Is Totally Laparoscopic Gastrectomy Less Invasive Than Laparoscopy-assisted Gastrectomy?: Prospective,Multicenter Study |
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Authors: | Kyo Young Song Cho Hyun Park Han Chol Kang Jin-Jo Kim Seung Man Park Kyong Hwa Jun Hyung Min Chin Hoon Hur |
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Institution: | (1) Department of Surgery, Kangnam St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea;(2) Department of Surgery, Our Lady of Mercy Hospital, College of Medicine, The Catholic University of Korea, 665 Bupyoung-6-Dong, Bupyoung-Gu, Incheon, 403–720, South Korea;(3) Department of Surgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea |
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Abstract: | Background Laparoscopic surgery has been adopted for the treatment of gastric cancer, and many reports have confirmed its favorable outcomes.
Most surgeons prefer to laparoscopy-assisted gastrectomy using minilaparotomy rather than totally laparoscopic procedures
because of technical difficulties of intracorporeal anastomosis. We conducted this study to compare laparoscopy-assisted distal
gastrectomy with totally laparoscopic distal gastrectomy. In addition, laparoscopic procedures were compared with open distal
gastrectomy.
Material and methods This prospective, nonrandomized, multicenter study enrolled 60 patients with early gastric cancer at three branch hospitals
of our institutes. Twenty-five- to 30-cm-long mid-line incision, 5-cm midline or transverse incision, and 3-cm U-shaped incision
were used in open distal gastrectomy, laparoscopy-assisted distal gastrectomy, and totally laparoscopic distal gastrectomy,
respectively. Postoperative outcomes, immunologic changes, and operation-related costs were compared between the three groups.
Results There was no difference in gender, mean age, body mass index, and tumor characteristics between the three groups. No operation-related
death occurred. Estimated blood loss, number of additional analgesics use, first flatus, and soft meal diet time were significantly
different between the three groups (P < 0.05). In totally laparoscopic distal gastrectomy, the time to first flatus was significantly shorter than laparoscopy-assisted
distal gastrectomy (3.7 vs. 2.8 days, in laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy,
respectively, P < 0.05). White blood cell count and C-reactive protein level at postoperative day 1 were significantly higher in open distal
gastrectomy than the other groups; however, there was no difference between laparoscopy-assisted distal gastrectomy and totally
laparoscopic distal gastrectomy. The operation-related costs were significantly greater in totally laparoscopic distal gastrectomy
(P < 0.05).
Conclusion Although totally laparoscopic distal gastrectomy needs more cost, totally laparoscopic distal gastrectomy provides shorter
bowel recovery time than laparoscopy-assisted distal gastrectomy. |
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Keywords: | Gastrectomy LADG TLDG Prospective Less invasive Multicenter |
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