Abstract
Background
Several studies have reported that intracorporeal anastomosis reduces the requirement for the additional incision for anastomosis, resulting in early recovery compared to extracorporeal anastomosis during laparoscopic distal gastrectomy. However, few studies have investigated postoperative outcome after laparoscopic total gastrectomy (LTG). We compared short-term postoperative outcomes between totally laparoscopic total gastrectomy (TLTG) with intracorporeal anastomosis and conventional laparoscopy-assisted total gastrectomy (LATG) with extracorporeal anastomosis for gastric cancer.
Methods
This retrospective case–control study included 202 patients who underwent LTG from January 2012 to June 2019. LATG was performed in the period before July 2015; TLTG was performed in the period after July 2015. Postoperative short-term outcomes and white blood cell (WBC) count, and C-reactive protein (CRP) levels at 1, 3, and 5 days postoperatively were compared between the groups.
Results
One hundred ten patients underwent LATG; 92 underwent TLTG. The pathologic stage was significantly higher in the TLTG group (p = 0.010). Intraoperative estimated blood loss was significantly lower in the TLTG group than in the LATG group (median [range]: 100 [50–150] mL versus [vs.] 50 [30–100], p < 0.001). Postoperative hospital stay duration was significantly longer in the TLTG group than in the LATG group (median [range]: 7 [7–9] days vs. 8 [7–11], p < 0.001). WBC count (6.3 109/L ± 1.9 vs. 8.2 ± 2.5, p = 0.004) and CRP levels (8.3 mg/L ± 6.1 vs. 13.3 ± 9.4, p < 0.001) were lower in the LATG group than in the TLTG group. The overall complication rate was higher in the TLTG group than in the LATG group (16.3% vs. 32.6%, p = 0.007). A higher American Society of Anesthesiologist score was the only significant risk factor for postoperative complications.
Conclusion
Both procedures are feasible, although TLTG has more risk for postoperative complications than LATG. TLTG should be improved to reduce postoperative complications and provide better postoperative outcomes.
Similar content being viewed by others
References
Kim HH, Han SU, Kim MC et al (2019) Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage i gastric cancer: the KLASS-01 randomized clinical trial. JAMA Oncol 251:417–420
Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study G (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72
Han WH, Yehuda AB, Kim DH et al (2018) A comparative study of totally laparoscopic distal gastrectomy versus laparoscopic-assisted distal gastrectomy in gastric cancer patients: short-term operative outcomes at a high-volume center. Chin J Cancer Res 30:537–545
Park KB, Kwon OK, Yu W, Jang BC (2016) Body composition changes after totally laparoscopic distal gastrectomy with delta-shaped anastomosis: a comparison with conventional Billroth I anastomosis. Surg Endosc 30:4286–4293
Ikeda O, Sakaguchi Y, Aoki Y et al (2009) Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2374–2379
Korean Gastric Cancer Association Nationwide Survey on Gastric Cancer in 2014 (2016) J Gastric Cancer 16:131–140
Kodera Y, Yoshida K, Kumamaru H et al (2019) Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer 22:202–213
Kawaguchi Y, Shiraishi K, Akaike H, Ichikawa D (2019) Current status of laparoscopic total gastrectomy. Ann Gastroenterol Surg 3:14–23
Schweigert M, Solymosi N, Dubecz A, Gonzalez MP, Stein HJ, Ofner D (2014) One decade of experience with endoscopic stenting for intrathoracic anastomotic leakage after esophagectomy: brilliant breakthrough or flash in the pan? Am Surg 80:736–745
Kim SH, Son SY, Park YS, Ahn SH, Park DJ, Kim HH (2015) Risk factors for anastomotic leakage: a retrospective cohort study in a single gastric surgical unit. J Gastric Cancer 15:167–175
Shim JH, Yoo HM, Oh SI et al (2013) Various types of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. Gastric Cancer 16:420–427
Schardey HM, Joosten U, Finke U et al (1997) The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial. Ann Surg 225:172
Chen K, Wu D, Pan Y et al (2016) Totally laparoscopic gastrectomy using intracorporeally stapler or hand-sewn anastomosis for gastric cancer: a single-center experience of 478 consecutive cases and outcomes. World J Surg Oncol 14:115
Ahn CW, Hur H, Han SU, Cho YK (2013) Comparison of intracorporeal reconstruction after laparoscopic distal gastrectomy with extracorporeal reconstruction in the view of learning curve. J Gastric Cancer 13:34–43
Choi BS, Oh HK, Park SH, Park JM (2013) Comparison of laparoscopy-assisted and totally laparoscopic distal gastrectomy: the short-term outcome at a low volume center. J Gastric Cancer 13:44–50
Lee SH, Kim IH, Kim IH, Kwak SG, Chae HD (2015) Comparison of short-term outcomes and acute inflammatory response between laparoscopy-assisted and totally laparoscopic distal gastrectomy for early gastric cancer. Ann Surg Treat Res 89:176–182
Gong CS, Kim BS, Kim HS (2017) Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience. World J Gastroenterol 23:8553–8561
Kim EY, Choi HJ, Cho JB, Lee J (2016) Totally laparoscopic total gastrectomy versus laparoscopically assisted total gastrectomy for gastric cancer. Anticancer Res 36:1999–2003
Guideline Committee of the Korean Gastric Cancer Association, Developing Working Group Reivew, Panel. Korean Practice Guideline for Gastric Cancer (2018) An evidence-based, multi-disciplinary approach. J Gastric Cancer 2019(19):1–48
Lee J, Kim D, Kim W (2012) Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. J Korean Surg Soc 82:135–142
Chen K, He Y, Cai J-Q et al (2016) Comparing the short-term outcomes of intracorporeal esophagojejunostomy with extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. BMC Surg 16:13
Bracale U, Marzano E, Nastro P et al (2010) Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 24:2475–2479
Wang JB, Zheng CH, Li P et al (2017) Effect of comorbidities on postoperative complications in patients with gastric cancer after laparoscopy-assisted total gastrectomy: results from an 8-year experience at a large-scale single center. Surg Endosc 31:2651–2660
Lee JH, Paik YH, Lee JS et al (2007) Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol 14:1288–1294
Kawamura H, Ohno Y, Ichikawa N et al (2017) Anastomotic complications after laparoscopic total gastrectomy with esophagojejunostomy constructed by circular stapler (OrVil()) versus linear stapler (overlap method). Surg Endosc 31:5175–5182
Kyogoku N, Ebihara Y, Shichinohe T et al (2018) Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study. Langenbecks Arch Surg 403:463–471
Jung DH, Son SY, Park YS et al (2016) The learning curve associated with laparoscopic total gastrectomy. Gastric Cancer 19:264–272
Yasukawa D, Hori T, Kadokawa Y et al (2017) Impact of stepwise introduction of esophagojejunostomy during laparoscopic total gastrectomy: a single-center experience in Japan. Ann Gastroenterol 30:564–570
Acknowledgments
This work was supported by a Grant (NCC 1710160–3) from the National Cancer Center, Republic of Korea.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Won Ho Han, Yoon Jung Oh, Bang Wool Eom, Hong Man Yoon, Young-Woo Kim, Keun Won Ryu declare that they have no conflicts of interest or financial ties to disclose
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Han, W.H., Oh, Y.J., Eom, B.W. et al. A comparative study of the short-term operative outcome between intracorporeal and extracorporeal anastomoses during laparoscopic total gastrectomy. Surg Endosc 35, 1602–1609 (2021). https://doi.org/10.1007/s00464-020-07539-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-07539-y