Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Comparison of Short-Term Postoperative Outcomes in Totally Laparoscopic Distal Gastrectomy Versus Laparoscopy-Assisted Distal Gastrectomy

  • Han, Gru (Department of Surgery, Soonchunhyang University Seoul Hospital) ;
  • Park, Ji Yeon (Department of Surgery, Soonchunhyang University Seoul Hospital) ;
  • Kim, Yong Jin (Department of Surgery, Soonchunhyang University Seoul Hospital)
  • Received : 2014.04.08
  • Accepted : 2014.06.05
  • Published : 2014.06.30
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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.

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References

  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. https://doi.org/10.4143/crt.2013.45.1.1
  2. Goh P, Tekant Y, Kum CK, Isaac J, Shang NS. Totally intraabdominal laparoscopic Billroth II gastrectomy. Surg Endosc 1992;6:160. https://doi.org/10.1007/BF02309093
  3. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 2010;17:3077-3079. https://doi.org/10.1245/s10434-010-1362-z
  4. Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996;77:217-222. https://doi.org/10.1093/bja/77.2.217
  5. Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg 2009;250:177-186. https://doi.org/10.1097/SLA.0b013e3181afde41
  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. https://doi.org/10.1007/s10120-011-0040-6
  7. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113-123. https://doi.org/10.1007/s10120-011-0042-4
  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. https://doi.org/10.5230/jkgca.2009.9.2.57
  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. https://doi.org/10.1097/SLA.0b013e3181cc8f6b
  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. https://doi.org/10.1007/s00464-013-3037-x
  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. https://doi.org/10.1097/SLA.0b013e318185e62e
  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. https://doi.org/10.5230/jgc.2013.13.1.26
  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. https://doi.org/10.5230/jgc.2013.13.1.34
  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. https://doi.org/10.3748/wjg.v11.i47.7508
  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. https://doi.org/10.1089/lap.2012.0580
  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. https://doi.org/10.1007/s00464-009-0360-3
  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. https://doi.org/10.1007/s11605-008-0484-0

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