Skip to main content

Advertisement

SpringerLink
Log in

Surgical Outcomes of Reduced-Port Laparoscopic Gastrectomy Versus Conventional Laparoscopic Gastrectomy for Gastric Cancer: A Propensity-Matched Retrospective Cohort Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The technical feasibility and oncologic efficacy of reduced-port laparoscopic gastrectomy (RPG) for gastric cancer remain unclear.

Methods

A series of 767 patients with gastric cancer who underwent R0 laparoscopic gastrectomy were retrospectively matched for age, gender, American Society of Anesthesiology score, body mass index, surgeon, lymph node dissection, and pathologic stages by propensity scoring. Finally, data from 274 patients (74 conventional laparoscopic distal gastrectomy [CLDG] cases, 74 reduced-port distal gastrectomy [RPDG] cases, 63 conventional laparoscopic total gastrectomy [CLTG] cases, and 63, reduced-port total gastrectomy [RPTG] cases) were selected for analysis.

Results

Compared with the conventional group, the reduced-port group had significantly longer operation times (RPDG 265 min vs CLDG 239 min; p = 0.001 and RPTG 305 min vs CLTG 285 min; p = 0.012) and reduced blood loss (RPDG 48 ml vs CLDG 68 ml; p = 0.001 and RPTG 75 ml vs CLTG 110 ml; p = 0.026). The number of dissected lymph nodes was significantly higher in the CLDG group than in the RPDG group (38 vs 31; p = 0.002). Cosmetic satisfaction showed significant superiority in the reduced-port group compared with the conventional group. No significant difference was observed in overall survival (OS) (5-year OS: RPDG 100% vs CLDG 96.7%; p = 0.207 and RPTG 91.6% vs CLTG 91.8%; p = 0.615) or relapse-free survival (RFS) (5-year RFS: RPTG 92.3% vs CLTG 92.1%; p = 0.587).

Conclusions

The study results suggest that RPG for gastric cancer by an experienced surgeon is a feasible and safe technique. The RPG procedure can be presented to patients as one of the effective treatment options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC. Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006;202:874–80.

    Article  PubMed  Google Scholar 

  2. Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255:446–56.

    Article  PubMed  Google Scholar 

  3. Takiguchi S, Fujiwara Y, Yamasaki M, et al. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy: a prospective randomized single-blind study. World J Surg. 2013;37:2379–86.

    Article  PubMed  Google Scholar 

  4. Kunisaki C, Makino H, Kosaka T, et al. Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case-control study. Surg Endosc. 2012;26:804–10.

    Article  PubMed  Google Scholar 

  5. Fukunaga T, Hiki N, Kubota T, et al. Oncologic outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20:2676–82.

    Article  PubMed  Google Scholar 

  6. Inaki N, Etoh T, Ohyama T, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg. 2015;39:2734–41.

    Article  PubMed  Google Scholar 

  7. Park DJ, Han SU, Hyung WJ, et al. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Surg Endosc. 2012;26:1548–53.

    Article  PubMed  Google Scholar 

  8. Yu J, Hu J, Huang C, et al. The impact of age and comorbidity on postoperative complications in patients with advanced gastric cancer after laparoscopic D2 gastrectomy: results from the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group. Eur J Surg Oncol. 2013;39:1144–9.

    Article  CAS  PubMed  Google Scholar 

  9. Kim KH, Kim YM, Kim MC, Jung GJ. Is laparoscopy-assisted total gastrectomy feasible for the treatment of gastric cancer? A case-matched study. Dig Surg. 2013;30:348–54.

    PubMed  Google Scholar 

  10. Kunisaki C, Makino H, Oshima T, et al. Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc. 2011;25:1300–5.

    Article  PubMed  Google Scholar 

  11. LaFemina J, Viñuela EF, Schattner MA, Gerdes H, Strong VE. Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol. 2013;20:2975–83.

    Article  CAS  PubMed  Google Scholar 

  12. Kawamura H, Tanioka T, Shibuya K, Tahara M, Takahashi M. Comparison of the invasiveness between reduced-port laparoscopy-assisted distal gastrectomy and conventional laparoscopy-assisted distal gastrectomy. Int Surg. 2013;98:247–53.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T. Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc. 2011;25:2400–4.

    Article  PubMed  Google Scholar 

  14. Kawamura H, Tanioka T, Kuji M, Tahara M, Takahashi M. the initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy. Gastric Cancer. 2013;16:602–8.

    Article  PubMed  Google Scholar 

  15. Kunisaki C, Ono HA, Oshima T, Makino H, Akiyama H, Endo I. Relevance of reduced-port laparoscopic distal gastrectomy for gastric cancer: a pilot study. Dig Surg. 2012;29:261–8.

    Article  PubMed  Google Scholar 

  16. Kunisaki C, Makino H, Kimura J, et al. Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen. Gastric Cancer. 2015;18:868–75.

    Article  CAS  PubMed  Google Scholar 

  17. Sobin LH, Gospodarowicz MK, Wittekind C. International Union Against Cancer (UICC) TNM classification of malignant tumors. 8th ed. New York: Wiley; 2016.

    Google Scholar 

  18. Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2018, Version 5, in Japanese. Tokyo: Kanehara; 2018.

    Google Scholar 

  19. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: third english edition. Gastric Cancer. 2011;14:101–12.

