Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects

Background Laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection for advanced gastric cancer is still controversial. To evaluate the technical and oncologic feasibility and advantage of LADG with D2 lymph node dissection, the authors compared the surgical outcomes of LADG with D2 dissection and those of conventional open distal gastrectomy (ODG) for patients with early gastric cancer (EGC). Methods Between September 2004 and August 2005, the study enrolled 75 patients with a preoperative diagnosis of EGC. Of these 75 patients, 44 underwent LADG, and remaining 31 underwent ODG. All the patients received D2 lymph node dissection. Their clinicopathologic characteristics, postoperative outcomes, and retrieved lymph nodes were compared at each station. Results Although the operative time was significantly longer for the LADG group than for the ODG group, the perioperative recovery was shorter and, consequently, the postoperative hospital stay was significantly shorter for the LADG group (7.7 vs 9.4 days, respectively; p = 0.003). No significant differences were found in the total number of retrieved lymph nodes (37.2 vs 42.4; p > 0.05) or node stations (p > 0.05) between the two groups. Conclusions LADG with D2 lymph node dissection is a safe and feasible procedure, and it is oncologically compatible with open gastrectomy. A large-scaled prospective randomized trial with advanced gastric cancer patients should be conducted to confirm the benefit of LADG. Part of this article was presented and awarded the Best Video Award at the 14th International Congress of EAES, Berlin, Germany, 13–16 September 2006     

腹腔镜辅助胃远端癌淋巴结清扫术近期疗效

目的探讨腹腔镜辅助胃远端癌D2淋巴结清扫术的可行性及近期疗效。方法2007年1月至2008年12月,对241例胃远端癌患者施行D2淋巴结清扫术。其中腹腔镜辅助远端胃大部切除术（LADG组）93例,常规开腹远端胃大部切除术（ODG组）148例。比较两组患者的淋巴结清扫数及术中、术后恢复情况、并发症发生率和住院死亡率。结果LADG组和ODG组患者淋巴结清扫数分别为（27．5±9．1）枚和（27．3±8．5）枚,两组差异无统计学意义（P〉0．05）。按肿瘤浸润深度进行分层分析,T1、T2、T3期患者两组平均清扫淋巴结数差异均无统计学意义（P〉0．05）。LADG组手术时间显著长于ODG组,但术中出血量、输血例数、术后首次下床时间、肛门排气时间、进流质时间、住院时间和手术并发症发生率均显著少于ODG组,两者差异有统计学意义（P〈0．05）。结论腹腔镜辅助胃远端癌D2淋巴结清扫术在淋巴结清扫方面能达到与开腹手术相同的效果,且具有安全、术后恢复快和并发症少等优点。     

Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer

Background Laparoscopically assisted distal gastrectomy (LADG) with limited lymph node dissection (D1+alpha) has been used to treat a subset of patients with early gastric cancer. Technical advances have expanded indications for LADG to more advanced gastric cancers. However, little data are available on the feasibility or advantages of LADG with standard radical D2 lymph node dissection for patients with gastric cancer. Methods This study reviewed the clinical features of 37 patients who underwent LADG with D2 lymph node dissection for preoperatively diagnosed gastric carcinoma, then compared the results with the features of 31 patients who underwent conventional open distal gastrectomy (ODG) with D2 lymph node dissection. Results The laparoscopic procedure was not converted to laparotomy in any patient. There was no operative mortality and no serious morbidity among the patients who underwent LADG with D2 lymph node dissection. As compared with the ODG group, the LADG group had less operative blood loss (p < 0.001), earlier recovery of bowel activity (p = 0.012), and a shorter duration of fever after surgery (p = 0.015), despite the longer operation time (p = 0.007). Conclusions According to this study, LADG with D2 lymph node dissection is feasible and provides several advantages similar to those of limited lymph node dissection (D1+alpha). Depending on surgeons’ technical proficiency, LADG can be used with standard radical lymph node dissection for patients with gastric cancers.     

Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer

Backgroud  Application of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) is still controversial because of scant evidence of long-term safety and feasibility. We evaluated the long-term outcome of LADG compared with conventional open distal gastrectomy (ODG) for EGC. Methods  Between March 1999 and July 2006, 106 patients underwent LADG and 105 patients underwent ODG for EGC. Clinicopathologic characteristics, postoperative outcomes, hospital course, postoperative morbidity, postoperative mortality, and long-term outcomes, including cancer recurrence and survival, were retrospectively compared between the two groups. Survival of all patients was confirmed with 55-month median follow-up. Results  Postoperative recovery was significantly faster in the LADG group; passing flatus occurred earlier, starting a liquid diet began sooner, and postoperative hospital stay was shorter (p < 0.05). Mean operation time was significantly longer in the LADG group. Postoperative complications in the LADG group occurred less frequently compared with in the ODG group (4.7% versus 13.3%, p = 0.046). Tumor recurrence occurred in two cases (0.9%) and death related to recurrence occurred in only one patient (0.5%). Overall 5-year survival rate (5-YSR) of all patients was 95.5%, while disease-specific 5-YSR was 98.8%. There was no significant difference in survival rates between the two groups; overall 5-YSR of the ODG and LADG groups was 94.9% and 95.9%, respectively. Conclusions  Our data suggest that LADG for EGC is feasible and safe. We expect the results of the present study to be confirmed by prospective randomized analysis. Dr. Lee and Dr. Yom contributed equally to the research and writing of the paper.     

进展期远端胃癌腹腔镜与开腹根治术的对照研究

目的探讨腹腔镜远端胃癌根治术治疗进展期远端胃癌的可行性、安全性及近期疗效．方法回顾性分析2007年1月至2008年6月间135例接受外科手术的远端胃癌患者的临床资料．其中腹腔镜远端胃癌根治术66例．开腹远端胃癌根治术69例。结果腹腔镜组与开腹组患者年龄、性别和TNM分期的差异均无统计学意义（均P〉0．05）。腹腔镜组均在腹腔镜下成功完成根治性胃切除手术,无中转开腹和手术死亡。与开腹组比较,腹腔镜组患者手术时间更长[（266．1±55．1）min比（223．8±26．8）min];但术中出血量更少[（131．9±88．7）ml比（342．3±178．7）ml],术后肠道恢复功能更快[（3．18±1．22）d比（4．50±1．59）d],术后住院时间更短[（9．20±3．39）d比（11．35±4．61）d];差异均有统计学意义（均P〈0．01）。两组清扫淋巴结数目[（25．81±12．53）枚比（27．47±10．28）枚]和术后并发症发生率[6．1％（4／66）比15．94％（11／69）1的差异均无统计学意义（均P〉0．05）。术后随访1～19个月．两组均未见肿瘤复发或肿瘤相关死亡病例。结论腹腔镜远端胃癌根治术是治疗进展期远端胃癌安全、可行、微创、有效的方法。     

腹腔镜辅助下胃癌D2根治性远端胃大部切除术安全性与有效性的系统评价

目的 评价腹腔镜辅助下胃癌D2根治性远端胃大部分切除术的安全性与有效性.方法 检索Pubmed、Medline、EMBASE和中国生物医学数据库（CBM）2001年1月至2010年2月间发表的D2根治性远端胃大部分切除术治疗胃癌的对照试验研究,用Revman 5.0统计软件进行分析.结果 共纳入7个对照试验,其中1项研究为随机对照试验,6项为非随机对照研究.腹腔镜辅助远端胃大部分切除组（LADG）与开腹远端胃大部切除术（ODG组）相比,术中出血量少[加权均数差（WMD）=-132.04,95% CI：-207.32～-56.77],术后第1次排气时间早（WMD=-0.82,95% CI：-1.20～-0.45）,术后并发症发生率低[相对危险度（OR）=0.45,95%CI：0.26～0.78],术后住院时间短（WMD=-3.63,95%CI：-4.19～-3.07）,清扫的淋巴结数目多（WMD=1.93,95%CI：0.36～3.50） 但术后复发率、转移率和近期（3年内）生存率差异无统计学意义（P＞0.05）.结论 腹腔镜辅助下胃癌D2根治性远端胃大部分切除术的短期效果优于开腹手术.     

