Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of Reduced Port Laparoscopic Distal Gastrectomy Performed by a Novice Surgeon

  • Received : 2021.03.30
  • Accepted : 2021.06.17
  • Published : 2021.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Reduced port laparoscopic distal gastrectomy (RPLDG) using 3 ports is less invasive than conventional laparoscopic distal gastrectomy (CLDG) using 5 ports. Although RPLDG performed by expert surgeons is safe and feasible, novice surgeons have difficulty performing this procedure. This study evaluated the surgical outcomes and feasibility of RPLDG performed by a novice surgeon. Materials and Methods: The records of 136 patients who underwent laparoscopic distal gastrectomy for gastric cancer performed by a single novice surgeon between May 2016 and December 2018 were retrospectively reviewed. Among these 136 patients, 52 underwent RPLDG and 84 underwent CLDG. The clinicopathological characteristics, operative outcomes, and short-term postoperative outcomes of the 2 groups were compared. Results: The percentage of women was significantly higher in the RPLDG group than in the CLDG group (48.1% vs. 31%; P=0.045), but other baseline characteristics did not differ significantly between the groups. Billroth II anastomosis was performed significantly more frequent (90.4% vs. 73.8%, P=0.015) and operation time was significantly shorter (207.1±43.3 min vs. 225.5±44.6 min, P=0.020) in the RPLDG group than in the CLDG group. The time to first flatus, postoperative pain score, length of postoperative hospital stay, and incidence and severity of complications did not differ significantly between the groups. Analysis of the learning curve based on the operation time showed that performing RPLDG on 20-30 patients was required to achieve technical proficiency. Conclusions: RPLDG is a safe and feasible surgical procedure for the treatment of gastric cancer, even when performed by a novice surgeon.

Keywords

Acknowledgement

The authors wish to express their sincere thanks to Nayoung Kim (Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea) and Eun Ji Park (Medical Information Center, Ulsan University Hospital, Ulsan, South Korea) for assistance with the statistical analysis.

