Hyui Eun Jin1, Min Seo Kim1, Chang Min Lee2, Ji Ho Park3, Chang In Choi4, Han Hong Lee5, Jae-Seok Min6, Ye Seob Jee7, Jeong Oh8, Hyundong Chae9, Sung-Il Choi10, Yoon Taek Lee2, Jong-Han Kim2, Hua Huang11, Sungsoo Park12. 1. Korea University College of Medicine, Seoul, South Korea. 2. Department of Surgery, Korea University College of Medicine, Seoul, South Korea. 3. Department of Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea. 4. Department of Surgery, Pusan National University College of Medicine, Pusan, South Korea. 5. Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 6. Department of Surgery, Dongnam Institute of Radiological & Medical Science, Pusan, South Korea. 7. Department of Surgery, Dankook University College of Medicine, Cheonan, South Korea. 8. Department of Surgery, Chonnam National University College of Medicine, Gwangju, South Korea. 9. Department of Surgery, Daegu Catholic University School of Medicine, Daegu, South Korea. 10. