Abstract
Background
Laparoscopy-assisted distal gastrectomy (LADG) is generally considered superior to open distal gastrectomy (ODG) with regard to postoperative quality-of-life. Differences in postoperative pain may exist due to recent pain control techniques including epidural anesthesia. There is little evidence for this difference. In this article we report the results of our randomized single-blind study in LADG versus ODG. The aim of the present study was to evaluate differences in postoperative physical activity between LADG and ODG.
Methods
Forty patients with early gastric cancer (stage IA and IB) were registered in this randomized study. For strict evaluation, patients were not told about the type of operation until postoperative day 7. Postoperative physical activity was evaluated objectively by Active Tracer, which records the cumulative acceleration over a 24 h period to investigate differences in postoperative recovery. Questionnaire and visual analog scale score related to postoperative pain were also investigated.
Results
Significant differences were observed with a more favorable outcome noted in the LADG group with respect to intraoperative blood loss (P < 0.001), total amount of pain rescue (P < 0.001), wound size (P < 0.001), postoperative hospital stay (P < 0.001), and inflammatory parameters (C-reactive protein, SaO2, and duration of febrile period) (P < 0.001). Cumulative physical recovery to 70 % of the preoperative level was significantly shorter (by 3 days, P < 0.001) in the LADG group.
Conclusions
Comparison of LADG and ODG for patients with early gastric cancer showed favorable outcome and earlier recovery of physical activity in the LADG group.
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References
Kitano S, Iso Y, Moriyama M et al (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148
Adachi Y, Shiraishi N, Shiromizu A et al (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135:806–810
Reyes CD, Weber KJ, Gagner M et al (2001) Laparoscopic vs open gastrectomy: a retrospective review. Surg Endosc 15:928–931
Shimizu S, Uchiyama A, Mizumoto K et al (2000) Laparoscopically assisted distal gastrectomy for early gastric cancer: is it superior to open surgery? Surg Endosc 14:27–31
Yano H, Monden T, Kinuta M et al (2001) The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer. Gastric Cancer 4:93–97
Hayashi H, Ochiai T, Shimada H et al (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
Kitano S, Shiraishi N, Fujii K et al (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311
Wong DL, Baker CM (1988) Pain in children: comparison of assessment scales. Pediatr Nurs 14:9–17
Squirrell DM, Majeed AW, Troy G et al (1998) A randomized, prospective, blinded comparison of postoperative pain, metabolic response, and perceived health after laparoscopic and small incision cholecystectomy. Surgery 12:485–495
Majeed AW, Troy G, Nicholl JP et al (1996) Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy. Lancet 13(347):989–994
Kawamura H, Homma S, Yokota R et al (2008) Assessment of pain by face scales after gastrectomy: comparison of laparoscopically assisted gastrectomy and open gastrectomy. Surg Endosc 23:991–995
Nomura A, Kakinoki S, Takechi S et al (1996) Physical activity affects ambulatory blood pressure in normotensive and hypertensive elderly people. Cardiol Elderly 4:101–104
Tsukioka M, Kamo C, Kaneko M et al (1995) The effect of nipradilol on essential hypertension with cerebrovascular disease assessed by 24-hour ambulatory blood pressure monitoring [in Japanese]. Ther Res 16:1161–1169
Steele BG, Holt L, Belza B et al (2000) Quantitating physical activity in COPD using a triaxial accelerometer. Chest 117:1359–1367
Inoue Y, Kimura T, Noro H et al (2003) Is laparoscopic colorectal surgery less invasive than classical open surgery? Surg Endosc 17:1269–1273
Kim YW, Baik YH, Yun YH et al (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
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229
Weeks JC, Nelson H, Gelber S et al (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328
Huscher CG, Mingoli A, Sgarzini G et al (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237
Mochiki E, Kamiyama Y, Aihara R et al (2005) Laparoscopic assisted distal gastrectomy for early gastric cancer: five years’ experience. Surgery 137:317–322
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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 37, 2379–2386 (2013). https://doi.org/10.1007/s00268-013-2121-7
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DOI: https://doi.org/10.1007/s00268-013-2121-7