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Liu LB, Ruan GT, Wu YD, Niu L, Cai J. Application of λ esophagojejunostomy in total gastrectomy under laparoscopy: a modified technique for post-gastrectomy reconstruction. Front Oncol 2024; 14:1335297. [PMID: 39184043 PMCID: PMC11341349 DOI: 10.3389/fonc.2024.1335297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/18/2024] [Indexed: 08/27/2024] Open
Abstract
Objective Common gastrectomy methods can significantly affect patients' postoperative quality of life. This study investigated the safety, feasibility, and short-term efficacy of λ-type esophagojejunostomy in total gastrectomy under total laparoscopy. Methods We retrospectively analyzed the clinical and follow-up data of 50 patients with adenocarcinoma of the gastric/gastroesophageal junction who underwent total laparoscopic radical gastrectomy with λ-type esophagojejunostomy at the Beijing Friendship Hospital from January 2021 to July 2022. Data are reported as mean ± standard deviation. Results Patients comprised 27 males and 23 females, aged 42 to 76 (60.9 ± 5.6) years. There were 26 cases of gastroesophageal junction adenocarcinoma (16 Siewert type II and 10 Siewert type III) and 24 cases of adenocarcinoma of the proximal gastric body. All patients underwent radical total gastrectomy and D2 lymph node dissection with λ-type esophagojejunostomy for digestive tract reconstruction under total laparoscopy. The total operation time was 235-295 (249.4 ± 48.5) min, digestive tract reconstruction time was (48.2 ± 23.2) min, intraoperative blood loss was (63.4 ± 48.4) mL, recovery time of exhaust was (3.1 ± 2.2) d, first drinking or eating time was (4.1 ± 2.1) d, and hospital stay was (9.3 ± 4.4) d. Three patients had postoperative complications, including one with duodenal remnant leakage combined with abdominal infection. Anastomotic bleeding and postoperative inflammatory intestinal obstruction occurred in one patient each, all of whom were cured by conservative treatment. The Nutritional Risk Index of the whole group was 53.5 ± 8.4 preoperatively, 47.3 ± 5.6 one week postoperatively, 50.3 ± 5.6 six months postoperatively, and 52.4 ± 4.2 at 12 months postoperatively. Roux-en-Y stasis syndrome and bile reflux esophagitis occurred in one patient each (2.0%). There were no occurrences of recanalization of the closed end of the afferent loop of the esophagojejunostomy anastomosis, anastomotic stricture or obstruction, or tumor recurrence. Conclusion λ-type esophagojejunostomy is safe and feasible for digestive tract reconstruction after total laparoscopic radical gastrectomy. This digestive tract reconstruction method not only maintains intestinal continuity but also simplifies surgical procedures, allowing patients to recover quickly with an excellent short-term effect.
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Affiliation(s)
- Lang-Biao Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Guo-Tian Ruan
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Ya-Dong Wu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Lei Niu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jun Cai
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
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Han H, Wang Z, Zhao X, Li G, Fu Y, Wang Z, Wang H. Global scientific trends in laparoscopy and gastric cancer in the 21st century: A bibliometric and visual mapping analysis. Front Oncol 2023; 13:1136834. [PMID: 36910670 PMCID: PMC9995981 DOI: 10.3389/fonc.2023.1136834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Aims To use visual mapping and bibliometrics to analyze and summarize the valuable information on laparoscopic surgery for gastric cancer (GC) obtained in the last 20 years, so as to determine the research hotspots and trends in this field. Methods We screened all literature on laparoscopic surgery for GC in the Web of Science published from 2000 to 2022 and analyzed the research hotspots and trends in this field using VOSviewer. Results A total of 2796 reports from 61 countries and regions were selected. Japanese researchers published the most papers (n=946), followed by those from China (n=747) and South Korea (n=557). Papers from Japan also had the most citations (n=21,836). Surgical Endoscopy and Other Interventional Techniques published the most reports on laparoscopic surgery for GC (n=386) and also had the highest total number of citations (n=11,076), making this journal the most authoritative in this field. Among the institutions, researchers from Seoul National University in South Korea had the highest numbers of published papers and citations. The keywords of the articles could be divided into five categories: surgical methods for GC, short-term and long-term efficacy of laparoscopic surgery, guiding role of laparoscopy in the treatment of advanced GC, diagnosis and treatment of early gastric cancer (EGC), and lymph node dissection. Keywords such as "laparoscopic proximal gastrectomy", "surgical outcomes", and "esophagogastric junction" have emerged recently, and relevant studies on laparoscopic surgery for adenocarcinoma of esophagogastric junction(AEG)have gradually become a hot topic and trend. Conclusion This study adopted bibliometric analysis to identify the current research hotspots and research trends in the field of laparoscopic surgery for GC. Five main research hotspots of laparoscopic surgery for GC were also identified. Laparoscopic surgery for AEG may become an important research focus in the future.
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Affiliation(s)
- Hongmin Han
- Department of General Surgery, The People's Hospital of China Medical University, Shenyang, China.,Department of General Surgery, Shenzhen Hyzen Hospital, Shenzhen, China
| | - Zhanwei Wang
- Department of General Surgery, The People's Hospital of China Medical University, Shenyang, China
| | - Xiaodan Zhao
- Department of General Surgery, The People's Hospital of China Medical University, Shenyang, China
| | - Guosheng Li
- Department of General Surgery, The People's Hospital of China Medical University, Shenyang, China
| | - Yuan Fu
- Department of General Surgery, The People's Hospital of China Medical University, Shenyang, China
| | - Zhongqing Wang
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China
| | - Hongyan Wang
- Department of General Surgery, The People's Hospital of China Medical University, Shenyang, China
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Zhao RY, Li HH, Zhang KC, Cui H, Deng H, Gao JW, Wei B. Comparison of short-term efficacy between totally laparoscopic gastrectomy and laparoscopic assisted gastrectomy for elderly patients with gastric cancer. World J Gastrointest Surg 2022; 14:950-962. [PMID: 36185561 PMCID: PMC9521479 DOI: 10.4240/wjgs.v14.i9.950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/04/2022] [Accepted: 08/21/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Totally laparoscopic gastrectomy (TLG) entails both gastrectomy and gastrointestinal reconstruction under laparoscopy. Compared with laparoscopic assisted gastrectomy (LAG), TLG has been demonstrated in many studies to require a smaller surgical incision, result in a faster postoperative recovery and less pain and have comparable long-term efficacy, which has been a research hotspot in recent years. Whether TLG is equally safe and feasible for elderly patients remains unclear.
AIM To compare the short-term efficacy of and quality of life (QOL) associated with TLG and LAG in elderly gastric cancer (GC) patients.
METHODS The clinicopathological data of 462 elderly patients aged ≥ 70 years who underwent LAG or TLG (including distal gastrectomy and total gastrectomy) between January 2017 and January 2022 at the Department of General Surgery, First Medical Center, Chinese PLA General Hospital were retrospectively collected. A total of 232 patients were in the LAG group, and 230 patients were in the TLG group. Basic patient information, clinicopathological characteristics, operation information and QOL data were collected to compare efficacy.
RESULTS Compared with those in the LAG group, intraoperative blood loss in the TLG group was significantly lower (P < 0.001), and the time to first flatus and postoperative hospitalization time were significantly shorter (both P < 0.001). The overall incidence of postoperative complications in the TLG group was significantly lower than that in the LAG group (P = 0.01). Binary logistic regression results indicated that LAG and an operation time > 220 min were independent risk factors for postoperative complications in elderly patients with GC (P < 0.05). In terms of QOL, no statistically significant differences in various preoperative indicators were found between the LAG group and the LTG group (P > 0.05). Compared with the laparoscopic-assisted total gastrectomy group, patients who received totally laparoscopic total gastrectomy had lower nausea and vomiting scores and higher satisfaction with their body image (P < 0.05). Patients who underwent laparoscopic-assisted distal gastrectomy were more satisfied with their body image than patients in the totally laparoscopic distal gastrectomy group (P < 0.05).
CONCLUSION TLG is safe and feasible for elderly patients with GC and has outstanding advantages such as reducing intracorporeal blood loss, promoting postoperative recovery and improving QOL.
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Affiliation(s)
- Rui-Yang Zhao
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Hang-Hang Li
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Ke-Cheng Zhang
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Hao Cui
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Huan Deng
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Jing-Wang Gao
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Bo Wei
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing 100853, China
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Oh YJ, Yang SG, Han WH, Eom BW, Yoon HM, Kim YW, Ryu KW. Effectiveness of Intraoperative Endoscopy for Localization of Early Gastric Cancer during Laparoscopic Distal Gastrectomy. Dig Surg 2022; 39:92-98. [PMID: 35477109 DOI: 10.1159/000524565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/12/2022] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Intraoperative localization of tumors has been considered crucial in determining adequate resection margins during laparoscopic gastrectomy for early gastric cancer (EGC). This study has evaluated the effectiveness of intraoperative endoscopy for localization of EGC during the totally laparoscopic distal gastrectomy. METHODS Patients with EGC who received totally laparoscopic distal gastrectomy from January 2018 to March 2020 were included in this study. Except the tumors located in the antrum, the patients were categorized into two groups: no localization procedure (n = 144) and intraoperative endoscopy (n = 65). To evaluate the effectiveness of the localization procedure, proximal resection margin (PRM) involvement by the tumor and approximation of optimal PRM were compared, including their postoperative outcomes. RESULTS There were 3 patients (2.1%) with tumor involvement of the PRM at the initial gastric resection in the no localization group. Distance from the tumor to the PRM was determined to be not significantly different between the no localization group and intraoperative endoscopy group. The PRM distribution pattern and reconstruction method were also not significantly different between the two groups. DISCUSSION/CONCLUSION Intraoperative endoscopy for localization of EGC is an effective method to avoid tumor involvement at the resection margin during the laparoscopic gastrectomy with intracorporeal gastric resection and reconstruction.
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Affiliation(s)
- Yoon Jung Oh
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea,
| | - Seung Geun Yang
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Won Ho Han
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
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Yalikun A, Aikemu B, Li S, Zhang T, Ma J, Zheng M, Zang L. A Modified Billroth-II with Braun Anastomosis in Totally Laparoscopic Distal Gastrectomy: Initial Experience Compared with Roux-en-Y Anastomosis. Ann Surg Oncol 2022; 29:2359-2367. [PMID: 34994886 DOI: 10.1245/s10434-021-11187-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND This retrospective study aimed to compare the feasibility and effectiveness of a modified Billroth-II with Braun (B-II Braun) reconstruction and those of a Roux-en-Y (R-Y) reconstruction after laparoscopic distal gastrectomy. METHODS From January 2016 to December 2019, 247 patients underwent total laparoscopic distal gastrectomy (TLDG), with B-II Braun reconstruction for 145 patients and R-Y reconstruction for 102 patients. The patients' data were collected prospectively and reviewed retrospectively. RESULTS In this study, the median times of the operation were statistically shorter for B-II Braun than for R-Y (167 min [range, 110-331 min] vs 191 min [range, 123-384 min]; p = 0.001), including anastomotic times (33 min [range, 30-42 min] vs 42 min [range, 40-48 min]; p = 0.001). After a short-term follow-up period, endoscopy showed 31 cases of bile reflux (21.4%), 15 cases of grade 2 gastritis (10.3%), and 6 cases of grade 2 food residue (4.1%) in the B-II Braun group after 6 months. After 1 year, 10 patients (6.9%) had grade 2 gastritis and 2 patients (1.4%) had grade 3 gastritis. However, the remnant stomach of the two groups did not differ significantly in the rate of gastric residue (p = 0.112 after 6 months; p = 0.579 after 1 year, respectively), gastritis (p = 0.726 after 6 months; p = 0.261 after 1 year, respectively), or bile reflux (p = 0.262 after 6 months; p = 0.349 after 1 year, respectively). CONCLUSIONS For gastric cancer patients, TLDG with modified B-II Braun reconstruction could be technically feasible. It has an acceptable range of postoperative complications and is effective in preventing bile reflux into the gastric remnant.
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Affiliation(s)
- Abudushalamu Yalikun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Batuer Aikemu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Shuchun Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Tao Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, China.
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, China.
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, China.
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Chen QY, Zhong Q, Liu ZY, Huang XB, Que SJ, Zheng WZ, Li P, Zheng CH, Huang CM. Advances in laparoscopic surgery for the treatment of advanced gastric cancer in China. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:e7-e13. [PMID: 32709375 DOI: 10.1016/j.ejso.2020.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
Most gastric cancer (GC) cases are diagnosed at an advanced stage in China. Because of its high morbidity and mortality, GC remains a major health crisis in China. Surgical resection is the only potentially curative treatment for GC. Owing to being minimally invasive, laparoscopic radical gastrectomy has been widely used in various countries, especially in East Asia, since Kitano first reported the feasibility and safety of this technique. Although laparoscopic gastric surgery was introduced relatively late in China, Chinese surgeons have made unique contributions to the research and clinical practice of laparoscopic gastric surgery due to the large number of clinical cases. This review focuses on the progress in laparoscopic gastrectomy for advanced stage GC in China, including reasonable approaches in different areas and oncologic efficacy of laparoscopic surgery, and introduce advanced technology to facilitate surgeons to rapidly overcome the learning curve in clinical practice.
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Affiliation(s)
- Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Xiao-Bo Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Si-Jin Que
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Wen-Ze Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Meng X, Wang L, Zhu B, Sun T, Guo S, Wang Y, Zhang J, Yang D, Zheng G, Zhang T, Zheng Z, Zhao Y. Totally Laparoscopic Gastrectomy Versus Laparoscopic-Assisted Gastrectomy for Gastric Cancer: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2020; 31:676-691. [PMID: 32955988 DOI: 10.1089/lap.2020.0566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Totally laparoscopic gastrectomy (TLG) has recently been accepted as a treatment strategy for gastric cancer (GC). Aim: In this study, we conducted a meta-analysis to evaluate the safety and feasibility of TLG compared with laparoscopic-assisted gastrectomy (LAG) in GC. Methods: Feasible studies comparing the TLG and LAG published up to March 2019 were searched online. The data showing short-term and complication outcomes were extracted to be pooled and analyzed. Results: Thirty-four studies, including 7974 patients were eventually eligible. There was no statistically significant difference on operation time between the two groups (weighted mean difference [WMD] = 2.43, 95% confidence interval [CI]: -4.16 to 9.02, P = .47). The time of anvil insertion time was shorter in the TLG group compared with the LAG group (WMD = -1.87, 95% CI: -2.60 to -1.15, P < .01). The TLG was significantly superior to LAG in the comparison of less trauma. In terms of radical resection, the number of lymph nodes obtained by TLG was significantly more than that obtained by LAG (WMD = 2.65, 95% CI: 1.54-3.76, P < .01). The pooled meta-analysis suggested that the patients undergoing TLG had a quicker recovery and less pain. In the advanced gastric cancer gastrectomy, the TLG could receive a longer proximal margin compared with the LAG (WMD = 0.72, 95% CI: 0.48-0.95, P < .01). Regardless of the reconstruction method, the TLG was superior to the LAG in terms of surgical parameters and postoperative recovery. Like the LAG, the TLG was safe and advantageous. A lower risk trend of conversion to open laparotomy was observed in the TLG (relative risk [RR] = 0.72, 95% CI: 0.12-4.38, P = .72). The body mass index >25 kg/m2 patients undergoing totally laparoscopic gastrectomy (TLGA) had a lower risk of overall complications (RR = 0.88, 95% CI: 0.48-1.63, P = .69). The patients with early gastric cancer or Billroth-I anastomosis were suitable to undergo the TLG (a lower risk of anastomotic leakage [RR = 0.01, 95% CI: 0.00-0.23, P < .01] and gastralgia [RR = 0.27, 95% CI: 0.08-0.88, P = .03], respectively). Conclusions: The TLG was a safe and reliable procedure compared with the LAG with reduced trauma, faster recovery, and not more complications.
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Affiliation(s)
- Xiangyu Meng
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Lu Wang
- Department of Ultrasonography, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Bo Zhu
- Department of Information Management, The Information Center, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Ting Sun
- Department of Information Management, The Information Center, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Shuai Guo
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Yue Wang
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Jun Zhang
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Dong Yang
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Guoliang Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Tao Zhang
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Zhichao Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
| | - Yan Zhao
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, China
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Zhou W, Dong CZ, Zang YF, Xue Y, Zhou XG, Wang Y, Ding YL. Initial experience of single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction. World J Gastroenterol 2020; 26:4669-4679. [PMID: 32884224 PMCID: PMC7445872 DOI: 10.3748/wjg.v26.i31.4669] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Single incision plus one port left-side approach (SILS+1/L) totally laparoscopic distal gastrectomy (TLDG) is an emerging technique for the treatment of gastric cancer. Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy: relieving postoperative pain, shortening hospital stay and offering a better cosmetic outcome. Nevertheless, there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y (uncut R-Y) reconstruction.
AIM To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction (uncut R-Y reconstruction) to treat distal gastric cancer.
METHODS A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled. All patients were treated at The Second Hospital of Shandong University. Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler. The clinicopathological characteristics, surgical details, postoperative short-term outcomes, postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively.
RESULTS All SILS+1/L operations were performed by SILS+1/L TLDG successfully. The patient population included 13 men and 8 women with a mean age of 48.2 years (ranged from 40 years to 70 years) and median body mass index of 22.8 kg/m2. There were no conversions to open laparotomy, and no other port was placed. The mean operation time was 146 min (ranged 130-180 min), and the estimated mean blood loss was 54 mL (ranged 20-110 mL). The mean duration to flatus and discharge was 2.3 (ranged 1-3.5) and 7.3 (ranged 6-9) d, respectively. The mean number of retrieved lymph nodes was 42 (ranged 30-47). Two patients experienced mild postoperative complications, including surgical site infection (wound at the navel incision) and mild postoperative pancreatic fistula (grade A). Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively. No patients experienced moderate or severe food stasis, alkaline gastritis or bile reflux during the follow-up period. No recanalization of the biliopancreatic limb was found.
CONCLUSION SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.
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Affiliation(s)
- Wei Zhou
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Chang-Zheng Dong
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yi-Feng Zang
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Ying Xue
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Xing-Guo Zhou
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yu Wang
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yin-Lu Ding
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
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Han WH, Oh YJ, Eom BW, Yoon HM, Kim YW, Ryu KW. A comparative study of the short-term operative outcome between intracorporeal and extracorporeal anastomoses during laparoscopic total gastrectomy. Surg Endosc 2020; 35:1602-1609. [PMID: 32270275 DOI: 10.1007/s00464-020-07539-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several studies have reported that intracorporeal anastomosis reduces the requirement for the additional incision for anastomosis, resulting in early recovery compared to extracorporeal anastomosis during laparoscopic distal gastrectomy. However, few studies have investigated postoperative outcome after laparoscopic total gastrectomy (LTG). We compared short-term postoperative outcomes between totally laparoscopic total gastrectomy (TLTG) with intracorporeal anastomosis and conventional laparoscopy-assisted total gastrectomy (LATG) with extracorporeal anastomosis for gastric cancer. METHODS This retrospective case-control study included 202 patients who underwent LTG from January 2012 to June 2019. LATG was performed in the period before July 2015; TLTG was performed in the period after July 2015. Postoperative short-term outcomes and white blood cell (WBC) count, and C-reactive protein (CRP) levels at 1, 3, and 5 days postoperatively were compared between the groups. RESULTS One hundred ten patients underwent LATG; 92 underwent TLTG. The pathologic stage was significantly higher in the TLTG group (p = 0.010). Intraoperative estimated blood loss was significantly lower in the TLTG group than in the LATG group (median [range]: 100 [50-150] mL versus [vs.] 50 [30-100], p < 0.001). Postoperative hospital stay duration was significantly longer in the TLTG group than in the LATG group (median [range]: 7 [7-9] days vs. 8 [7-11], p < 0.001). WBC count (6.3 109/L ± 1.9 vs. 8.2 ± 2.5, p = 0.004) and CRP levels (8.3 mg/L ± 6.1 vs. 13.3 ± 9.4, p < 0.001) were lower in the LATG group than in the TLTG group. The overall complication rate was higher in the TLTG group than in the LATG group (16.3% vs. 32.6%, p = 0.007). A higher American Society of Anesthesiologist score was the only significant risk factor for postoperative complications. CONCLUSION Both procedures are feasible, although TLTG has more risk for postoperative complications than LATG. TLTG should be improved to reduce postoperative complications and provide better postoperative outcomes.
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Affiliation(s)
- Won Ho Han
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Yoon Jung Oh
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea.
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Jin HE, Kim MS, Lee CM, Park JH, Choi CI, Lee HH, Min JS, Jee YS, Oh J, Chae H, Choi SI, Lee YT, Kim JH, Huang H, Park S. Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer: Preliminary study for a multicenter prospective KLASS07 trial. Eur J Surg Oncol 2019; 45:2231-2240. [DOI: 10.1016/j.ejso.2019.06.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/05/2019] [Accepted: 06/21/2019] [Indexed: 12/23/2022] Open
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Milone M, Manigrasso M, Burati M, Elmore U, Gennarelli N, Cesare Giglio M, Maione F, Musella M, Lo Conte V, Milone F, Domenico De Palma G. Intracorporeal versus extracorporeal anastomosis after laparoscopic gastrectomy for gastric cancer. A systematic review with meta-analysis. J Visc Surg 2019; 156:305-318. [PMID: 30737053 DOI: 10.1016/j.jviscsurg.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM To perform a systematic review and meta-analyses of studies comparing the totally laparoscopic procedures with intracorporeal anastomosis (IA) to laparoscopic-assisted surgery with extracorporeal anastomosis (EA) in gastric resections. METHODS We performed a systematic search in the electronic databases. Outcomes analysed were: intraoperative (operative time and intraoperative blood loss), oncologic (harvested nodes, distance of the tumour from proximal and distal margin), postoperative complications (gastric stasis, intraluminal and extraluminal bleeding, leakage and wound infection) recovery (time to first flatus, time to first oral intake and hospital stay). We performed meta-regression analyses after implementing a regression model with the analysed outcomes as dependent variables (y) and the demographic and pathologic covariates as independent variables (x). RESULTS A total of 26 studies (20 on distal gastrectomy and 6 on total gastrectomy) were included in the final analysis. Regarding distal gastrectomy, there was no statistical difference between the two groups in the above-mentioned outcomes, except for intraoperative blood loss (less in IA group, P=0.003), number of harvested nodes (better in the IA group, P=0.022) and length of hospital stay (shorter in the IA group, P=0.037). Regarding total gastrectomy, there was no statistical difference for all outcomes, except for the distal margin (further in the EA group, P=0.040). Meta-regression analysis showed that a lot of variables influenced results in distal gastric resections, but not in total gastric resections. CONCLUSION We can state laparoscopic gastric resections with IA are safe and feasible when performed by expert surgeons. However, new well-designed studies comparing the two techniques are needed to confirm the benefits of laparoscopic IA.
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Affiliation(s)
- M Milone
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - M Manigrasso
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - M Burati
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - U Elmore
- Department of Gastrointestinal surgery, Vita Salute University, San Raffaele Scientific Institute, Via Olgettina Milano 58, 20132, Milan, Italy
| | - N Gennarelli
- Department of Surgery and Advanced Technologies, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - M Cesare Giglio
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - F Maione
- Department of Surgery and Advanced Technologies, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - M Musella
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - V Lo Conte
- Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - F Milone
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - G Domenico De Palma
- Department of Surgery and Advanced Technologies, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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Lee CM, Park JH, In Choi C, Lee HH, Min JS, Jee YS, Jeong O, Chae H, Choi SI, Huang H, Park S. A multi-center prospective randomized controlled trial (phase III) comparing the quality of life between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy for gastric Cancer (study protocol). BMC Cancer 2019; 19:206. [PMID: 30845995 PMCID: PMC6407283 DOI: 10.1186/s12885-019-5396-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/20/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND KLASS (the Korean Laparoendoscopic Gastrointestinal Surgery Study) is a time-honored study group that has established laparoscopic surgery for gastrointestinal disease in Korea and has performed some important studies for the rationale of laparoscopic gastrointestinal surgery. A multi-center RCT (randomized controlled trial) to compare the quality of life (QOL) of patients undergoing totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer, named as KLASS 07, has been currently prepared in Korea. METHODS Patients diagnosed as gastric cancer, with clinical stage IA (T1N0M0) or IB (T1N1M0 / T2N0M0) according to the 7th edition of the Americal Joint Committee on Cancer System, were randomized to receive either TLDG or LADG. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 gastrectomies and at least 30 gastrectomies annually (regardless of open or laparoscopic surgery for gastric cancer). The patients who are allocated to TLDG group undergo intracorporeal anastomosis and those who are assigned to LADG undergo extracorporeal anastomosis for gastrointestinal reconstruction. DISCUSSION Thirty-one surgeons from 26 institutions were engaged in this trial. The primary endpoint is 30-day morbidity, and secondary endpoint is QOL assessed by the questionnaire score. The KLASS 07 trial is the first multi-center RCT to investigate whether there are significant and quantifiable differences between the QOL of TLDG and LADG. The findings from this trial are expected to be the critical clues for designing the detailed procedures during laparoscopic surgery for gastric cancer. TRIAL REGISTRATION The protocol of KLASS 07 (CKLASS 01) was registered in http://register.clinicaltrials.gov as NCT03393182 (Date of registration: January 2nd, 2018.).
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Affiliation(s)
- Chang Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ji Ho Park
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang In Choi
- Department of Surgery, Medical Research Institute, Pusan National Universtiy Hospital, Busan, Korea
| | - Han Hong Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Science, Busan, Korea
| | - Ye Seob Jee
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Oh Jeong
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Hyundong Chae
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gang Dong, Seoul, Korea
| | - Hua Huang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. .,Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No.270 Dong an Road, Shanghai, 200032, China.
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea. .,Department of Surgery, Korea University Medical Center Anam Hospital, Inchon-ro 73, Seongbuk-gu, Seoul, 02841, Korea.
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Shao XX, Tian YT. Hot issues in minimally invasive surgery for gastric cancer. Shijie Huaren Xiaohua Zazhi 2018; 26:1149-1155. [DOI: 10.11569/wcjd.v26.i19.1149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Xin-Xin Shao
- Department of Oncological Surgery, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Chen B, Xiong D, Pan Z, Chen M, Liu G, Wang S, Ye Y, Xiao R, Zeng J, Li J, Huang Z. Totally laparoscopic verse laparoscopic assisted distal gastrostomy for gastric cancer: an update meta-analysis. Oncotarget 2018; 9:12333-12342. [PMID: 29552314 PMCID: PMC5844750 DOI: 10.18632/oncotarget.23895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/13/2017] [Indexed: 02/06/2023] Open
Abstract
Totally laparoscopic distal gastrostomy (TLDG) and laparoscopic- assisted distal gastrostomy (LADG) are the minimally invasive surgical technology for gastric cancer. This study aimed to compare the surgical outcomes of these two methods. Relevant studies were selected through electronic searches of EMBASE, PubMed and Web of Science. In total, 21 non-randomized controlled studies containing 2475 patients in the totally laparoscopic distal gastrostomy and 1889 patients in the laparoscopic-assisted distal gastrostomy were included in this study. And operative time, operative blood loss, retrieved lymph nodes, time to liquid diet (days), postoperative hospital stay and overall complications were pooled and compared using meta-analysis. There were no significant differences between operative time (WMD = 0.38, 95% CI –10.43 –11.18, P = 0.95) and overall complications (RR = 1.09, 95% CI 0.91–1.30, P = 0.36). But totally laparoscopic distal gastrostomy had more advantages in aspects of intraoperative blood loss (WMD = 24.4, 95% CI 12.45–36.36, P < 0.0001), time to liquid diet (days) (WMD = 0.21, 95% CI 0.03–0.40, P = 0.03) and postoperative hospital stay (WMD = 0.72, 95% CI 0.31–1.13, P = 0.0006). Moreover, totally laparoscopic distal gastrostomy had more retrieved lymph nodes (WMD = –1.24, 95% CI–1.90 to–0.58, P = 0.0002). This meta-analysis indicates that totally laparoscopic distal gastrostomy may be a safe, feasible, and favorable surgical technology in terms of less blood loss, faster liquid diet, shorter postoperative hospital stay and more lymph nodes retrieved.
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Affiliation(s)
- Borong Chen
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Disheng Xiong
- Department of Gastrointestinal Surgery, First Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Zirong Pan
- Department of General Surgery, Xiamen Haicang Hospital, Xiamen, China
| | - Mingyuan Chen
- Department of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Gang Liu
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Shengjie Wang
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yongzhi Ye
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Rui Xiao
- Department of Gastrointestinal Surgery, First Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Junjie Zeng
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jiayi Li
- Department of Medical Oncology, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhengjie Huang
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, Xiamen, China.,Department of Gastrointestinal Surgery, First Clinical Medical College of Fujian Medical University, Fuzhou, China
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Han WH, Yehuda AB, Kim DH, Yang SG, Eom BW, Yoon HM, Kim YW, Ryu KW. 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. Chin J Cancer Res 2018; 30:537-545. [PMID: 30510365 PMCID: PMC6232361 DOI: 10.21147/j.issn.1000-9604.2018.05.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
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±1.5vs. 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.
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Affiliation(s)
- Won Ho Han
- Center for Gastric Cancer, National Cancer Center, Goyang 410-769, Republic of Korea
| | - Amir Ben Yehuda
- Department of Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel
| | - Deok-Hee Kim
- Center for Gastric Cancer, National Cancer Center, Goyang 410-769, Republic of Korea
| | - Seung Geun Yang
- Center for Gastric Cancer, National Cancer Center, Goyang 410-769, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang 410-769, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang 410-769, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang 410-769, Republic of Korea
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A propensity score matched case-control comparative study of totally laparoscopic distal gastrectomy and laparoscopic-assisted distal gastrectomy for early gastric cancer. Eur Surg 2017. [DOI: 10.1007/s10353-017-0495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lee SH, Kim IH, Kim IH, Kwak SG, Chae HD. 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. [PMID: 26446446 PMCID: PMC4595817 DOI: 10.4174/astr.2015.89.4.176] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 05/04/2015] [Accepted: 05/07/2015] [Indexed: 02/07/2023] Open
Abstract
Purpose Laparoscopic gastrectomy is widely used to treat early gastric cancer. The advantages of totally laparoscopic distal gastrectomy (TLDG) are unproven, and some concerns remain regarding the early surgical outcomes due to its technical difficulty. We compared the early surgical outcomes and acute inflammatory response between patients undergoing TLDG and laparoscopy-assisted distal gastrectomy (LADG) for treatment of early gastric cancer. Methods We performed a retrospective study on 212 consecutive patients who underwent laparoscopic distal gastrectomy for gastric cancer between January 2008 and June 2014. A total of 179 LADG cases and 33 TLDG cases were included. After age, sex, body mass index, and American Society of Anesthesiologists physical status score were matched using propensity score matching (PSM), we compared the short-term surgical outcomes between the LADG and TLDG groups. Results The TLDG group had a shorter hospital stay (9.5 days vs. 11.0 days, P = 0.046) and less blood loss (116.6 mL vs. 141.5 mL, P = 0.031) than those in the LADG group. There were no differences in the preoperative WBC count and CRP level and the other clinical data between the two groups after PSM. Postoperative WBC count, serum CRP level, and decrease rate of WBC count in the TLDG group were significantly lower than those in the LADG group. Conclusion The short-term outcomes of TLDG revealed better than that of LADG in this study. Therefore, TLDG is one of the safe and feasible procedure for the treatment of early gastric cancer.
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Affiliation(s)
- Sang-Ho Lee
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - In-Ho Kim
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - In-Hwan Kim
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sang-Gyu Kwak
- Department of Medical Statistics, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyun-Dong Chae
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Zhang YX, Wu YJ, Lu GW, Xia MM. Systematic review and meta-analysis of totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer. World J Surg Oncol 2015; 13:116. [PMID: 25889971 PMCID: PMC4384388 DOI: 10.1186/s12957-015-0532-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 03/02/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Totally laparoscopic distal gastrectomy (TLDG) has been developed in the hope of improving surgical quality and overcoming the limitations of conventional laparoscopic assisted distal gastrectomy (LADG) for gastric cancer. The aim of this study was to determine the extent of evidence in support of these ideals. METHODS A systematic review of the two operation types (LADG and TLDG) was carried out to evaluate short-term outcomes including duration of operation, retrieved lymph nodes, estimated blood loss, resection margin status, technical postoperative complications, and hospital stay. RESULTS Twelve non-randomized observational clinical studies involving 2,255 patients satisfied the eligibility criteria. Operative time was not statistically different between groups (P > 0.05). The number of retrieved lymph nodes and the resection margin length in TLDG were comparable with those in LADG. Estimated blood loss was significantly less in TLDG than that in LAG (P < 0.01). Compared to LADG, TLDG also involved lesser postoperative hospital stay (P < 0.01) and earlier time to soft diet intake (P < 0.05). Time to flatus and postoperative complications were similar for those two operative approaches. CONCLUSIONS TLDG may be a technically safe, feasible, and favorable approach in terms of better cosmesis, less blood loss, and faster recovery compared with LADG.
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Affiliation(s)
- Yi-Xin Zhang
- Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China.
| | - Ying-Jie Wu
- Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China.
| | - Guo-Wen Lu
- Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China.
| | - Min-Ming Xia
- Department of Surgical Oncology, Yinzhou Affiliated Hospital of Medical College of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang, 315040, People's Republic of China.