腹腔镜辅助下胃癌D2根治性远端胃大部切除术安全性与有效性的系统评价

目的 评价腹腔镜辅助下胃癌D2根治性远端胃大部分切除术的安全性与有效性.方法 检索Pubmed、Medline、EMBASE和中国生物医学数据库(CBM)2001年1月至2010年2月间发表的D2根治性远端胃大部分切除术治疗胃癌的对照试验研究,用Revman 5.0统计软件进行分析.结果 共纳入7个对照试验,其中1项研究为随机对照试验,6项为非随机对照研究.腹腔镜辅助远端胃大部分切除组(LADG)与开腹远端胃大部切除术(ODG组)相比,术中出血量少[加权均数差(WMD)=-132.04,95% CI:-207.32～-56.77],术后第1次排气时间早(WMD=-0.82,95% CI:-1.20～-0.45),术后并发症发生率低[相对危险度(OR)=0.45,95%CI:0.26～0.78],术后住院时间短(WMD=-3.63,95%CI:-4.19～-3.07),清扫的淋巴结数目多(WMD=1.93,95%CI:0.36～3.50);但术后复发率、转移率和近期(3年内)生存率差异无统计学意义(P＞0.05).结论 腹腔镜辅助下胃癌D2根治性远端胃大部分切除术的短期效果优于开腹手术.     

The role of hand-assisted laparoscopic distal gastrectomy for distal gastric cancer

BACKGROUND: The aim of this study was to evaluate the role of hand-assisted distal gastrectomy (HALDG) for gastric cancer. METHODS: This study prospectively enrolled 16 patients who underwent HALDG for early gastric cancer and matched them individually by sex, age, and body mass index to patients who underwent laparoscopically assisted distal gastrectomy (LADG) or open distal gastrectomy (ODG). Surgical outcomes were compared among the surgical methods. RESULTS: The mean operating time was the longest for the HALDG group, whereas wound size of the HALDG group was intermediate between that of the LADG and the ODG groups. The other surgical outcomes, such as the number of harvested lymph nodes, were not different among the groups. CONCLUSIONS: According to the findings, HALDG may not be as beneficial for patients with early gastric cancer as has been previously suggested. However, because of easier hand-eye coordination, HALDG may be an excellent bridge learning technique as a surgeon gains experience in laparoscopic gastrectomy.     

Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gastrectomy in advanced gastric cancer

Background

The use of laparoscopy-assisted distal gastrectomy (LADG) in advanced gastric cancer (AGC) remains a controversial topic, mainly because of doubts about its oncologic validity. To date, literature on the prognosis for AGC after LADG is scarce. This study evaluated the procedure’s long-term benefits compared with those of the conventional, open distal gastrectomy (ODG).

Methods

This study involved 201 patients, 66 of whom underwent LADG, with a mean follow-up period of 49.2 months, from January 1999 to March 2010. A clear set of criteria was used to select patients (including no evidence of lymph node metastasis) and surgeons (subject to their experience). Survival outcomes were assessed by Kaplan–Meier analysis and log-rank testing. The postoperative recovery and complications of the patients also were monitored.

Results

No significant difference was observed between LADG and ODG in terms of overall survival or disease-specific survival. The corresponding 5-year survival rates for individual tumor node metastasis stages also were comparable in each group. The number of lymph nodes harvested was similar in the two groups, although the operation time was significantly shorter for ODG. The postoperative hospital stay was shorter for LADG patients (average stay of 8.4 vs. 18.1 days in the ODG group; p < 0.001), and the postoperative complication rate was almost half that for ODG (13.6 vs. 25.0 %; p = 0.048).

