BACKGROUND: The safety and efficacy of laparoscopic gastrectomy in the treatment of early gastric cancer have been demonstrated in many clinical studies. Most surgeons prefer laparoscopy-assisted gastrectomy with extracorporeal anastomosis rather than total laparoscopic procedures because of the technical difficulties of intracorporeal anastomosis. This study assessed the efficacy of total laparoscopic Billroth-I (B-I) gastrectomy. METHODS: We conducted a retrospective analysis of a single surgeon's experience. We reviewed patients with gastric cancer who underwent laparoscopic B-I gastrectomy (n=83) and classified them into laparoscopy-assisted distal gastrectomy (LADG; n=41) and total laparoscopic distal gastrectomy (TLDG; n=42) groups. Short-term surgical variables and outcomes were compared between the groups. RESULTS: There was no difference in gender, mean age, body mass index, or tumor characteristics between the groups. Estimated blood loss was significantly less in TLDG (21.2±36.8 g) than in LADG (62.5±81.6 g). Anastomotic leakage was not recorded in either group, and there was no difference in the incidence of other postoperative complications. Postoperative hospital stay was shorter for TLDG (10.6±2.6 days) than for LADG (12.0±3.5 days). Serum C-reactive protein level on day 7 after surgery was significantly lower in TLDG (2.58±2.57 mg/ml) than LADG (4.85±6.17 mg/ml); however, the level on day 1 or 4 was not significantly different. There was no difference in nutritional status or clinical symptoms during the 3 months after surgery. CONCLUSIONS: TLDG can be performed safely after appropriate experience with LADG. Our results imply that TLDG may lead to faster recovery, better cosmesis, and improved quality of life in the short-term compared with LADG. Because of the limitations of a retrospective analysis on the study and a patient selection bias, a prospective randomized study should be conducted to reach definitive conclusions.
BACKGROUND: The safety and efficacy of laparoscopic gastrectomy in the treatment of early gastric cancer have been demonstrated in many clinical studies. Most surgeons prefer laparoscopy-assisted gastrectomy with extracorporeal anastomosis rather than total laparoscopic procedures because of the technical difficulties of intracorporeal anastomosis. This study assessed the efficacy of total laparoscopic Billroth-I (B-I) gastrectomy. METHODS: We conducted a retrospective analysis of a single surgeon's experience. We reviewed patients with gastric cancer who underwent laparoscopic B-I gastrectomy (n=83) and classified them into laparoscopy-assisted distal gastrectomy (LADG; n=41) and total laparoscopic distal gastrectomy (TLDG; n=42) groups. Short-term surgical variables and outcomes were compared between the groups. RESULTS: There was no difference in gender, mean age, body mass index, or tumor characteristics between the groups. Estimated blood loss was significantly less in TLDG (21.2±36.8 g) than in LADG (62.5±81.6 g). Anastomotic leakage was not recorded in either group, and there was no difference in the incidence of other postoperative complications. Postoperative hospital stay was shorter for TLDG (10.6±2.6 days) than for LADG (12.0±3.5 days). Serum C-reactive protein level on day 7 after surgery was significantly lower in TLDG (2.58±2.57 mg/ml) than LADG (4.85±6.17 mg/ml); however, the level on day 1 or 4 was not significantly different. There was no difference in nutritional status or clinical symptoms during the 3 months after surgery. CONCLUSIONS:TLDG can be performed safely after appropriate experience with LADG. Our results imply that TLDG may lead to faster recovery, better cosmesis, and improved quality of life in the short-term compared with LADG. Because of the limitations of a retrospective analysis on the study and a patient selection bias, a prospective randomized study should be conducted to reach definitive conclusions.
Authors: Jin-Jo Kim; Kyo Young Song; Hyung Min Chin; Wook Kim; Hae Myung Jeon; Cho Hyun Park; Seung Man Park Journal: Surg Endosc Date: 2008-02 Impact factor: 4.584
Authors: Young-Woo Kim; Yong Hae Baik; Young Ho Yun; Byung Ho Nam; Dae Hyun Kim; Il Ju Choi; Jae-Moon Bae Journal: Ann Surg Date: 2008-11 Impact factor: 12.969
Authors: Jung Ho Shim; Han Mo Yoo; Seong Il Oh; Myung Jin Nam; Hae Myung Jeon; Cho Hyun Park; Kyo Young Song Journal: Gastric Cancer Date: 2012-10-25 Impact factor: 7.370
Authors: Deok Gie Kim; Yoon Young Choi; Ji Yeong An; In Gyu Kwon; In Cho; Yoo Min Kim; Jung Min Bae; Myung Gyu Song; Sung Hoon Noh Journal: Surg Endosc Date: 2013-03-14 Impact factor: 4.584