J Gastric Cancer.  2014 Jun;14(2):105-110.

Comparison of Short-Term Postoperative Outcomes in Totally Laparoscopic Distal Gastrectomy Versus Laparoscopy-Assisted Distal Gastrectomy

Affiliations
  • 1Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea. jybark99@hanmail.net

Abstract

PURPOSE
The advantages of totally laparoscopic surgery in early gastric cancer (EGC) are unproven, and some concerns remain regarding the oncologic safety and technical difficulty. This study aimed to evaluate the technical feasibility and clinical benefits of totally laparoscopic distal gastrectomy (TLDG) for the treatment of gastric cancer compared with laparoscopy-assisted distal gastrectomy (LADG).
MATERIALS AND METHODS
A retrospective review of 211 patients who underwent either TLDG (n=134; 63.5%) or LADG (n=77; 36.5%) for EGC between April 2005 and October 2013 was performed. Clinicopathologic features and surgical outcomes were analyzed and compared between the groups.
RESULTS
The operative time in the TLDG group was significantly shorter than that in the LADG group (193 [range, 160~230] vs. 215 minutes [range, 170~255]) (P=0.021). The amount of blood loss during TLDG was estimated at 200 ml (range, 100~350 ml), which was significantly less than that during LADG, which was estimated at 400 ml (range, 400~700 ml) (P<0.001). The hospital stay in the TLDG group was shorter than that in the LADG group (7 vs. 8 days, P<0.001). One patient from each group underwent laparotomic conversion. Two patients in the TLDG group required reoperation: one for hemostasis after intraabdominal bleeding and 1 for repair of wound dehiscence at the umbilical port site.
CONCLUSIONS
TLDG for distal EGC is a technically feasible and safe procedure when performed by a surgeon with sufficient experience in laparoscopic gastrectomy and might provide the benefits of reduced operating time and intraoperative blood lossand shorter convalescence compared with LADG.

Keyword

Stomach neoplasms; Laparoscopy; Gastrectomy

MeSH Terms

Convalescence
Gastrectomy*
Hemorrhage
Hemostasis
Humans
Laparoscopy
Length of Stay
Operative Time
Reoperation
Retrospective Studies
Stomach Neoplasms
Wounds and Injuries

Reference

1. Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat. 2013; 45:1–14. PMID: 23613665.
Article
2. Goh P, Tekant Y, Kum CK, Isaac J, Shang NS. Totally intra-abdominal laparoscopic Billroth II gastrectomy. Surg Endosc. 1992; 6:160. PMID: 1386948.
Article
3. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 2010; 17:3077–3079. PMID: 20882416.
Article
4. Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996; 77:217–222. PMID: 8881629.
Article
5. Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg. 2009; 250:177–186. PMID: 19638919.
Article
6. Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer. 2011; 14:97–100. PMID: 21573921.
Article
7. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123. PMID: 21573742.
8. Seo MW, Kim YJ, Song D, Kang GH, Cho GS, Lee MS, et al. Comparison of end-to-side and end-to-end anastomosis in circular stapled gastroduodenostomy. J Korean Gastric Cancer Assoc. 2009; 9:57–62.
Article
9. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010; 251:417–420. PMID: 20160637.
10. Kim YW, Yoon HM, Yun YH, Nam BH, Eom BW, Baik YH, et al. Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc. 2013; 27:4267–4276. PMID: 23793805.
Article
11. 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. PMID: 18948798.
12. Kim HG, Park JH, Jeong SH, Lee YJ, Ha WS, Choi SK, et al. Totally laparoscopic distal gastrectomy after learning curve completion: comparison with laparoscopy-assisted distal gastrectomy. J Gastric Cancer. 2013; 13:26–33. PMID: 23610716.
Article
13. Ahn CW, Hur H, Han SU, Cho YK. Comparison of intracorporeal reconstruction after laparoscopic distal gastrectomy with extracorporeal reconstruction in the view of learning curve. J Gastric Cancer. 2013; 13:34–43. PMID: 23610717.
Article
14. Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol. 2005; 11:7508–7511. PMID: 16437724.
Article
15. Gao J, Li P, Li QG, Chen J, Wang DR, Tang D. Comparison between totally laparoscopic and laparoscopically assisted distal gastrectomy for gastric cancer with a short follow-up: a meta-analysis. J Laparoendosc Adv Surg Tech A. 2013; 23:693–697. PMID: 23678885.
Article
16. Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, et al. Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc. 2009; 23:2374–2379. PMID: 19263143.
Article
17. Song KY, Park CH, Kang HC, Kim JJ, Park SM, Jun KH, et al. Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study. J Gastrointest Surg. 2008; 12:1015–1021. PMID: 18256884.
Article
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