Abstract
Objective
This study aimed to compare the short-term surgical outcomes and cost–benefits following totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for the treatment of gastric cancer.
Methods
Between April 2007 and December 2013, a total of 100 patients with gastric cancer underwent laparoscopic distal gastrectomy. The patients were classified into two groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed. The comparison between the groups was based on clinicopathological characteristics and surgical and economic outcomes.
Results
There were 57 and 43 patients who underwent TLDG and LADG, respectively. The patients’ demographics and tumor characteristics did not show any statistically significant differences with the exception for tumor location. In the LADG group, tumors were localized to relatively higher positions (p = 0.024) and received Roux-en-Y reconstruction more frequently (p < 0.001). There were no differences in the incidence of morbidity. Anastomotic leakage was not recorded in either group, although anastomotic stenosis occurred in one patient (1.8 %) after TLDG and in two patients (4.7 %) after LADG. Compared with the LADG group, the TLDG group was associated with significantly less operative blood loss (p < 0.001), a shorter time to oral intake (p = 0.012), and hospital stay (p = 0.018). The median operation costs were greater in the TLDG group than in the LADG group (¥982,000 in TLDG vs. ¥879,830 in LADG; p < 0.001), whereas the median total hospital costs were similar between the two groups (¥1302,665 in LADG vs. ¥1383,322 in TLDG: p = 0.119).
Conclusion
This study suggests that TLDG is as technically feasible, safe, and effective as LADG for treating patients with gastric cancer. Furthermore, TLDG is associated with equivalent total hospital costs compared with LADG. The increased operation cost is offset by the decreased costs associated with longer periods of hospitalization.
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References
Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open versus laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173
Ohtani H, Tamamori Y, Noguchi K, Azuma T, Fujimoto S, Oba H, Aoki T, Minami M, Hirakawa K (2010) A meta-analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer. J Gastrointest Surg 14:958–964
Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer. Ann Surg 241:232–237
Lee JH, Yom CK, Han HS (2009) Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 23:1759–1763
Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27:286–294
Kinoshita T, Shibasaki H, Oshiro T, Ooshiro M, Okazumi S, Katoh R (2011) Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer: a report of short-term outcomes. Surg Endosc 25:1395–1401
Song KY, Park CH, Kang HC, Kim JJ, Park SM, Jun KH, Chin HM, Hur H (2008) Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy? prospective, multicenter study. J Gastrointest Surg 12:1015–1021
Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Toh Y, Okamura T, Baba H (2009) Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2374–2379
Kanaji S, Harada H, Nakayama S, Yasuda T, Oshikiri T, Kawasaki K, Yamamoto M, Imanishi T, Nakamura T, Suzuki S, Tanaka K, Fujino Y, Tominaga M, Kakeji Y (2014) Surgical outcomes in the newly introduced phase of intracorporeal anastomosis following laparoscopic distal gastrectomy is safe and feasible compared with established procedures of extracorporeal anastomosis. Surg Endosc 28:1250–1255
Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma. 3rd English ed. Gastric Cancer 14:101–112
Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intra abdominal gastroduodenostomy. J Am Coll Surg 195:284–287
Sobin LH, Wittekind CH (2002) TNM classification of malignant tumors, 6th edn. Springer, Heidelberg
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Etoh T, Shiraishi N, Kitano S (2009) Current trends of laparoscopic gastrectomy for gastric cancer in Japan. Asian J Endosc Surg 2:18–23
Goh P, Tekant Y, Issac J, Kum CK, Ngoi SS (1992) The technique of laparoscopic Billroth II gastrectomy. Surg Laparosc Endosc 2:258–260
Nagasako Y, Satoh S, Isogaki J, Inaba K, Taniguchi K, Uyama I (2012) Impact of anastomotic complications on outcomes after laparoscopic gastrectomy for early gastric cancer. Br J Surg 99:849–854
Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese laparoscopic Surgery Study Group (2007) A multicenter study on oncological outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72
Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized trial (KLASS Trial). Ann Surg 251:417–420
Woo J, Lee JH, Shim KN, Jung HK, Lee HM, Lee HK (2014) Dose the difference of invasiveness between totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy lead to a difference in early surgical outcomes? a prospective randomized trial. Ann Surg Oncol 22:1836–1843
Sugimoto M, Kinoshita T, Shibasaki H, Kato Y, Gotohda N, Takahashi S, Konishi M (2013) Sort-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer. Surg Endosc 27:4291–4296
Ojima T, Iwahashi M, Nakamori M, Nakamura M, Takifuji K, Katsuda M, Iida T, Tsuji T, Hayata K, Yamaue H (2011) The impact of abdominal shape index of patients on laparoscopy-assisted distal gastrectomy for early gastric cancer. Langenbecks Arch Surg 397:437–445
Kumagai K, Hiki N, Nunobe S, Jiang X, Kubota T, Aikou S, Watanabe R, Tanimura S, Sano T, Kitagawa Y, Yamaguchi T (2011) Different features of complications with Billroth-I and Roux-en-Y reconstruction after laparoscopy-assisted distal gastrectomy. J Gastrointest Surg 15:2145–2152
Keller DS, Lawrence JK, Nobel T, Delaney CP (2013) Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery. Surg Endosc 27:4463–4468
Hardy KM, Kwong J, Pitzul KB, Vergis AS, Jackson TD, Urbach DR, Okrainec A (2014) A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution. Surg Endosc 28:1213–1222
Braga M, Vignali A, Zuliani W, Frasson M, Serio CD, Carlo VD (2005) Laparoscopic versus open colorectal surgery cost-benefit analysis in a single-center randomized trial. Ann Surg 242:890–896
Authors’ contributions
Toshihiko Shinohara contributed to study conception and design; Susumu Kawano, Yujiro Tanaka, Muneharu Fujisaki, Atsushi Watanabe, and Katsuhiro Yamamoto contributed to acquisition of data; Toshihiko Shinohara and Nobuyoshi Hanyu analyzed and interpreted the data; Toshihiko Shinohara drafted the manuscript; and Nobuyoshi Hanyu contributed to critical revision of manuscript.
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Drs. Toshihiko Shinohara, Susumu Kawano, Yujiro Tanaka, Muneharu Fujisaki, Atsushi Watanabe, and Nobuyoshi Hanyu, and Katsuhiro Yamamoto have no competing interests or financial disclosures.
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Shinohara, T., Kawano, S., Tanaka, Y. et al. Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison. Surg Endosc 30, 3573–3581 (2016). https://doi.org/10.1007/s00464-015-4656-1
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DOI: https://doi.org/10.1007/s00464-015-4656-1