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Laparoscopy assisted distal gastrectomy for T1 to T2 stage gastric cancer: a pilot study of three ports technique

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Abstract

Laparoscopy assisted distal gastrectomy (LADG) was first reported in 1994. Since then, it has gradually gained maturity. This procedure is less invasive than conventional open gastrectomy, and the oncologic outcomes are comparable. Recently, single-incision laparoscopic surgery (SILS) has been developed, which seems to be less invasive than conventional laparoscopic surgery. However, SILS technique is characterized by a limited working area, crowding and crossing of instruments which make it difficult to be applied for oncologic gastrectomy. In a trial to overcome SILS difficulties, the authors report their initial clinical experience of LADG with D1 lymphadenectomy using a novel 3-ports technique. Twenty-one patients have been enrolled for 3-ports laparoscopic gastrectomy. The patient’s demographic and perioperative data have been collected prospectively. The mean operative time in the first ten cases was 170 min and for the last eleven cases was 140 min (P = 0.01). The mean estimated blood loss was 65 ml. There was no use for additional ports or conversion to open surgery. There were no intra-operative major complications. The mean time for hospital stay was 9 days. One case of pneumonia and one death were the postoperative complications. The mean number of retrieved lymph nodes was 21 and all the cases had free surgical margin. Three-ports LADG with D1 lymphadenectomy could be a safe and oncologically feasible procedure; however, a prospective randomized controlled trial comparing three ports LADG with conventional multi-ports LADG is required. It is a step towards three-port total laparoscopic distal gastrectomy.

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References

  1. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth-I gastrectomy. Surg Laparosc Endosc 4(2):146–148

    CAS  PubMed  Google Scholar 

  2. Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19(2):168–173

    Article  PubMed  Google Scholar 

  3. Dulucq JL, Wintringer P, Stabilini C, Solinas L, Perissat J, Mahajna A (2005) Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study. Surg Endosc 19(7):933–938

    Article  PubMed  Google Scholar 

  4. De Manzoni G, Baiocchi GL, Framarini M et al (2014) The SIC-GIRCG 2013 Consensus Conference on Gastric Cancer. Updates Surg. 66(1):1–6. doi:10.1007/s13304-014-0248-1

  5. Zhao Y, Yu P, Hao Y et al (2011) Comparison of outcomes for laparoscopically assisted and open radical distal gastrectomy with lymphadenectomy for advanced gastric cancer. Surg Endosc 25(9):2960–2966

    Article  PubMed  Google Scholar 

  6. Du J, Zheng J, Li Y et al (2010) Laparoscopy-assisted total gastrectomy with extended lymph node resection for advanced gastric cancer–reports of 82 cases. Hepatogastroenterology 57(104):1589–1594

    PubMed  Google Scholar 

  7. Asakuma M, Hayashi M, Komeda K et al (2011) Impact of single port cholecystectomy on postoperative pain. Br J Surg 98(7):991–995

    Article  CAS  PubMed  Google Scholar 

  8. Sun DP, Wang WC, Wen KC et al (2011) Two-port laparoscopic common bile duct exploration with T-tube choledochostomy for management of choledocholithiasis: an initial clinical report. Am Surg 77(4):422–425

    PubMed  Google Scholar 

  9. Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahlis (2011) Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 254(1):22–27

  10. Qiu Z, Sun J, Pu Y, Jiang T, Cao J, Wu W (2011) Learning curve of transumbilical single incision laparoscopic cholecystectomy (SILS): a preliminary study of 80 selected patients with benign gallbladder diseases. World J Surg 35(9):2092–2101

    Article  PubMed  Google Scholar 

  11. Raakow R, Jacob DA (2011) Initial experience in laparoscopic single-port appendectomy: a pilot study. Dig Surg 28(1):74–79

    Article  PubMed  Google Scholar 

  12. Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Ouchi M, Hirasaki Y (2011) Single-incision laparoscopic colectomy for colon cancer: early experience with 31 cases. Dis Colon Rectum 54(6):705–710

    Article  PubMed  Google Scholar 

  13. Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T (2011) Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc 25(7):2400–2404

    Article  PubMed  Google Scholar 

  14. Kunisaki C, Makino H, Yamamoto N et al (2008) Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer. Surg Laparosc Endosc Percutan Tech 18(3):236–241