    Article  Google Scholar 

  20. Lee TG, Lee IS, Yook JH, Kim BS. Totally laparoscopic total gastrectomy using the overlap method: early outcomes of 50 consecutive cases. Surg Endosc. 2017;31:3186–90.

    Article  PubMed  Google Scholar 

  21. Li X, Hong L, Ding D, et al. Comparison of OrVil and RPD in laparoscopic total gastrectomy for gastric cancer. Surg Endosc. 2017;31:4773–9.

    Article  PubMed  Google Scholar 

  22. Shi Y, Xu X, Zhao Y, et al. Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc. 2018;32:2427–33.

    Article  PubMed  Google Scholar 

  23. Nakauchi M, Suda K, Nakamura K, et al. Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional, and oncological outcomes. Surg Endosc. 2017;31:4631–40.

    Article  PubMed  Google Scholar 

  24. Kim SM, Ha MH, Seo JE, et al. Comparison of reduced-port totally laparoscopic distal gastrectomy (Duet TLDG) and conventional laparoscopic-assisted distal gastrectomy Ann Surg Oncol. 2015;22:2567–72.

    Article  PubMed  Google Scholar 

  25. Jeong O, Park YK, Ryu SY. Early experience of due to laparoscopic distal gastrectomy (duet-LDG) using three abdominal ports for gastric carcinoma: surgical technique and comparison with conventional laparoscopic distal gastrectomy. Surg Endosc. 2016;30:3559–66.

    Article  PubMed  Google Scholar 

  26. Oh SD, Oh SJ. Three-port versus five-port laparoscopic distal gastrectomy for early gastric cancer patients: a propensity score-matched case-control study. J Invest Surg. 2017;22:1–9.

    Article  Google Scholar 

  27. Seo HS,. Song KY, Jung YJ, Kim JH, Park CH, Lee HH. Right-side approach-duet totally laparoscopic distal gastrectomy (R-Duet TLDG) using a three-port to treat gastric cancer. J Gastrointest Surg. 2018;22:578–86.

    Article  PubMed  Google Scholar 

  28. Kashiwagi H, Kumagai K, Monma E, Nozue M. Dual-port distal gastrectomy for the early gastric cancer. Surg Endosc. 2015;29:1321–6.

    Article  PubMed  Google Scholar 

  29. Kim HB, Kim SM, Ha MH, et al. Comparison of reduced port totally laparoscopic-assisted total gastrectomy (Duet TLTG) and conventional laparoscopic-assisted total gastrectomy. Surg Laparosc Endosc Percutan Tech. 2016;26:e132–6.

    Article  PubMed  Google Scholar 

  30. Seo HS, Lee HH. Is the 5-ports approach necessary in laparoscopic gastrectomy? Feasibility of reduced-port totally laparoscopic gastrectomy for the treatment of gastric cancer: a prospective cohort study. Int J Surg. 2016;29:118–22.

    Article  PubMed  Google Scholar 

  31. Kim SM, Ha MH, Seo JE, et al. Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer. Surg Endosc. 2016;30:3950–7.

    Article  PubMed  Google Scholar 

  32. Seo HS, Lee HH. Short-term outcomes of three-port totally laparoscopic distal gastrectomy in the treatment of gastric cancer: comparison with a four-port approach using a propensity score-matching analysis. J Laparoendosc Adv Surg Tech A. 2016;26:531–5.

    Article  PubMed  Google Scholar 

  33. 33 Lee S, Kim JK, Kim YN, et al. Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial. Surg Endosc. 2017;31:4002–9.

    Article  PubMed  Google Scholar 

  34. Kodera Y. Reduced-port surgery for gastric cancer: another giant leap for mankind? Gastric Cancer. 2013;16:457–9.

    Article  PubMed  Google Scholar 

  35. Kunisaki C, Makino H, Yamaguchi N, et al. Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer. Surg Endosc. 2016;30:5520–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan

    Chikara Kunisaki MD, PhD, Hiroshi Miyamoto MD, PhD, Sho Sato MD, PhD, Yusaku Tanaka MD, Kei Sato MD & Norio Yukawa MD, PhD

  2. Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan

    Yusuke Izumisawa MD, Takashi Kosaka MD, PhD, Hirotoshi Akiyama MD, PhD & Itaru Endo MD, PhD

  3. Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Japan

    Yusuke Saigusa PhD, Kentaro Sakamaki PhD & Takeharu Yamanaka PhD

  4. Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Kentaro Sakamaki PhD

Authors
  1. Chikara Kunisaki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Miyamoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sho Sato MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yusaku Tanaka MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kei Sato MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yusuke Izumisawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Norio Yukawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takashi Kosaka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hirotoshi Akiyama MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yusuke Saigusa PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kentaro Sakamaki PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Takeharu Yamanaka PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Itaru Endo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chikara Kunisaki MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kunisaki, C., Miyamoto, H., Sato, S. et al. Surgical Outcomes of Reduced-Port Laparoscopic Gastrectomy Versus Conventional Laparoscopic Gastrectomy for Gastric Cancer: A Propensity-Matched Retrospective Cohort Study. Ann Surg Oncol 25, 3604–3612 (2018). https://doi.org/10.1245/s10434-018-6733-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6733-x

Keywords

Search

Navigation