, et al. Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc. 2009. 23:2416–2423.

11. Zhu Q, Mao Z, Jin J, Deng Y, Zheng M, Yu B. The safety of CO2 pneumoperitoneum for elderly patients during laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech. 2010. 20:54–57.