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Comparison of the major postoperative complications between laparoscopic distal and total gastrectomies for gastric cancer using Clavien-Dindo classification. Surg Endosc 2015; 29:3196-204. [PMID: 25582964 DOI: 10.1007/s00464-014-4053-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/16/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Laparoscopy-assisted total gastrectomy (LATG) has not been as popular as laparoscopy-assisted distal gastrectomy (LADG) because of its undetermined safety and postoperative complications compared with LADG. Therefore, LATG requires further study. PATIENTS AND METHODS A total of 663 patients who underwent LADG or LATG for gastric cancer in a single institution from April 2004 to April 2014 were included. The clinicopathologic characteristics and risk factors related to major complications (Clavien-Dindo grade ≥ IIIa) were analyzed between the LADG (n = 569) and LATG groups (n = 94). RESULTS The incidence of major postoperative complications was significantly higher for LATG (LADG vs. LATG: 8.1 vs. 18.1 %, P = 0.002). Although postoperative bleeding was not different between the groups (3.2 vs. 3.2 %, P = 0.991), the incidence of bowel leakage was significantly higher for LATG (2.6 vs. 6.8 %, P = 0.028). Leakage from the anastomosis site was more frequent following LATG (5.3 %) compared with LADG (0.5 %) (P < 0.001). Leakage from the duodenal stump tended to be more frequent, though not significant, for LADG (2.0 vs. 1.1 %, P = 0.602). Advanced gastric cancer, LATG, and longer operation time were significant factors that affected the incidence of postoperative complications in a univariate analysis. In multivariate analysis, there were no independent risk factors, but LATG was nearly a significant, independent risk factor (odds ratio 1.89; 95 % CI 0.965-3.71, P = 0.063). CONCLUSION More major complications were observed for LATG, particularly with esophagojejunostomy. These results show that LATG is more invasive than LADG in terms of the postoperative morbidity. More caution and experience are needed when performing LATG.
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Kim KH, Kim SH, Kim MC. How much progress has been made in minimally invasive surgery for gastric cancer in Korea?: a viewpoint from Korean prospective clinical trials. Medicine (Baltimore) 2014; 93:e233. [PMID: 25526443 PMCID: PMC4603086 DOI: 10.1097/md.0000000000000233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Gastric cancer is the most common cancer in Korea. Because the incidence of gastric cancer is still high even with early detection and because of developments in surgical instruments and technological advances, minimally invasive surgery has rapidly become an accepted treatment for gastric cancer in Korea. Many Korean gastric surgeons have contributed to the rapid adaptation of minimally invasive surgery for gastric cancer: not only the Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) group, but also other expert surgeons after the 2000s. Thanks to their vigorous efforts involving active learning, education, workshops, academic communications, and international communications with active laparoscopic gastric surgeons in Korea, numerous results and well-designed large-scale clinical studies have been published or are actively ongoing, thus increasing its wide acceptance as an option for gastric cancer. Now, Korea has become one of the leading countries using minimally invasive surgery for the treatment of gastric cancer. This review article will summarize the current status and issues, as well as the clinical trials that have finished or are ongoing, regarding minimally invasive surgery for gastric cancer in Korea.
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Affiliation(s)
- Ki-Han Kim
- From the Department of Surgery, Dong-A University College of Medicine, Busan, Korea
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Chen K, Mou YP, Xu XW, Pan Y, Zhou YC, Cai JQ, Huang CJ. 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 2014; 194:367-374. [PMID: 25488721 DOI: 10.1016/j.jss.2014.10.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 09/21/2014] [Accepted: 10/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) are two commonly used methods of laparoscopic gastrectomy for gastric cancer. This study aimed to compare the short-term surgical outcomes of these two methods. METHODS A prospectively maintained gastric cancer database between October 2004 and February 2014 was reviewed and 115 patients underwent LADG and 198 patients underwent TLDG were included. The clinical characteristics and perioperative clinical outcomes of two groups were compared. Moreover, a systematic review and meta-analysis were conducted. RESULTS The mean operation time and blood loss were similar in two groups, as was the number of retrieved lymph nodes. There was no significant difference in time to first flatus, the time to restart oral intake, the length of the hospital stay after surgery, and postoperative complications. The meta-analysis revealed no significant differences in the operative time, surgical margin, time to first flatus, length of hospital stay, mortality, overall, and anastomosis-related complications among the groups. However, the intraoperative blood loss was lower in TLDG (weighted mean difference = 21.50 mL; 95% confidence interval: 9.79-33.22; P < 0.01), and number of retrieved lymph nodes was higher in TLDG (weighted mean difference = -1.56; 95% confidence interval: -2.69 to -0.44; P < 0.01). CONCLUSIONS TLDG is safe and feasible compared with LADG. However, it is difficult to identify the clinical advantages of TLDG over LADG based on our study. Thus, the choice of surgical approach mainly depends on the patient conditions and the preference of the patients or surgeons.
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Affiliation(s)
- Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Yi-Ping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China.
| | - Xiao-Wu Xu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Yu-Cheng Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Jia-Qin Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
| | - Chao-Jie Huang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou, China
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Abstract
Mini gastric bypass is a modification of Mason loop gastric bypass with a longer lesser curvature-based pouch. Though it has been around for more than 15 years, its uptake by the bariatric community has been relatively slow, and the procedure has been mired in controversy right from its early days. Lately, there seems to be a surge in the interest in this procedure, and there is now published experience with more than 5,000 procedures globally. This review examines the major controversial aspects of this procedure against the available scientific literature. Surgeons performing this procedure need to be aware of these controversies and counsel their patients appropriately.
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Zhang C, Xiao W, Chen K, Zhang Z, Du G, Jiang E, Yang H. A new intracorporeal Billroth II stapled anastomosis technique in totally laparoscopic distal gastrectomy. Surg Endosc 2014; 29:1636-42. [PMID: 25270612 DOI: 10.1007/s00464-014-3825-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND We introduced a new, safe and simple intracorporeal Billroth II (B-II) gastrojejunostomy technique using laparoscopic linear staplers with totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. We further compared the short-term operative outcomes between intracorporeal B-II gastrojejunostomy with TLDG and extracorporeal B-II gastrojejunostomy with laparoscopy-assisted distal gastrectomy (LADG). METHODS From January 01, 2012 to January 31, 2013, a total of 36 patients with gastric cancer underwent TLDG and LADG. Overall, 11 patients underwent intracorporeal B-II gastrojejunostomy with TLDG, and 25 patients underwent a mini-laparotomy incision for extracorporeal B-II anastomosis with LADG. Perioperative parameters, including patient and tumor characteristics, short-term postoperative outcomes, and anastomosis-related complications, were analyzed to compare the two operations. RESULTS The time to first flatus, the time on a liquid diet, and the mean postoperative length of hospital stay were significantly different between the groups (P < 0.05). In the TLDG group, the postoperative time to first flatus and the mean postoperative length of hospital stay were significantly shorter than in the LADG group (2.6 ± 0.20 vs. 3.8 ± 0.1 days; 10 ± 1.84 vs. 12.7 ± 3.35 days). However, the operation-related costs were significantly greater for totally laparoscopic distal gastrectomy (P < 0.001). The mean number of staples used in TLDG was six compared with four in LADG. CONCLUSION Our new intracorporeal B-II anastomosis method using laparoscopic linear staplers with TLDG was safe, feasible, and minimally invasive compared with extracorporeal B-II gastrojejunostomy with LADG. At the same time, one of its characteristics of our technique is to avoid stricturing of the efferent loop or afferent loop of the jejunum when the entry hole is closed with a stapler.
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Affiliation(s)
- Chaojun Zhang
- Department of General Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China,
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Han Y, Qu XL, Fu H. Gastric cancer surgery without nasogastric decompression. Shijie Huaren Xiaohua Zazhi 2014; 22:4075-4080. [DOI: 10.11569/wcjd.v22.i27.4075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nasogastric decompression (ND) has been used worldwide in gastric cancer surgery as a traditional way since Hunter pioneered. Most surgeons believe that using ND in abdominal surgery could relieve the internal pressure of anastomosis and reduce the incidence of anastomotic leakage. However, there has no strict scientific evidence for this obtained from medical studies, especially prospective studies. In recent years, several studies have shown that routine use of ND after surgery could not prevent anastomotic leakage or accelerate the recovery of bowel function, and surgery without ND did not increase the risk of anastomotic leakage. All kinds of gastric cancer surgery could be performed safely without ND, which greatly reduces the suffering of the patients, accelerates postoperative recovery, and reduces the workload significantly. If patients with pyloric obstruction or bleeding receive ND before surgery, nasogastric tube could be removed after they waked up. Gastric cancer surgery without ND is safe and deserves clinical popularization. This review summarizes the safety and significance of gastric cancer surgery without ND.
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Chen K, Mou YP, Xu XW, Cai JQ, Wu D, Pan Y, Zhang RC. Short-term surgical and long-term survival outcomes after laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer. BMC Gastroenterol 2014; 14:41. [PMID: 24568165 PMCID: PMC3939636 DOI: 10.1186/1471-230x-14-41] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 02/17/2014] [Indexed: 12/24/2022] Open
Abstract
Background Laparoscopic distal gastrectomy (LDG) for gastric cancer has gradually gained popularity. However, the long-term oncological outcomes of LDG have rarely been reported. This study aimed to investigate the survival outcomes of LDG, and evaluate the early surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG). Methods Clinical outcomes of 240 consecutive patients with gastric cancer who underwent LDG at our institution between October 2004 and April 2013 were analyzed. Early surgical outcomes of LADG and TLDG were compared and operative experiences were evaluated. Results Of the 240 patients, 93 underwent LADG and 147 underwent TLDG. There were 109 T1, 36 T2, 31 T3, and 64 T4a lesions. The median follow-up period was 31.5 months (range: 4–106 months). Tumor recurrence was observed in 40 patients and peritoneal recurrence was observed most commonly. The 5-year disease-free survival (DFS) and overall survival (OS) rates according to tumor stage were 90.3% and 93.1% in stage I, 72.7% and 67.6% in stage II, and 34.8% and 41.5% in stage III, respectively. No significant differences in early surgical outcomes were noted such as operation time, blood loss and postoperative recovery between LADG and TLDG (P >0.05). Conclusions LDG for gastric cancer had acceptable long-term oncologic outcomes. The early surgical outcomes of the two commonly used LDG methods were similar.
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Affiliation(s)
| | - Yi-Ping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China.
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Xiao SM, Gao XJ, Zhao P. Comparison between total laparoscopy and laparoscopy-assisted distal gastrectomy for gastric cancer. A meta-analysis based on Japanese and Korean articles. Saudi Med J 2014; 35:1318-23. [PMID: 25399207 PMCID: PMC4362143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the safety and feasibility of total laparoscopy distal gastrectomy (TLDG). METHODS This meta-analysis was conducted between April and July 2013 in Sichuan Cancer Hospital, Chengdu, China. We searched PubMed, EMBASE and China Knowledge Resource Integrated Database updated until May 2013. Eight retrospective studies and one prospective study involving 2,046 total patients were included. RESULTS The results showed that TLDG was associated with lower blood loss (mean difference=-22.39, p=0.04). and a greater number of harvested lymph nodes (mean difference=2.74, p=0.02). There was no significant difference between the 2 groups in operation time, time to first flatus, length of postoperative hospital stay, and postoperative complications. CONCLUSION Compared with laparoscopy-assisted distal gastrectomy, TLDG resulted in reduced blood loss, and a greater number of harvested lymph nodes. Total laparoscopy distal gastrectomy is safe and feasible for gastric cancer.
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Affiliation(s)
- Shuo-Meng Xiao
- From the Department of Gastro-Hepatic Surgery (Xiao, Zhao), Sichuan Cancer Hospital, and the Department of Ophthalmology (Gao), Chengdu First People's Hospital, Chengdu, China.
| | - Xiao-Jin Gao
- From the Department of Gastro-Hepatic Surgery (Xiao, Zhao), Sichuan Cancer Hospital, and the Department of Ophthalmology (Gao), Chengdu First People's Hospital, Chengdu, China.
| | - Ping Zhao
- From the Department of Gastro-Hepatic Surgery (Xiao, Zhao), Sichuan Cancer Hospital, and the Department of Ophthalmology (Gao), Chengdu First People's Hospital, Chengdu, China.,Address correspondence and reprint request to: Dr. Ping Zhao, Department of Liver and Stomach Surgery, Sichuan Cancer Hospital, No. 55 Renmin South Road, Chengdu, China. Tel/Fax. +86 (28) 85420845. E-mail:
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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. [PMID: 23678885 DOI: 10.1089/lap.2012.0580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic surgery has become common in the treatment of gastric cancer because of improvements of both surgical techniques and devices. The aim of this study was to compare totally laparoscopic distal gastrectomy (TLDG) with laparoscopically assisted distal gastrectomy (LADG) implemented by experienced laparoscopic surgeons. Studies and relevant literature regarding LADG versus TLDG were searched for in the PubMed and Embase databases. Operative time, volume of bleeding, number of retrieved lymph nodes, time to first flatus, duration of postoperative hospitalization, and postoperative complications in LADG and TLDG were pooled and compared by meta-analysis. Odds ratios (ORs) and weighted mean differences (WMDs) were calculated with 95% confidence intervals (CIs) to evaluate the effect of TLDG. Six recent studies of 1644 patients were included in the meta-analysis. Compared with LADG, TLDG had advantages of less bleeding (WMD -17.79, 95% CI -32.57 to -3.02, P=.02), shorter time to first flatus (WMD -0.14, 95% CI -0.23 to -0.06, P=.001), and shorter postoperative hospitalization (WMD -0.32, 95% CI -0.53 to -0.12, P=.002). Operative time, mean number of lymph nodes retrieved, and postoperative complication rate were not statistically different (P>.05). Compared with LADG, TLDG significantly reduced bleeding, time to first flatus, and postoperative hospital stay and can be considered a useful technique for patients with gastric cancer.
