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

Abstract

ObjectiveLaparoscopic 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. MethodsA 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.ResultsA 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. ConclusionsBased 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.

Comparison of short-term outcomes and quality of life in totally laparoscopic distal gastrectomy and totally robotic distal gastrectomy for clinical stage I–III gastric cancer: study protocol for a multi-institutional randomised clinical trial

“…According to these data, the incidence rate of complications after TLDG ranged from 11.8% to 19.0%. [28][29][30] Thus, we set the proportion in the TLDG group as 16.5%. For RDG, Lu's RCT study showed that patients in the RDG group reduced postoperative morbidity compared with LDG group (9.2% vs 17.6%, p=0.039).…”

Intraoperative gastroscopy to determine proximal resection margin during totally laparoscopic gastrectomy for patients with upper third gastric cancer

“…Totally laparoscopic gastrectomy (TLG) for gastric cancer requires that all procedures are completed using only laparoscopic devices but does not require additional minilaparotomy for specimen resection and anastomosis. Since this type of surgery results in less postoperative pain, rapid postoperative recovery, less blood loss, better cosmetic outcomes, and fewer complications relative to open or laparoscopy-assisted surgery that require laparotomy, more surgeons prefer it (4)(5)(6). However, an obstacle to TLG for gastric cancer is tumor localization without direct visualization or palpation to determine the area of stomach resection necessary, especially for patients with adenocarcinoma of the esophagogastric junction (EGJ).…”

Safety and Feasibility of No.12a Lymph Node Dissection by Portal Vein Approach in Radical Laparoscopic Gastrectomy for Gastric Cancer

“…In recent years, laparoscopic technology has developed rapidly, and laparoscopic gastrectomy with D2 lymphadenectomy has been recognized by the world medical community. 4 - 7 How to regularly, thoroughly and safely perform laparoscopic lymphadenectomy for GC is crucial for the therapeutic effect and prognosis of patients.…”