Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases

Tanimura, Shinya; Higashino, Masayuki; Fukunaga, Yosuke; Takemura, Masashi; Tanaka, Yoshinori; Fujiwara, Yushi; Osugi, Harushi

doi:10.1007/s00464-008-9786-2

Cited by 93 publications

(54 citation statements)

References 5 publications

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“…In conventional LADG, techniques of taping vessels and pushing the pancreas downward after the duodenal transection are often used for complete dissection of lymph nodes around the common and proper hepatic arteries as well as the splenic artery [6]. In laparoscopic suprapancreatic lymph node dissection, better methods are required for improving the operative fi eld and handling the lymph node dissection.…”

mentioning

confidence: 99%

What technique is suitable for laparoscopic suprapancreatic lymph node dissection?

Kitano

2009

Gastric Cancer

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mentioning

confidence: 99%

What technique is suitable for laparoscopic suprapancreatic lymph node dissection?

Kitano

2009

Gastric Cancer

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“…Quality of life post operation is important for patients with early gastric cancer because they have a better postoperative prognosis [23]. LADG is widely performed for early gastric cancer in Japan since its introduction by Kitano et al [3][4][5][6]. However, LADG is technically a more complex operation compared with other laparoscopic procedures and still in the development phase.…”

Section: Discussionmentioning

confidence: 99%

“…In the initial 10 cases (training period), an experienced surgeon (ST) directly instructed the inexperienced surgeon (MT), who was a first assistant for the procedures, in the technique of laparoscopic gastrectomy. ST had already performed over 600 cases of laparoscopic gastrectomy for early gastric cancer [6], and MT had experienced open gastrointestinal surgery among 15 years and no prior experience performing LADG. MT had operated open gastrictomy over 200 cases.…”

Section: Methodsmentioning

confidence: 99%

“…Laparoscopy-assisted gastrectomy (LADG) for early gastric cancer has evolved and become rapidly accepted in Japan since it was first reported by Kitano et al [3][4][5]. LADG with regional lymph node dissection has recently become a treatment option for patients with early gastric cancer [6,7]. LADG has many advantages over conventional open distal gastrectomy (ODG): less invasiveness, blood loss, and postoperative pain, faster recovery, shortened hospital stay, and better cosmetic results [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy

Takemura¹,

Mayumi²,

Ikebe³

et al. 2013

IJCM

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Aim: Laparoscopy-assisted distal gastrectomy (LADG) with regional lymph node dissection is a treatment option for patient with early gastric cancer. However, LADG is a technically complex and advanced procedure, which is challenging for inexperienced surgeons. In this report, we retrospectively evaluated the learning curve for LADG of a single surgeon with no previous experience in LADG and the usefulness of direct instruction by a surgeon experienced in LADG in shortening the learning curve. Patients and Methods: This study was analyzed 80 consecutive patients, who underwent LADG by a single surgeon (first assistant in 10 cases and operator in 70 cases) between January 2008 and December 2012. Patients were divided into 3 sequential groups of 10 (training period), 30 (learning period), and 40 (operating period) cases in each group. Median operation time and estimated blood loss for these 3 groups were determined. Other learning indicators, including transfusion requirement, postoperative complications, number of lymph node harvested, and rate of conversion open gastrectomy, were also evaluated. Results: During the training period, median operation time and estimated blood loss were 219.5 min and 83.0 ml, respectively. During the learning period, the operation time was significantly longer than that of training period. In the operating period, the operation time was significantly lesser than that during the learning period. However, the operation time was not different from that during the training period and reached a plateau. The estimated blood loss during the operating period was significantly lesser than that during the learning period. The difference in the number of lymph nodes retrieved between each group was not significant. Conclusions: Direct instructions by an experienced surgeon can decrease the number of cases required for learning. Because LADG is technically more complex than other laparoscopic procedures, standardization of LADG and an effective training system for performing it should be established.

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“…Providing oncological outcomes similar to those obtained in a developed setting will further encourage and support the steady growth of laparoscopy for cancer in low income countries [12] [13] [14] [15] [16]. Currently, there are almost no data referring to the oncologic feasibility and the surgical safety of laparoscopic distal gastrectomy for cancer in the situation of limited equipment in developing countries.…”

Section: Introductionmentioning

confidence: 92%

Laparoscopy Assisted Distal Gastrectomy for Cancer at a Tertiary Center in Egypt. Is It Safe and Feasible?

Amin¹,

Salem²,

Fakhry³

et al. 2017

JCT

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Background: Laparoscopic radical gastrectomy for cancer has significant short-and long-term advantages. The feasibility and safety of laparoscopicdistal gastrectomy for cancer (LADG) is unclear in low to middle income countries as resources are limited. Therefore, the aim of this study was to evaluate the safety and feasibility of (LADG) in low to middle income countries; Egypt as an example. Methods: Thirty four Patients with stage I-II cancer at the pylorus and antrum have been enrolled for LADG between 2012 and 2015 with the reuse of single use vascular sealing device has been evaluated. Results: Finally 27 patients had been included in the study and successful LADG has been done for all selected cases. The average operative time was 151 ± 10 minutes. The average estimated blood loss was 73.3 ± 13 ml. No intra-operative complications have been recorded. The average time for postoperative patient ambulation was 9 hours (SD ± 1.8) and for oral fluid intake was 3.5 SD ± 1 days. The average duration of the hospital stay was 9.3 ± 1.2 days. The average number of retrieved lymph nodes was 21.7 ± 3.8 days. All the cases had free surgical margin. The median number of reuse of the vascular sealing device was 3.8 times (3 -5 times). Conclusion: Laparoscopic distal gastrectomy for cancer could be safe and feasible in developing countries and give similar results for that of developed countries. Safe reuse of single use expensive parts of some instruments for laparoscopy could help in utilization of these advanced surgeries in low to middle income countries. Long term follow up as well as comparative studies with open surgery are required.

show abstract

Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases

Abstract: The laparoscopic technique is not only less invasive, but also similarly safe and curative compared with open gastrectomy.

Cited by 93 publications

References 5 publications

What technique is suitable for laparoscopic suprapancreatic lymph node dissection?

What technique is suitable for laparoscopic suprapancreatic lymph node dissection?

Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy

Laparoscopy Assisted Distal Gastrectomy for Cancer at a Tertiary Center in Egypt. Is It Safe and Feasible?

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