Conclusion

The combination of the long- and short-term data indicates that LADG should be considered as a feasible alternative to ODG for the treatment of AGC. Its widespread integration requires the accumulation of similar results across multiple centers worldwide.     

Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer

Background Laparoscopy-assisted surgery with extraperigastric lymph node dissection for gastric cancers has been described, but the clinical benefits of these surgeries still are unclear. Short-term clinical outcomes were compared between laparoscopy-assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) for early gastric cancer in a prospective randomized fashion. Methods For this study, 28 patients with early gastric cancers in the lower half of the stomach were randomly assigned to either LADG (n = 4) or ODG (n = 14). Postoperative pain, levels of acute inflammatory responses, and pathologic evaluation of the operative specimens were compared. Results The LADG group required a significantly shorter period of postoperative epidural anesthesia, showed significantly lower levels of serum interleukin-6 and C-reactive protein, and had no major postsurgery complications. Pathologic examinations showed that surgery was equally radical in the two groups. Conclusion The findings show that LADG with extraperigastric lymph node dissection is a safe and less invasive alternative to the open procedure. This work was supported in part by the 21st Century COE (Center of Excellence) Programs Grant and a Grant-in-Aid for Scientific Research (#15591377) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.     

Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer

Background  Laparoscopic-assisted gastric surgery has become an option for the treatment of early gastric cancer. However, there are few reports of laparoscopic surgery in the management of advanced gastric cancer. In this study we describe our experience with laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC). Methods  Between November 2004 and June 2007, 47 patients with AGC underwent LADG at our hospital, and 45 of those patients were enrolled in this study. These patients were compared with 83 patients who had AGC and underwent conventional open distal gastrectomy (ODG) during the same period. Results  Operation time was significantly longer in the LADG group than in the ODG group. Estimated blood loss in the LADG group was significantly less than in the ODG group. Time to ambulation and first flatus and duration of analgesic medication were significantly shorter in the LADG group. The morbidity and mortality rate were also lower than in the ODG group, with no statistically significant difference. The distance of the proximal resection margin showed no significant difference compared with ODG (6.3 ± 0.9 versus 6.5 ± 0.9 cm; p = 0.228). The mean number of nodes resected with LADG was 35.6 ± 14.2, and that with ODG was 38.3 ± 11.4 (p = 0.269). The mean follow-up for the LADG group was 23.6 months (range 9–40 months). In the LADG group, recurrence was observed in six patients (13.3%). Three patients had recurrence and died after 10 (IIIB), 11 (IIIA), and 13 (IIIB) months. Conclusions  LADG with extended lymphadenectomy for AGC is a feasible and safe procedure and has several advantages. Moreover, this method can achieve a radical oncologic equivalent resection. Indications for LADG with extended lymphadenectomy could be expanded in the treatment of locally advanced gastric cancer.     

远端进展期胃癌腹腔镜辅助与开腹根治术的远期疗效比较

目的 探讨进展期胃癌腹腔镜根治术的安全性和可行性,并评价其远期临床疗效。方法 对2004年1月至2009年6月远端进展期胃癌行腹腔镜辅助胃癌根治术346例患者的临床及随访资料和同期在我院行传统开腹胃癌手术的313例进行回顾性分析,比较两组的手术安全性、术后并发症、生存率以及癌症复发转移情况。结果 腹腔镜组手术平均用时与开腹组相比差异无统计学意义[(211±56) min比（204±41）min,P＞0.05]。腹腔镜组术中出血量、切口长度显著低于开腹手术组。腹腔镜组肿瘤近、远端切缘长度分别为(6.3±2.0) cm、(5.7±1.7)cm,开腹组分别为(6.3±2.1) cm、(5.6±1.6) cm,两组相比差异均无统计学意义。腹腔镜组淋巴结清扫数量为(33±13)枚,开腹组为(33±16)枚,两组相比差异无统计学意义。腹腔镜组术后并发症的发生率显著低于开腹组（6.7％比13.1％,P＜0.01）。随访时间6～72个月,平均37个月,腹腔镜组1、3、5年生存率分别为87.2％、57.2％和50.3％,开腹组分别为87.1％、54.1％和49.2％,两组相比差异均无统计学意义。两组癌症复发转移率相比差异无统计学意义。结论 腹腔镜辅助的进展期胃癌根治术与开腹组在生存率及术后复发方面无显著差异,且具有创伤小、术后恢复快、并发症少等优点。     

