Comparison of Laparoscopy-Assisted and Totally Laparoscopic Distal Gastrectomy: The Short-Term Outcome at a Low Volume Center

Abstract

PurposeLaparoscopic 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 MethodsThe 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.ResultsThere 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.ConclusionsOur 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.

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

“…Postoperative complication was not different between the two groups. Previous studies have reported no difference in the postoperative complications between LADG and TLDG ( 4 , 14 , 15 , 18 , 19 , 21 ). Theoretically, a reduction of incision size in the TLDG may reduce wound complication, but there is no significant difference in wound complication rate between the two approaches.…”

“…First, intracorporeal anastomosis requires more experience of performing laparoscopic surgery than LADG ( 9 ). Second, complications might increase with difficulty of manipulating the linear stapler in the early introductory period ( 13 , 14 ). Given that there were few large-scale randomized studies, the advantages of TLDG were debatable.…”

Systematic review and meta-analysis of totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer

“…The present analysis showed no statistically significant difference in the operation time of the two groups (WMD = 7.59 min; 95% CI, −8.08 to 23.25; P = 0.34) (Figure 2 ). Ten studies reported blood loss [ 16 - 18 , 20 , 21 , 23 - 27 ]. Intraoperative blood loss was significantly lower in the TLDG compared with the LADG group (WMD = 36.92 ml; 95% CI, 13.43 to 60.41 ml; P < 0.01) (Figure 3 ).…”

Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer in middle–low-volume centers in Western countries: a propensity score matching analysis

“…Recently, the CRITICS trial results showed that high-volume centers (≥ 21 procedures per year) were associated with higher both overall and disease-free survival, emphasizing the value of centralizing gastric cancer surgeries in the Western world [14]. On the other hand, some Korean studies revealed that LDG in lowvolume centers is feasible and safe [15,16]. Interestingly, Kim et al showed that the early surgical outcomes of LDG performed by the same surgeon in two different Korean hospital setting seems to be better when carried out in the high-volume center (> 1000 laparoscopic gastrectomies per year) [17].…”