References

  1. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 2002;131 Suppl:S306-S311. https://doi.org/10.1067/msy.2002.120115
  2. Hiki N, Katai H, Mizusawa J, Nakamura K, Nakamori M, Yoshikawa T, et al. Long-term outcomes of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG0703). Gastric Cancer 2018;21:155-161. https://doi.org/10.1007/s10120-016-0687-0
  3. Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric cancer: the KLASS-01 randomized clinical trial. JAMA Oncol 2019;5:506-513. https://doi.org/10.1001/jamaoncol.2018.6727
  4. Yu J, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial. JAMA 2019;321:1983-1992. https://doi.org/10.1001/jama.2019.5359
  5. Inaki N. Reduced port laparoscopic gastrectomy: a review, techniques, and perspective. Asian J Endosc Surg 2015;8:1-10. https://doi.org/10.1111/ases.12163
  6. Inaki N, Tsuji T, Doden K, Sakimura Y, Tawara H, Matsui R, et al. Reduced port laparoscopic gastrectomy for gastric cancer. Transl Gastroenterol Hepatol 2016;1:38. https://doi.org/10.21037/tgh.2016.04.04
  7. Kunisaki C, Makino H, Yamaguchi N, Izumisawa Y, Miyamato H, Sato K, et al. Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer. Surg Endosc 2016;30:5520-5528. https://doi.org/10.1007/s00464-016-4916-8
  8. Seo HS, Lee HH. Is the 5-ports approach necessary in laparoscopic gastrectomy? Feasibility of reducedport totally laparoscopic gastrectomy for the treatment of gastric cancer: A Prospective Cohort Study. Int J Surg 2016;29:118-122. https://doi.org/10.1016/j.ijsu.2016.03.035
  9. Kunisaki C, Miyamoto H, Sato S, Tanaka Y, Sato K, Izumisawa Y, et al. Surgical outcomes of reduced-port laparoscopic gastrectomy versus conventional laparoscopic gastrectomy for gastric cancer: a propensitymatched retrospective cohort study. Ann Surg Oncol 2018;25:3604-3612. https://doi.org/10.1245/s10434-018-6733-x
  10. Kim HG, Kim DY, Jeong O. Transition from conventional to reduced-port laparoscopic gastrectomy to treat gastric carcinoma: a single surgeon's experience from a small-volume center. J Gastric Cancer 2018;18:172-181. https://doi.org/10.5230/jgc.2018.18.e18
  11. Seo HS, Jung YJ, Kim JH, Park CH, Lee HH. Three-port right-side approach-duet totally laparoscopic distal gastrectomy for uncut Roux-en-Y reconstruction. J Laparoendosc Adv Surg Tech A 2018;28:1109-1114. https://doi.org/10.1089/lap.2018.0331
  12. Seo HS, Song KY, Jung YJ, Kim JH, Park CH, Lee HH. Right-side approach-duet totally laparoscopic distal gastrectomy (R-duet TLDG) using a three-port to treat gastric cancer. J Gastrointest Surg 2018;22:578-586. https://doi.org/10.1007/s11605-017-3575-y
  13. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC Cancer Staging Manual. 8th ed. Chicago (IL): Springer; 2017.
  14. Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel. Korean practice guideline for gastric cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer 2019;19:1-48. https://doi.org/10.5230/jgc.2019.19.e8
  15. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021;24:1-21. https://doi.org/10.1007/s10120-020-01042-y
  16. Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol 1971;110:886-887. https://doi.org/10.1016/0002-9378(71)90593-X
  17. Kim JS, Park EY, Park DJ, Kim GY. Modified book binding technique (MBBT) for intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy: initial experience. J Gastric Cancer 2019;19:355-364. https://doi.org/10.5230/jgc.2019.19.e30
  18. Kang SH, Cho YS, Min SH, Park YS, Ahn SH, Park DJ, et al. Early experience and learning curve of solo single-incision distal gastrectomy for gastric cancer: a review of consecutive 100 cases. Surg Endosc 2019;33:3412-3418. https://doi.org/10.1007/s00464-018-06638-1
  19. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
  20. Kim YY, Kim UN, Kim YS, Lee JS. Factors associated with the specialty choice of Korean medical students: a cross-sectional survey. Hum Resour Health 2016;14:45. https://doi.org/10.1186/s12960-016-0141-8
  21. Yu HW, Choi JY, Park YS, Park HS, Choi Y, Ahn SH, et al. Implementation of a resident night float system in a surgery department in Korea for 6 months: electronic medical record-based big data analysis and medical staff survey. Ann Surg Treat Res 2019;96:209-215. https://doi.org/10.4174/astr.2019.96.5.209
  22. Jeong O, Park YK, Ryu SY. Early experience of duet laparoscopic distal gastrectomy (duet-LDG) using three abdominal ports for gastric carcinoma: surgical technique and comparison with conventional laparoscopic distal gastrectomy. Surg Endosc 2016;30:3559-3566. https://doi.org/10.1007/s00464-015-4653-4
  23. Chi F, Lan Y, Zhou S, Yang L, Chen M, Bi T. Learning curve of totally laparoscopic distal gastrectomy for gastric cancer: a single teaching hospital study. Wideochir Inne Tech Malo Inwazyjne 2018;13:442-447.
  24. 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
  25. Ichikawa D, Hiki N, Fukunaga T, Tokunaga M, Komatsu S, Kuriu Y, et al. Usefulness of standardization in spreading of laparoscopy-assisted distal gastrectomy. Hepatogastroenterology 2010;57:975-979.
  26. Kang SY, Lee SY, Kim CY, Yang DH. Comparison of learning curves and clinical outcomes between laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Gastric Cancer 2010;10:247-253. https://doi.org/10.5230/jgc.2010.10.4.247