加速康复外科指导下的腹腔镜辅助远端胃癌根治术

目的 探讨在加速康复外科(fast track surgery,FTS)理念指导下,联合围手术期应用肠内营养,腹腔镜辅助远端胃癌根治术(laparoscopy assisted radical distal gastrectomy,LADG)的安全性及临床效果.方法 将61例远端胃癌患者随机分为3组:FTS+LADG组(19例)行LADG并应用FTS方案进行围手术期处理,LADG组(22例)行LADG,应用传统围手术期处理、FTS+开腹远端胃癌根治术(open distal gastrectomy,ODG)组(21例),即施行ODG并应用FTS方案进行围手术期处理.比较3组患者术后体质量、血清ALB、BUN、CRP、肠蠕动恢复时间、术后住院时间、住院费用、并发症发生等情况.结果 FTS +LADG组手术前后血清ALB水平高于FTS+ ODG组及LADG组,术后第4、7天FTS+ LADG组明显高于LADG组(P＜0.05、P＜0.01),术前至第4天血清ALB水平变化FTS+ LADG组、FTS+ODG组与LADG组间相比差异均具有统计学意义(均P＜0.01、均P＜0.05);在术后第4、7天FTS+ LADG组血清CRP水平与FTS+ODG组之间相比差异均具有统计学意义(均P＜0.05);FTS+ LADG组术后肠蠕动恢复时间明显快于LADG组、FTS+ ODG组(P＜0.05),FTS+ LADG组术后住院时间短于LADG组、FTS+ODG组,但差异无统计学意义(均P＞0.05),FTS+LADG组住院费用较LADG组明显低(P=0.003),但仍明显高于FTS+ ODG组(P＜0.01).3组均无吻合口漏等严重并发症,3组总的并发症发生率之间相比差异无统计学意义(P＞0.05).结论 FTS理念应用于腹腔镜辅助远端胃癌根治术可以改善患者的营养状态、减轻应激反应、促进胃肠道功能恢复、加速患者康复、缩短住院时间.     

T lymphocyte subsets and Th1/Th2 balance after laparoscopy-assisted distal gastrectomy

Background: Laparoscopic surgery provides for a less invasive procedure than open surgery in patients with gastric cancer, but the immune responses after laparoscopic surgery for early gastric cancer remain unknown. Methods: Peripheral blood mononuclear cells from 20 patients with early gastric cancer who underwent laparoscopy-assisted distal gastrectomy (LADG) or open distal gastrectomy (ODG) were obtained; the cell surface molecules and intracellular cytokines (IFN-gamma and IL-4) were measured by flow cytometry. Results: The populations of T lymphocytes after LADG, including CD3-, 4-, 8-, 57-, and HLA-DR-positive lymphocytes, showed patterns similar to those after ODG. The production of IFN-gamma as Th1 cell function decreased significantly on the third postoperative day after ODG but increased after LADG. The production of IL-4, representing Th2 cell function, increased postoperatively after ODG but not after LADG. Conclusions: When compared with ODG, LADG contributes to the preservation of postsurgical Th1 cell-mediated immune function.     

