A comparative study of totally laparoscopic distal gastrectomy versus laparoscopic-assisted distal gastrectomy in gastric cancer patients: Short-term operative outcomes at a high-volume center
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摘要
Objective: Laparoscopic gastrectomy has been established as a standard treatment for early gastric cancer, and its use is increasing recently. Compared with the conventional laparoscopy-assisted distal gastrectomy(LADG), totally laparoscopic distal gastrectomy(TLDG) involves intracorporeal reconstruction, which can avoid the additional incision, resulting in pain reduction and early recovery. This study aimed to compare the short-term postoperative outcomes of TLDG vs. LADG in gastric cancer in a high-volume center.Methods: A retrospective cohort study was conducted on 1,322 patients who underwent laparoscopic distal gastrectomy from June 2012 to June 2017 at the National Cancer Center, Korea. LADG was performed in the early period before July 2015, and TLDG was applied in the later period. Postoperative short-term outcomes were compared in terms of complication and clinical course between the two groups. Pain score was measured by rating the pain intensity from 0 to 10 points on postoperative day(POD) 1 and 3.Results: A total of 667 patients underwent LADG and 655 patients underwent TLDG. Clinicopathologic characteristics were not different in both groups. Intraoperative estimated blood loss(EBL) was significantly lower in the TLDG group(P<0.001). Postoperative pain scores were significantly lower in the TLDG group than in the LADG group on POD 1(5.1±1.5 vs. 4.8±1.4, P=0.015). First flatus passage after operation was significantly earlier in the TLDG group(3.4±0.8 d vs. 3.2±0.6 d, P<0.001). There were no differences in postoperative complications and hospital stay between the two groups.Conclusions: Based on the reported short-term postoperative outcomes, TLDG is safe and feasible as well as LADG. Moreover, compared with LADG, TLDG can reduce intraoperative EBL and postoperative pain and enhance the bowel motility in gastric cancer surgery.
Objective: Laparoscopic gastrectomy has been established as a standard treatment for early gastric cancer, and its use is increasing recently. Compared with the conventional laparoscopy-assisted distal gastrectomy(LADG), totally laparoscopic distal gastrectomy(TLDG) involves intracorporeal reconstruction, which can avoid the additional incision, resulting in pain reduction and early recovery. This study aimed to compare the short-term postoperative outcomes of TLDG vs. LADG in gastric cancer in a high-volume center.Methods: A retrospective cohort study was conducted on 1,322 patients who underwent laparoscopic distal gastrectomy from June 2012 to June 2017 at the National Cancer Center, Korea. LADG was performed in the early period before July 2015, and TLDG was applied in the later period. Postoperative short-term outcomes were compared in terms of complication and clinical course between the two groups. Pain score was measured by rating the pain intensity from 0 to 10 points on postoperative day(POD) 1 and 3.Results: A total of 667 patients underwent LADG and 655 patients underwent TLDG. Clinicopathologic characteristics were not different in both groups. Intraoperative estimated blood loss(EBL) was significantly lower in the TLDG group(P<0.001). Postoperative pain scores were significantly lower in the TLDG group than in the LADG group on POD 1(5.1±1.5 vs. 4.8±1.4, P=0.015). First flatus passage after operation was significantly earlier in the TLDG group(3.4±0.8 d vs. 3.2±0.6 d, P<0.001). There were no differences in postoperative complications and hospital stay between the two groups.Conclusions: Based on the reported short-term postoperative outcomes, TLDG is safe and feasible as well as LADG. Moreover, compared with LADG, TLDG can reduce intraoperative EBL and postoperative pain and enhance the bowel motility in gastric cancer surgery.
Objective: Laparoscopic gastrectomy has been established as a standard treatment for early gastric cancer, and its use is increasing recently. Compared with the conventional laparoscopy-assisted distal gastrectomy(LADG), totally laparoscopic distal gastrectomy(TLDG) involves intracorporeal reconstruction, which can avoid the additional incision, resulting in pain reduction and early recovery. This study aimed to compare the short-term postoperative outcomes of TLDG vs. LADG in gastric cancer in a high-volume center.Methods: A retrospective cohort study was conducted on 1,322 patients who underwent laparoscopic distal gastrectomy from June 2012 to June 2017 at the National Cancer Center, Korea. LADG was performed in the early period before July 2015, and TLDG was applied in the later period. Postoperative short-term outcomes were compared in terms of complication and clinical course between the two groups. Pain score was measured by rating the pain intensity from 0 to 10 points on postoperative day(POD) 1 and 3.Results: A total of 667 patients underwent LADG and 655 patients underwent TLDG. Clinicopathologic characteristics were not different in both groups. Intraoperative estimated blood loss(EBL) was significantly lower in the TLDG group(P<0.001). Postoperative pain scores were significantly lower in the TLDG group than in the LADG group on POD 1(5.1±1.5 vs. 4.8±1.4, P=0.015). First flatus passage after operation was significantly earlier in the TLDG group(3.4±0.8 d vs. 3.2±0.6 d, P<0.001). There were no differences in postoperative complications and hospital stay between the two groups.Conclusions: Based on the reported short-term postoperative outcomes, TLDG is safe and feasible as well as LADG. Moreover, compared with LADG, TLDG can reduce intraoperative EBL and postoperative pain and enhance the bowel motility in gastric cancer surgery.
引文
1.Kim W, Kim HH, Han SU, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer:short-term outcomes from a multicenter randomized controlled trial(KLASS-01).Ann Surg 2016;263:28-35.
2.Vi?uela EF, Gonen M, Brennan MF, et al.Laparoscopic versus open distal gastrectomy for gastric cancer:a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 2012;255:446-56.
3.Shinohara T, Satoh S, Kanaya S, et al. Laparoscopic versus open D2 gastrectomy for advanced gastric cancer:a retrospective cohort study. Surg Endosc2013;27:286-94.
4.Chen K, Mou YP, Xu XW, et al. Comparison of short-term surgical outcomes between totally laparoscopic and laparoscopic-assisted distal gastrectomy for gastric cancer:a 10-y single-center experience with meta-analysis. J Surg Res 2015;194:367-74.
5.Jun G, Ping L, Jie C, et al. Totally laparoscopic vs.laparoscopically assisted distal gastrectomy for gastric cancer:a meta-analysis. Hepatogastroenterology2013;60:1530-4.
6.Lee SW, Tanigawa N, Nomura E, et al. Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol2012;10:267.
7.Kim MG, Kawada H, Kim BS, et al. A totally laparoscopic distal gastrectomy with gastroduodenostomy(TLDG)for improvement of the early surgical outcomes in high BMI patients. Surg Endosc2011;25:1076-82.
8 .Sugimoto M, Kinoshita T, Shibasaki H, et al. Short term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer.Surg Endosc 2013;27:4291-6.
9.Kim HG, Park JH, Jeong SH, et al. Totally laparoscopic distal gastrectomy after learning curve completion:comparison with laparoscopy-assisted distal gastrectomy. J Gastric Cancer 2013;13:26-33.
10.Ahn CW, Hur H, Han SU, et al. Comparison of intracorporeal reconstruction after laparoscopic distal gastrectomy with extracorporeal reconstruction in the view of learning curve. J Gastric Cancer 2013;13:34-43.
11.Kanaya S, Kawamura Y, Kawada H, et al. The deltashaped anastomosis in laparoscopic distal gastrectomy:analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer2011;14:365-71.
12.Dindo D, Demartines N, Clavien PA. Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
13.Song KY, Park CH, Kang HC, et al. Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?:prospective, multicenter study. J Gastrointest Surg 2008;12:1015-21.
14.Choi BS, Oh HK, Park SH, et al. Comparison of laparoscopy-assisted and totally laparoscopic distal gastrectomy:the short-term outcome at a low-volume center. J Gastric Cancer 2013;13:44-50.
15.Kinoshita T, Shibasaki H, Oshiro T, et al.Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer:a report of short-term outcomes. Surg Endosc 2011;25:1395-401.
16.Ryu KW, Lee JH, Choi IJ, et al. Preoperative endoscopic clipping:localizing technique of early gastric cancer. J Surg Oncol 2003;82:75-7.
17.Lee J, Kim D, Kim W. Comparison of laparoscopyassisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. J Korean Surg Soc2012;82:135-42.
18.Kim JH, Jun KH, Chin HM. Short-term surgical outcomes of laparoscopy-assisted versus totally laparoscopic Billroth-II gastrectomy for gastric cancer:a matched-cohort study. BMC Surg 2017;17:45.
19 .Woo J, Lee JH, Shim KN, et al. Does the difference of invasiveness between totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy lead to a difference in early surgical outcomes? A prospective randomized trial. Ann Surg Oncol 2015;22:1836-43.
20.Lin M, Zheng CH, Huang CM, et al. Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer:a case-control and case-matched study. Surg Endosc 2016;30:5245-54.
