Laparoscopic D2 plus complete mesogastrium excision using the "enjoyable space" approach versus conventional D2 total gastrectomy for local advanced gastric cancer: short-term outcomes.

Aim The aim of the study was to compare the outcomes of robot-assisted (RAGD2) and laparoscopy-assisted gastrectomy with D2 lymphadenectomy (LAGD2) for patients with gastric cancer. Material and methods Relevant articles published up to September 2020 were searched. The weighted mean difference (WMD) was used to pool continuous variables, while risk ratio (RR) was calculated for dichotomous outcomes. Results RAGD2 required a longer operating time (WMD = 29.78, 95% confidence interval (CI): 15.97–43.59) and had less operative blood loss (WMD = − 31.93, 95% CI: − 44.03 to − 19.83), shorter time to first flatus (WMD = − 0.13, 95% CI: − 0.22 to − 0.04), shorter time to liquid diet (WMD = − 0.20, 95% CI: − 0.28 to 0.12), and fewer severe complications (RR = 0.62, 95% CI: 0.43–0.90) and overall complications (RR = 0.75, 95% CI: 0.62–0.91) than LAGD2. Conclusions RAGD2 could be beneficial in reducing operative blood loss and postoperative complications relative to LAGD2.

Section: Discussionmentioning

confidence: 97%

Comparison of short-term outcomes of robotic-assisted and laparoscopic-assisted D2 gastrectomy for gastric cancer: a meta-analysis.

Zhang

Feng

et al. 2021

“…Laparoscopic gastrectomy is a complex procedure that includes lymph node dissection and various intestinal anastomoses [ 17 , 18 ], requiring a considerable learning curve to overcome [ 1 , 15 ]. The learning curve, the definition of which is clearly arbitrary, depends on factors such as the talent of surgeons, quality of teaching programs, and amount of experience of the surgeons [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

First experience of junior surgeons with laparoscopic distal gastrectomy: in view of comparison with experienced surgeons.

Park¹,

Lee²,

Kim³

2020

Introduction Laparoscopic surgery is not easily performed by junior surgeons who have limited experience. Aim To investigate the safety and feasibility of the first experience of junior surgeons with laparoscopic distal gastrectomy (LDG) who were trained in super high-volume centers. Material and methods Clinicopathological data from the first 85 LDG cases performed by three gastric cancer surgeons were collected. All three surgeons were trained for > 1 year in super high-volume centers. The surgical and postoperative outcomes of the first experiences of junior surgeons were compared with the short-term outcomes reported in a multicenter randomized controlled trial (Korean Laparoendoscopic Gastrointestinal Surgery Study, KLASS-01 trial), conducted by the KLASS group, which is composed of experienced surgeons who practice in a high-volume center. Results A significantly greater number of older patients with longer operation times and lower estimated blood loss was observed for the junior surgeons than in the KLASS data. Although junior surgeons performed significantly more Billroth II anastomoses with D1+ lymph node dissection, there was no difference between the two groups in terms of hospital stay, number of retrieved lymph nodes, or postoperative morbidity. Conclusions The surgical outcomes of early gastric cancer managed by laparoscopic surgery performed by well-trained beginners were similar to the outcomes reported in the large-scale trial. Therefore, with regard to the surgical training system, training at super high-volume centers may be considered to provide some assurance in terms of surgical technique-related safety.

“…The enjoyable space approach and SPLT reconstruction have been reported previously in the literature [ 10 , 19 ]. The procedure can be briefly described as follows.…”

Section: Methodsmentioning

confidence: 99%

“…Although the prognosis of colorectal cancer has significantly improved due to the widespread application of complete mesenteric excision, the concept and importance of complete mesogastrium excision (CME) have not yet been widely recognized and effectively evaluated in curative gastrectomy [15][16][17][18]. Our previous study presented the "enjoyable space" approach to achieve D2 + CME and confirmed its feasibility and safety in the LATG procedure [19]. However, this technique has not yet been further appraised in TLTG.…”

Section: Introductionmentioning

confidence: 98%

Totally laparoscopic total gastrectomy using the "enjoyable space" approach coupled with self-pulling and latter transection reconstruction versus laparoscopic-assisted total gastrectomy for upper gastric cancer: short-term outcomes.

Qiu¹,

Zheng²,

Liang³

et al. 2022

Self Cite

Introduction: With the development of minimally invasive surgery in recent years, totally laparoscopic total gastrectomy (TLTG) has attracted more attention.Aim: To introduce the more comprehensive "enjoyable space" approach coupled with the self-pulling and latter transaction (SPLT) reconstruction technique to perform TLTG and investigate its safety and feasibility. Material and methods: Ninety-seven patients with primary upper gastric cancer underwent laparoscopic radical total gastrectomy between January 2020 and December 2020. Among these patients, 46 underwent laparoscopic-assisted total gastrectomy (LATG), and 51 underwent TLTG. We compared the clinicopathological characteristics, surgical outcomes and postoperative complications between the two groups. Results: There were no significant differences in the clinicopathological characteristics between the two groups (p > 0.05). However, the TLTG group had a slightly lower mean operative time and mean blood loss than the LATG group (p < 0.05 each). Although there were similarities in the mean times to first flatus, liquid diet, and soft diet, the duration of hospital stay was significantly reduced in the TLTG group (p < 0.05). No significant differences in overall complications and E-J-related complications were found between the two groups (15.2% vs. 25.4%, p > 0.05). Conclusions: TLTG is a safe and feasible procedure for treating upper gastric cancer. The enjoyable space approach in conjunction with SPLT reconstruction is an appropriate comprehensive technique with several advantages over LATG.