Laparoscopic assisted distal gastrectomy for early gastric cancer: Five years' experience

BACKGROUND: Laparoscopic assisted gastrectomy is being reported increasingly as the treatment of choice for early gastric cancer. However, no reports concerning the prognosis of patients who have undergone laparoscopic assisted distal gastrectomy (LADG) for early gastric cancer or data comparing the results to those obtained after open gastric surgery are yet available. METHODS: A retrospective study was performed comparing laparoscopic assisted and open distal gastrectomies for early gastric cancer. Eighty-nine patients who underwent LADG were compared to 60 who underwent conventional open distal gastrectomy (DG) in terms of pathologic findings, operative outcome, complications, and survival. RESULTS: There were no significant differences between LADG and DG in operation time (209 vs 200 minutes), complication rate (9% vs 18%), and 5-year survival rate (98% vs 95%). There were differences between LADG and DG with regard to blood loss (237 vs 412 mL), number of lymph nodes (19 vs 25), postoperative stay (17 vs 25 days), and the duration of epidural analgesia (2 vs 4 days) ( P < .05 each). CONCLUSIONS: For properly selected patients, LADG can be a curative and minimally invasive treatment for early gastric cancer.     

开腹与腹腔镜辅助远端胃癌根治术的临床对比研究

目的:对比开腹与腹腔镜辅助远端胃癌根治术的手术效果、围手术期恢复情况及预后,探讨腹腔镜辅助远端胃癌根治术的可行性及安全性。方法:选取2011年1月至2012年12月行远端胃癌根治术(远端胃切除+D2淋巴结清扫)的216例患者其分为两组,观察组行腹腔镜手术(n=104),対照组行开腹手术(n=112)。対比研究两组间的肿瘤生物学行为、手术时间、术中出血、术中淋巴结切除数量、术后胃肠道功能恢复时间、术后下床活动时间、术后并发症、住院时间、3年无瘤生存率。结果:两组在肿瘤生物学行为方面差异无统计学意义。观察组手术时间明显长于对照组(P0.05),术中出血量、淋巴结清扫数量、术后排气时间、术后下床活动时间及住院时间均优于对照组,差异有统计学意义(P0.05);术后并发症按Clavien-Dindo法分级并进行対比两组间差异无统计学意义(P0.05);3年无瘤生存率两组差异无统计学意义(P0.05)。结论:腹腔镜辅助下远端胃癌根治术是安全、可行的,与传统手术相比,在术中出血量、淋巴结清扫数量、术后恢复方面具有明显优势。     

腹腔镜手术对早期远端胃癌短期疗效的meta分析

目的:通过meta分析评估早期远端胃癌根治术中腹腔镜手术的短期临床疗效与安全性。方法:从Pub Med、Cochrane library等数据库中搜索2014年4月以前发表的研究对象为腹腔镜辅助远端胃大部切除术(laparoscopy-assisted distal gastrectomy,LADG)、开腹远端胃癌根治术(open distal gastrectomy,ODG)治疗早期远端胃癌患者近期疗效的随机对照试验(randomized controlled trials,RCT)文献,采用Rev Man 5.2软件对纳入的数据进行meta分析。结果:共7篇RCT纳入本研究。纳入病例数为692例,其中LADG组354例,ODG组338例,meta分析结果提示:两组患者进食时间[加权均数差(WMD)=-0.49,95%CI(-1.45,0.47)]与术后住院时间[WMD=-1.44,95%CI(-3.17,0.29)]差异无统计学意义,LADG组手术时间较长[WMD=82.91,95%CI(58.59,107.24)],淋巴结清扫数量略少[WMD=-4.62,95%CI(-6.58,-2.66)];但术中出血量[WMD=-103.58,95%CI(-140.75,-66.42)]更少,术后排气时间[WMD=-0.55,95%CI(-1.02,-0.08)]更短,术后早期并发症发生率[比值比(OR)=0.44,95%CI(0.27,0.70)]更低。结论:腹腔镜早期远端胃癌根治术后患者肠道功能恢复较快,并发症较少,短期效果优于开腹手术。     

Short-term outcomes of laparoscopic-assisted distal gastrectomy for gastric cancer during a surgeon’s learning curve period

Background

Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for treating early gastric cancer (EGC). However, many gastric surgeons are still reluctant to perform LADG, mainly because this procedure entails a considerable learning curve. We aimed to evaluate the technical feasibility and short-term outcomes of performing LADG by a single experienced gastric surgeon who initially had no experience with laparoscopic surgery as compared with open distal gastrectomy (ODG).