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Affiliation(s)
- Jun Gao
- Department of Gastrointestinal Surgery, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu Province, PR China
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Kim HG, Park JH, Jeong SH, Lee YJ, Ha WS, Choi SK, Hong SC, Jung EJ, Ju YT, Jeong CY, Park T. Totally laparoscopic distal gastrectomy after learning curve completion: comparison with laparoscopy-assisted distal gastrectomy. J Gastric Cancer 2013; 13:26-33. [PMID: 23610716 PMCID: PMC3627803 DOI: 10.5230/jgc.2013.13.1.26] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/04/2013] [Accepted: 03/06/2013] [Indexed: 12/21/2022] Open
Abstract
Purpose The aims are to: (i) display the multidimensional learning curve of totally laparoscopic distal gastrectomy, and (ii) verify the feasibility of totally laparoscopic distal gastrectomy after learning curve completion by comparing it with laparoscopy-assisted distal gastrectomy. Materials and Methods From January 2005 to June 2012, 247 patients who underwent laparoscopy-assisted distal gastrectomy (n=136) and totally laparoscopic distal gastrectomy (n=111) for early gastric cancer were enrolled. Their clinicopathological characteristics and early surgical outcomes were analyzed. Analysis of the totally laparoscopic distal gastrectomy learning curve was conducted using the moving average method and the cumulative sum method on 180 patients who underwent totally laparoscopic distal gastrectomy. Results Our study indicated that experience with 40 and 20 totally laparoscopic distal gastrectomy cases, is required in order to achieve optimum proficiency by two surgeons. There were no remarkable differences in the clinicopathological characteristics between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy groups. The two groups were comparable in terms of open conversion, combined resection, morbidities, reoperation rate, hospital stay and time to first flatus (P>0.05). However, totally laparoscopic distal gastrectomy had a significantly shorter mean operation time than laparoscopy-assisted distal gastrectomy (P<0.01). We also found that intra-abdominal abscess and overall complication rates were significantly higher before the learning curve than after the learning curve (P<0.05). Conclusions Experience with 20~40 cases of totally laparoscopic distal gastrectomy is required to complete the learning curve. The use of totally laparoscopic distal gastrectomy after learning curve completion is a feasible and timesaving method compared to laparoscopy-assisted distal gastrectomy.
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Affiliation(s)
- Han-Gil Kim
- Department Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea. ; Department Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
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Choi BS, Oh HK, Park SH, Park JM. 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. [PMID: 23610718 PMCID: PMC3627806 DOI: 10.5230/jgc.2013.13.1.44] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/05/2013] [Accepted: 03/06/2013] [Indexed: 12/27/2022] Open
Abstract
Purpose Laparoscopic gastrectomy has been adopted for the treatment of gastric cancer, and despite the technical difficulties, totally laparoscopic distal gastrectomy has been considered less invasive than laparoscopy-assisted distal gastrectomy. Although there have been many reports regarding the feasibility and safety of totally laparoscopic distal gastrectomy at large volume centers, few reports have been conducted at low-volume centers. The purpose of this study is to try to assess the feasibility and safety of totally laparoscopic distal gastrectomy at a low volume center through the analysis of short-term outcomes of totally laparoscopic distal gastrectomy compared with laparoscopy-assisted distal gastrectomy. Materials and Methods The clinical data and short-term surgical outcomes of 35 patients who had undergone laparoscopy-assisted distal gastrectomy between April 2007 and March 2010, and 37 patients who underwent totally laparoscopic distal gastrectomy between April 2010 and August 2012 were retrospectively reviewed. Results There was no significant difference in the demographic and clinical data. However the reconstruction method and extent of lymphadenectomy showed statistically significant differences. Operation time and estimated blood loss did not show significant differences. Surgical and medical complications did not show significant differences but postoperative courses including time-to-first oral intake and postoperative hospital stay were significantly increased. Conclusions Our study shows that totally laparoscopic distal gastrectomy is technically feasible at a low volume center. Therefore, totally laparoscopic distal gastrectomy can be considered as one of the surgical treatment for early gastric cancer. However the possibility that totally laparoscopic distal gastrectomy may have less benefit should also be considered.
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Affiliation(s)
- Byung Seo Choi
- Department of Surgery, National Medical Center, Seoul, Korea
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Jiang L, Yang KH, Guan QL, Cao N, Chen Y, Zhao P, Chen YL, Yao L. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials. Surg Endosc 2013; 27:2466-80. [PMID: 23361259 DOI: 10.1007/s00464-012-2758-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/12/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND We carry out a meta-analysis to evaluate the effectiveness and safety of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy for resectable gastric cancer. METHODS We searched EMBASE, the Cochrane Library, PubMed, Science Citation Index (SCI), Chinese biomedicine literature database to identify randomized controlled trials (RCTs) from their inception to April 2012. Meta-analyses were performed using RevMan 5.0 software. It was in line with the preferred reporting items for systematic reviews and meta-analyses statement. The quality of evidence was assessed by GRADEpro 3.6. RESULTS Eight RCTs totaling 784 patients were analyzed. Compared with open gastrectomy group, no significant differences were found in postoperative mortality (OR = 1.49; 95 % CI 0.29-7.79), anastomotic leakage (OR = 1.02; 95 % CI 0.24-4.27) , overall mean number of harvested lymph nodes [weighed mean difference (MD) = -3.17; 95 % CI -6.39 to 0.05]; the overall postoperative complication morbidity (OR = 0.54; 95 % CI 0.36-0.82), estimated blood loss (MD = -107.23; 95 % CI -148.56 to -65.89,) frequency of analgesic administration (MD = -1.69; 95 % CI -2.18 to -1.21, P < 0.00001), incidence of pulmonary complications (OR = 0.43, 95 % CI 0.20-0.93, P = 0.03) were significantly less in LAG group; LAG had shorter time to start first flatus (MD = -0.23; 95 % CI -0.41 to -0.05) and decreased hospital stay (MD = -1.72; 95 % CI -3.40 to 0.04), but, LAG still had longer operation time (MD = 76.70; 95 % CI 51.54-101.87). CONCLUSIONS On the basis of this meta-analysis we conclude that although LAG was still a time-consuming and technically dependent procedure, it has the advantage of better short-term outcome. Long term survival data from other studies are urgently needed to estimate the survival benefit of this technique.
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Affiliation(s)
- Lei Jiang
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Dong Gang Road, Cheng Guan District, Lanzhou 730000, Gansu, China
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