21 .Lee SH, Kim IH, Kim IH, et al. Comparison of short-term outcomes and acute inflammatory response between laparoscopy-assisted and totally laparoscopic distal gastrectomy for early gastric cancer. Ann Surg Treat Res 2015;89:176-82.
22 .Jeong O, Jung MR, Park YK, et al. Safety and feasibility during the initial learning process of intracorporeal Billroth I(delta-shaped)anastomosis for laparoscopic distal gastrectomy. Surg Endosc2015;29:1522-9.
2.Vi?uela EF, Gonen M, Brennan MF, et al.Laparoscopic versus open distal gastrectomy for gastric cancer:a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 2012;255:446-56.
3.Shinohara T, Satoh S, Kanaya S, et al. Laparoscopic versus open D2 gastrectomy for advanced gastric cancer:a retrospective cohort study. Surg Endosc2013;27:286-94.
4.Chen K, Mou YP, Xu XW, et al. Comparison of short-term surgical outcomes between totally laparoscopic and laparoscopic-assisted distal gastrectomy for gastric cancer:a 10-y single-center experience with meta-analysis. J Surg Res 2015;194:367-74.
5.Jun G, Ping L, Jie C, et al. Totally laparoscopic vs.laparoscopically assisted distal gastrectomy for gastric cancer:a meta-analysis. Hepatogastroenterology2013;60:1530-4.
6.Lee SW, Tanigawa N, Nomura E, et al. Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol2012;10:267.
7.Kim MG, Kawada H, Kim BS, et al. A totally laparoscopic distal gastrectomy with gastroduodenostomy(TLDG)for improvement of the early surgical outcomes in high BMI patients. Surg Endosc2011;25:1076-82.
8 .Sugimoto M, Kinoshita T, Shibasaki H, et al. Short term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer.Surg Endosc 2013;27:4291-6.
9.Kim HG, Park JH, Jeong SH, et al. Totally laparoscopic distal gastrectomy after learning curve completion:comparison with laparoscopy-assisted distal gastrectomy. J Gastric Cancer 2013;13:26-33.
10.Ahn CW, Hur H, Han SU, et al. Comparison of intracorporeal reconstruction after laparoscopic distal gastrectomy with extracorporeal reconstruction in the view of learning curve. J Gastric Cancer 2013;13:34-43.
11.Kanaya S, Kawamura Y, Kawada H, et al. The deltashaped anastomosis in laparoscopic distal gastrectomy:analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer2011;14:365-71.
12.Dindo D, Demartines N, Clavien PA. Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
13.Song KY, Park CH, Kang HC, et al. Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?:prospective, multicenter study. J Gastrointest Surg 2008;12:1015-21.
14.Choi BS, Oh HK, Park SH, et al. Comparison of laparoscopy-assisted and totally laparoscopic distal gastrectomy:the short-term outcome at a low-volume center. J Gastric Cancer 2013;13:44-50.
15.Kinoshita T, Shibasaki H, Oshiro T, et al.Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer:a report of short-term outcomes. Surg Endosc 2011;25:1395-401.
16.Ryu KW, Lee JH, Choi IJ, et al. Preoperative endoscopic clipping:localizing technique of early gastric cancer. J Surg Oncol 2003;82:75-7.
17.Lee J, Kim D, Kim W. Comparison of laparoscopyassisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. J Korean Surg Soc2012;82:135-42.
18.Kim JH, Jun KH, Chin HM. Short-term surgical outcomes of laparoscopy-assisted versus totally laparoscopic Billroth-II gastrectomy for gastric cancer:a matched-cohort study. BMC Surg 2017;17:45.
19 .Woo J, Lee JH, Shim KN, et al. Does the difference of invasiveness between totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy lead to a difference in early surgical outcomes? A prospective randomized trial. Ann Surg Oncol 2015;22:1836-43.
20.Lin M, Zheng CH, Huang CM, et al. Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer:a case-control and case-matched study. Surg Endosc 2016;30:5245-54.
21 .Lee SH, Kim IH, Kim IH, et al. Comparison of short-term outcomes and acute inflammatory response between laparoscopy-assisted and totally laparoscopic distal gastrectomy for early gastric cancer. Ann Surg Treat Res 2015;89:176-82.
22 .Jeong O, Jung MR, Park YK, et al. Safety and feasibility during the initial learning process of intracorporeal Billroth I(delta-shaped)anastomosis for laparoscopic distal gastrectomy. Surg Endosc2015;29:1522-9.