Skip to main content

Advertisement

SpringerLink
Log in

Is Totally Laparoscopic Gastrectomy Less Invasive Than Laparoscopy-assisted Gastrectomy?: Prospective, Multicenter Study

  • original article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic surgery has been adopted for the treatment of gastric cancer, and many reports have confirmed its favorable outcomes. Most surgeons prefer to laparoscopy-assisted gastrectomy using minilaparotomy rather than totally laparoscopic procedures because of technical difficulties of intracorporeal anastomosis. We conducted this study to compare laparoscopy-assisted distal gastrectomy with totally laparoscopic distal gastrectomy. In addition, laparoscopic procedures were compared with open distal gastrectomy.

Material and methods

This prospective, nonrandomized, multicenter study enrolled 60 patients with early gastric cancer at three branch hospitals of our institutes. Twenty-five- to 30-cm-long mid-line incision, 5-cm midline or transverse incision, and 3-cm U-shaped incision were used in open distal gastrectomy, laparoscopy-assisted distal gastrectomy, and totally laparoscopic distal gastrectomy, respectively. Postoperative outcomes, immunologic changes, and operation-related costs were compared between the three groups.

Results

There was no difference in gender, mean age, body mass index, and tumor characteristics between the three groups. No operation-related death occurred. Estimated blood loss, number of additional analgesics use, first flatus, and soft meal diet time were significantly different between the three groups (P < 0.05). In totally laparoscopic distal gastrectomy, the time to first flatus was significantly shorter than laparoscopy-assisted distal gastrectomy (3.7 vs. 2.8 days, in laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy, respectively, P < 0.05). White blood cell count and C-reactive protein level at postoperative day 1 were significantly higher in open distal gastrectomy than the other groups; however, there was no difference between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy. The operation-related costs were significantly greater in totally laparoscopic distal gastrectomy (P < 0.05).

Conclusion

Although totally laparoscopic distal gastrectomy needs more cost, totally laparoscopic distal gastrectomy provides shorter bowel recovery time than laparoscopy-assisted distal gastrectomy.

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

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Lee HJ, Yang HK, Ahn YO. Gastric cancer in Korea. Gastric Cancer 2002;5:177–182.

    Article  PubMed  Google Scholar 

  2. Park CH, Song KY, Kim SN. Treatment results for gastric cancer surgery: 12 years’ experience at a single institute in Korea. Eur J Surg Oncol 2008;34:36–41.

    PubMed  CAS  Google Scholar 

  3. Shimada S, Yagi Y, Shiomori K, Honmyo U, Hayashi N, Matsuo A, Marutsuka T, Ogawa M. Characterization of early gastric cancer and proposal of the optimal therapeutic strategy. Surgery 2001;129:714–719.

    Article  PubMed  CAS  Google Scholar 

  4. Hyung WJ, Cheong JH, Kim J, Chen J, Choi SH, Noh SH. Application of minimally invasive treatment for early gastric cancer. J Surg Oncol 2004;85:181–185.

    Article  PubMed  Google Scholar 

  5. Korean Laparoscopic Gastrointestinal Surgery Study Group. Nationwide survey of laparoscopic gastric surgery in Korea, 2004. J Korean Gastric Cancer Assoc 2005;5:295–303.

    Google Scholar 

  6. Shiraishi N, Yasuda K, Kitano S. Laparoscopic gastrectomy with lymph node dissection for gastric cancer. Gastric Cancer 2006;9:167–176.

    Article  PubMed  Google Scholar 

  7. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4:146–148.

    PubMed  CAS  Google Scholar 

  8. Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M. Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 2002;195:284–287.

    Article  PubMed  Google Scholar 

  9. Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM, Lim KW, Park WB, Kim SN. The early experience with a totally laparoscopic distal gastrectomy. J Korean Gastric Cancer Assoc 2005;5:16–22.

    Google Scholar 

  10. Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Soga R, Wakayama A, Okamoto K, Ohyama A, Hasumi A. Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer 1999;2:186–190.

    Article  PubMed  Google Scholar 

  11. Song KY, Kim SN, Park CH. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 2008 (in press).

  12. Kitano S, Yasuda K, Shiraishi N. Laparoscopic surgical resection for early gastric cancer. Eur J Gastroenterol Hepatol 2006;18:855–861.

    Article  PubMed  Google Scholar 

  13. 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;202:874–880.

    Article  PubMed  Google Scholar 

  14. Goh P, Tekant Y, Isaac J, Kum CK, Ngoi SS. The technique of laparoscopic Billroth II gastrectomy. Surg Laparosc Endosc 1992;2:258–260.

    PubMed  CAS  Google Scholar 

  15. Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M. Curative laparoscopic surgery for early gastric cancer: Five years experience. World J Surg 1999;23:187–192.

    Article  PubMed  CAS  Google Scholar 

  16. Yamada H, Kojima K, Inokuchi M, Kawano T, Sugihara K. Effect of obesity on technical feasibility and postoperativeo of laparoscopy-assisted distal gastrectomy-comparison with open distal gastrectomy. J Gastrointest Surg 2008 (in press).

  17. Fujiwara M, Kodera Y, Kasai Y, Kanyama Y, Hibi K, Ito K, Akiyama S, Nakao A. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: a review of 43 cases. J Am Coll Surg 2003;196:75–81.

    Article  PubMed  Google Scholar 

  18. 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;19:168–173.

    Article  PubMed  Google Scholar 

  19. Kim MC, Kim KH, Kim HH, Jung GJ. Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 2005;91:90–94.

    Article  PubMed  Google Scholar 

  20. Dulucq JL, Wintringer P, Perissat J, Mahajna A. Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute's prospective analysis. J Am Coll Surg 2005;200:191–197.

    Article  PubMed  Google Scholar 

  21. Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM. Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 2008 (in press).

  22. Hyung WJ, Lim JS, Cheong JH, Kim J, Choi SH, Song SY, Noh SH. Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy. Surg Endosc 2005;19:1353–1357.

    Article  PubMed  CAS  Google Scholar 

  23. Tanimura S, Higashino M, Fukunaga Y, Osugi H. Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 2003;17:758–762.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was partly supported by the Catholic Cancer Center.

Author information

Authors and Affiliations

  1. Department of Surgery, Kangnam St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea

    Kyo Young Song, Cho Hyun Park, Han Chol Kang & Hoon Hur

  2. Department of Surgery, Our Lady of Mercy Hospital, College of Medicine, The Catholic University of Korea, 665 Bupyoung-6-Dong, Bupyoung-Gu, Incheon, 403–720, South Korea

    Jin-Jo Kim & Seung Man Park

  3. Department of Surgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea

    Kyong Hwa Jun & Hyung Min Chin

Authors
  1. Kyo Young Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cho Hyun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Han Chol Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin-Jo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seung Man Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kyong Hwa Jun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hyung Min Chin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hoon Hur
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin-Jo Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Song, K.Y., Park, C.H., Kang, H.C. et al. Is Totally Laparoscopic Gastrectomy Less Invasive Than Laparoscopy-assisted Gastrectomy?: Prospective, Multicenter Study. J Gastrointest Surg 12, 1015–1021 (2008). https://doi.org/10.1007/s11605-008-0484-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0484-0

Keywords

Search

Navigation