Methods

Between January 2006 and December 2007, 177 patients with preoperatively diagnosed EGC located at the middle or lower third of the stomach were enrolled; 102 patients underwent LADG, 4 patients had open conversion, and 71 patients underwent conventional ODG. The operative and early postoperative outcomes from a prospective database were compared between the two groups.

Results

The clinicopathological characteristics were similar between the two groups. No operation-related deaths occurred. Although operation time was significantly longer for LADG than for ODG, time to first flatus was shorter and, consequently, postoperative hospital stay was significantly shorter in the LADG group. There was no significant difference in the overall complication rates between the two groups. On comparing the early (n = 50) and late groups (n = 52) of LADG patients, operation time and postoperative hospital stay were shorter and number of retrieved lymph nodes was greater in the late group (p < 0.05). Major and minor complications were markedly reduced in the late group (p < 0.05).

Conclusions

Although LADG was more time consuming than ODG, it was a feasible, safe procedure that accomplished the oncological requirements. Postoperative morbidity of LADG was similar to that of ODG, and LADG led to faster postoperative recovery. However, LADG should be performed carefully to prevent unexpected complications, especially during the early learning period.     

A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results

Background We conducted a prospective randomized trial to compare laparoscopy-assisted distal gastrectomy (LADG) including lymphadenectomy with open distal gastrectomy for the management of early gastric cancer (EGC).Methods Forty-seven patients who had been diagnosed endoscopically with EGC were included in a study that ran from November 2001 to August 2003. With the aid of random number table, 23 patients were assigned to the open group (group O) and 24 patients were assigned to the LADG group (group L).Results Estimated blood loss and transfusion amounts were similar in the two groups. The mean postoperative hospital stay and the duration of analgesic administration were shorter for group L but not significantly so. The mean number of harvested lymph nodes was 38.1 in the O group and 31.8 in the L group (p = 0.098). Postoperative pulmonary complications occurred more frequently in the O group (p = 0.043). At a median follow-up of 14 months, there has been no recurrence of disease in either group.Conclusion In terms of resulting in fewer pulmonary complications while maintaining the curability of EGC, LADG has a clear advantage over its open counterpart.     

Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer

Background

Laparoscopic gastrectomy for gastric cancer has become common due to improvement of the surgical techniques and devices for laparoscopic surgery. Although laparoscopically assisted distal gastrectomy (LADG) has several advantages over open distal gastrectomy, little has been reported about the safety and feasibility of totally laparoscopic distal gastrectomy (TLDG).

Methods

Between October 2005 and June 2007, 80 laparoscopic distal gastrectomies with regional lymphadenectomies were performed for patients with gastric cancer. After 24 patients underwent LADG and 56 patients underwent TLDG, the clinical data were compared between the two groups.

Results

The groups were comparable in terms of age, gender, body mass index (BMI), tumor location, tumor size, macroscopic type, depth of invasion, histologic type, lymph node metastasis, and length of proximal margin. However, when only the patients with gastric cancer in the middle third of the stomach were compared between the two groups, the length of the proximal margin was significantly longer in the TLDG group (p < 0.05). The mean blood loss was significantly less in the TLDG group (p < 0.05). The patients in the TLDG group recovered earlier and thus had a significantly shorter postoperative hospital stay. Furthermore, the C-reactive protein level on postoperative day 7 was lower in the TLDG group than in the LADG group (p < 0.05). There was no significant difference in the postoperative complications between the two groups.

Conclusion

This study demonstrated that TLDG has several advantages over LADG including smaller wounds, less invasiveness, and better feasibility of a secure ablation. The TLDG procedure yields safe anastomosis independently of the patient’s constitution or the location of the cancer. Therefore, TLDG is considered to be a useful technique for patients with gastric cancer.