    Article  PubMed  Google Scholar 

  15. Kawamura H, Tanioka T, Funakoshi T, Takahashi M (2011) Dual-ports laparoscopy-assisted distal gastrectomy compared with conventional laparoscopy-assisted distal gastrectomy. Surg Laparosc Endosc Percutan Tech 21:429–433

    Article  PubMed  Google Scholar 

  16. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2):101–112

    Article  Google Scholar 

  17. Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours. Wiley, New York

    Google Scholar 

  18. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines (2010, ver. 3). Gastric Cancer 14:113–123. doi:10.1007/s10120-011-0042-4

    Article  Google Scholar 

  19. Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2007) Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival. Ann Surg 245(1):1–7

    Article  PubMed Central  PubMed  Google Scholar 

  20. Gill IS, Canes D, Aron M et al (2008) Single port transumbilical (E-NOTES) donor nephrectomy. J Urol 180(2):637–641

    Article  PubMed  Google Scholar 

  21. Hernandez JM, Morton CA, Ross S, Albrink M, Rosemurgy AS (2009) Laparoendoscopic single site cholecystectomy: the first 100 patients. Am Surg 75(8):681–686

    PubMed  Google Scholar 

  22. Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10(8):823–826

    Article  CAS  PubMed  Google Scholar 

  23. Amin Anwar Tawfik, Elsaba Tarek M, Amira Gamal (2014) Three ports laparoscopic resection for colorectal cancer: a step on refining of reduced port surgery. ISRN Surg. 2014:781549. doi:10.1155/2014/781549

    Google Scholar 

  24. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 131(1 Suppl):S306–S311

    Article  PubMed  Google Scholar 

  25. Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176

    Article  CAS  PubMed  Google Scholar 

  26. Kim YW, Baik YH, Yun YH (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727

    Article  PubMed  Google Scholar 

  27. Kawamura H, Ishii C (2012) Mechnical analysis of the formation of forceps and scope for single-port laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 22(4):168–175

    Article  Google Scholar 

  28. Verlato Giuseppe, Giacopuzzi Simone, Bencivenga Maria, Morgagni Paolo, De Manzoni Giovanni (2014) Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer. World J Gastroenterol 20(36):12883–12891. doi:10.3748/wjg.v20.i36.12883

    Article  PubMed Central  PubMed  Google Scholar 

  29. Zong L, Chen P (2011) Billroth I vs. Billroth II vs. Roux-en-Y following distal gastrectomy: a meta-analysis based on 15 studies. Hepatogastroenterology 58(109):1413–1424. doi:10.5754/hge10567

    Article  PubMed  Google Scholar 

  30. Xiong JJ, Altaf K, Javed MA et al (2013) Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol 19(7):1124–1134. doi:10.3748/wjg.v19.i7.1124

    Article  PubMed Central  PubMed  Google Scholar 

  31. Kunisaki C, Ono HA, Oshima T, Makino H, Akiyama H, Endo I (2012) Relevance of reduced-port laparoscopic distal gastrectomy: a pilot study. Dig Surg 29(3):261–268

    Article  PubMed  Google Scholar 

  32. Omori T, Tanaka K, Tori M, Ueshema S, Akamatsu H, Nishida T (2012) Intracorporeal circular-stapled Billroth I anastomosis in single-incision laparoscopic distal gastrectomy. Surg Endosc 26(5):1490–1494

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by a grant from Scientific Research Unit at South Egypt Cancer Institute (Grant no. 10/2013).

Conflict of interest

The Authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Asyut, Egypt

    Anwar Tawfik Amin

  2. Department of Clinical Oncology, South Egypt Cancer Institute, Assiut University, Asyut, Egypt

    Adel Gabr & Hamza Abbas

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  1. Anwar Tawfik Amin
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  2. Adel Gabr
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  3. Hamza Abbas
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Correspondence to Anwar Tawfik Amin.

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Amin, A.T., Gabr, A. & Abbas, H. Laparoscopy assisted distal gastrectomy for T1 to T2 stage gastric cancer: a pilot study of three ports technique. Updates Surg 67, 69–74 (2015). https://doi.org/10.1007/s13304-015-0279-2

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