Annals of Surgical Oncology

, Volume 22, Issue 6, pp 1836–1843 | Cite as

Does 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

  • Joohyun Woo
  • Joo-Ho LeeEmail author
  • Ki-Nam Shim
  • Hye-Kyung Jung
  • Hyung Mo Lee
  • Hyeon Kook Lee
Gastrointestinal Oncology



Resection and anastomosis in laparoscopic distal gastrectomy can be performed extracorporeally or intracorporeally. Most surgeons have performed laparoscopy-assisted distal gastrectomy (LADG) because of technical difficulties of intracorporeal anastomosis. However, totally laparoscopic distal gastrectomy (TLDG) has recently been attempted and is expected to be feasible and less invasive compared with LADG. In this study, we tried to evaluate the clinical effect of the difference of invasiveness between TLDG and LADG, by way of a randomized prospective trial.


From February 2011 to September 2013, a total of 110 patients with primary gastric cancer were randomly assigned to either TLDG or LADG. Clinicopathologic features, operative details, postoperative course, and quality of life (QoL) were compared between the two groups. QoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and gastric module STO22 at 2 weeks and 3 months after surgery.


The two groups were comparable in clinical and pathological characteristics. The proximal resection margin was significantly longer and the length of wound was shorter in the TLDG group. We could not find any significant difference in postoperative inflammatory parameters, postoperative pulmonary function, postoperative recovery, and QoL scores at 2 weeks and 3 months after surgery. There were no significant differences in complication rates.


This study suggests that TLDG is as safe and feasible as LADG in gastric cancer. The parameters used routinely in the clinical field to evaluate early surgical outcomes could not reflect the delicate difference in surgical invasiveness between TLDG and LADG.


Early Gastric Cancer Distal Gastrectomy Laparoscopic Gastrectomy Open Gastrectomy Open Distal Gastrectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.





Joohyun Woo, Joo-Ho Lee, Ki-Nam Shim, Hye-Kyung Jung, Hyung Mo Lee, and Hyeon Kook Lee declare no conflicts of interest.


  1. 1.
    Hottenrott C. Totally laparoscopic vs. laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc. 2010;24:961–3.Google Scholar
  2. 2.
    Kim YW, Baik YH, Yun YH, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721-7.CrossRefPubMedGoogle Scholar
  3. 3.
    Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS. The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg. 2008;248:793-9.CrossRefPubMedGoogle Scholar
  4. 4.
    Ohtani H, Tamamori Y, Noguchi K, et al. Meta-analysis of laparoscopy-assisted and open distal gastrectomy for gastric cancer. J Surg Res. 2011;171:479-85.CrossRefPubMedGoogle Scholar
  5. 5.
    Chen XZ, Hu JK, Yang K, Wang L, Lu QC. Short-term evaluation of laparoscopy-assisted distal gastrectomy for predictive early gastric cancer: a meta-analysis of randomized controlled trials. Surg Laparosc Endosc Percutan Tech. 2009;19:277-84.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005;19:168-73.CrossRefPubMedGoogle Scholar
  7. 7.
    Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc. 2009;23:1759-63.CrossRefPubMedGoogle Scholar
  8. 8.
    Kim MG, Kim KC, Kim BS, et al. A totally laparoscopic distal gastrectomy can be an effective way of performing laparoscopic gastrectomy in obese patients (body mass index ≥ 30). World J Surg. 2011;35:1327-32.CrossRefPubMedGoogle Scholar
  9. 9.
    Ikeda O, Sakaguchi Y, Aoki Y, et al. Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc. 2009;23:2374-9.CrossRefPubMedGoogle Scholar
  10. 10.
    Song KY, Park CH, Kang HC, et al. Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy? Prospective, multicenter study. J Gastrointest Surg. 2008;12:1015-21.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim BS, Yook JH, Choi YB, et al. Comparison of early outcomes of intracorporeal and extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A. 2011;21:387-91.CrossRefPubMedGoogle Scholar
  12. 12.
    Sugimoto M, Kinoshita T, Shibasaki H, et al. Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer. Surg Endosc. 2013;27:4291-6.CrossRefPubMedGoogle Scholar
  13. 13.
    Tanimura S, Higashino M, Fukunaga Y, et al. Respiratory function after laparoscopic distal gastrectomy: an index of minimally invasive surgery. World J Surg. 2006;30:1211-5.CrossRefPubMedGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Ford GT, Rosenal TW, Clergue F, Whitelaw WA. Respiratory physiology in upper abdominal surgery. Clin Chest Med. 1993;14:237-52.PubMedGoogle Scholar
  16. 16.
    Desai PM. Pain management and pulmonary dysfunction. Crit Care Clin. 1999;15:151–66.Google Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Joohyun Woo
    • 1
  • Joo-Ho Lee
    • 1
    Email author
  • Ki-Nam Shim
    • 2
  • Hye-Kyung Jung
    • 2
  • Hyung Mo Lee
    • 1
  • Hyeon Kook Lee
    • 1
  1. 1.Department of Surgery, Ewha Womans University School of MedicineEwha Womans University Mokdong HospitalSeoulKorea
  2. 2.Department of Internal Medicine, Ewha Womans University School of MedicineEwha Womans University Mokdong HospitalSeoulKorea

Personalised recommendations