Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience. World J Gastroenterol 2017; 23(48): 8553-8561 [PMID: 29358863 DOI: 10.3748/wjg.v23.i48.8553]
Corresponding Author of This Article
Hee Sung Kim, PhD, Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. vangogh420@amc.seoul.kr
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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World J Gastroenterol. Dec 28, 2017; 23(48): 8553-8561 Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8553
Table 1 Clinical characteristics of patients who underwent laparoscopic-assisted total gastrectomy and totally laparoscopic total gastrectomy
Variable
LATG, n = 266
TLTG, n = 421
P value
Age in years, mean ± SD
55.69 ± 11.96
57.78 ± 11.20
0.020
Sex
0.583
Male
167 (62.8)
273 (64.8)
Female
99 (37.2)
148 (35.2)
ASA score
0.064
I
181 (68.0)
249 (59.1)
II
68 (25.6)
145 (34.4)
III
17 (6.4)
27 (6.4)
BMI in kg/m2
0.883
< 23
119 (44.7)
198 (47.0)
≥ 23, < 25
70 (26.3)
103 (24.5)
≥ 25, < 30
69 (25.9)
110 (26.1)
≥ 30
8 (3.0)
10 (2.4)
History of abdominal surgery
33 (12.4)
85 (20.2)
0.008
Table 2 Pathologic results of the laparoscopic-assisted total gastrectomy and totally laparoscopic total gastrectomy groups
Variable
LATG, n = 266
TLTG, n = 421
P value
Tumor size in cm
3.72 ± 2.47
3.95 ± 2.90
0.302
Retrieved lymph nodes, n
34.91 ± 13.92
40.04 ± 15.59
< 0.001
metastatic lymph nodes, n
0.63 ± 2.59
0.82 ± 3.20
0.421
Proximal margin in cm
3.85 ± 3.11
2.68 ± 2.62
< 0.001
Distal margin in cm
12.72 ± 4.86
12.79 ± 4.67
0.870
TNM (AJCC/UICC) staging
0.395
IA
202 (75.9)
285 (67.7)
IB
26 (9.8)
52 (12.4)
IIA
19 (7.1)
40 (9.5)
IIB
8 (3.0)
22 (5.2)
IIIA
5 (1.9)
8 (1.9)
IIIB
4 (1.5)
11 (2.6)
IIIC
2 (0.8)
3 (0.7)
Table 3 Early surgical outcomes in patients undergoing laparoscopic-assisted total gastrectomy and totally laparoscopic total gastrectomy
Variables
LATG, n = 266
TLTG, n = 421
P value
Operation time in min
170 (65-453)
149 (75-342)
< 0.001
Hematocrit change in (%)
4.04 (-3.8-15.2)
3.49 (-4.9-18.6)
0.002
Intra-operative transfusion
1 (0.4)
1 (0.2)
1.000
Post operative transfusion
28 (10.5)
55 (13.1)
0.32
Intra-operative event
27 (10.2)
13 (3.1)
< 0.001
Intra-operative anastomosis event
19 (7.1)
10 (2.4)
0.003
Combined operation
17 (6.4)
27 (6.4)
1.000
Time to first flatus in d (range)
3.60 (1-7)
3.30 (1-7)
< 0.001
Time to soft diet in d (range)
4.61 (2-68)
4.30 (3-36)
< 0.001
Pick of pain score, score (range)
7.11 (2-10)
6.96 (3-10)
0.912
8AM Pain socre of POD #1, score (range)
3.45 (0-10)
3.49 (0-10)
0.841
8AM Pain socre of POD #3, score (range)
2.44 (0-9)
2.54 (0-7)
0.529
8AM Pain socre of POD #5, score (range)
1.75 (0-10)
1.51 (0-8)
0.055
Number of administration of analgesics, n (range)
2.49 (0-69)
2.86 (0-67)
0.131
Post-operative hospital stay in d (range)
7.02 (5-1117)
6.75 (4-82)
0.005
Table 4 Early and late postoperative complications n (%)
Early complications
Late complications
LATG, n = 266
TLTG, n = 421
P value
LATG, n = 266
TLTG, n = 421
P value
CDC
0.447
0.681
0
213 (80.1)
334 (79.3)
245 (92.1)
384 (91.2)
1
24 (9.0)
26 (6.2)
10 (3.8)
15 (3.6)
2
13 (4.9)
26 (6.2)
0 (0)
4 (1.0)
3
12 (4.5)
33 (7.8)
11 (4.1)
18 (4.3)
4
4 (1.5)
2 (0.5)
0 (0)
0 (0)
Cx of EJ
0.211
0.439
None
252 (94.7)
407 (96.7)
262 (98.5)
418 (99.3)
Leakage
14 (5.3)
14 (3.3)
1 (0.4)
1 (0.2)
Stricture
0 (0.0)
0 (0.0)
3 (1.1)
2 (0.5)
Table 5 Postoperative complications in patients who underwent laparoscopic-assisted total gastrectomy and totally laparoscopic total gastrectomy n (%)
LATG, n = 266
TLTG, n = 421
Bleeding
4 (1.50)
8 (1.90)
EJ leakage
15 (5.64)
15 (3.56)
EJ stricture
3 (1.13)
2 (0.48)
Intraabdominal fluid collection
8 (3.01)
26 (6.18)
Internal hernia
5 (1.88)
12 (2.85)
Mechanical ileus
10 (3.76)
28 (6.65)
Paralytic ileus
3 (1.13)
7 (1.66)
Wound infection
18 (6.77)
9 (2.14)
Other surgical complications
4 (1.50)
8 (1.90)
Medical complications
4 (1.50)
2 (0.48)
Citation: Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience. World J Gastroenterol 2017; 23(48): 8553-8561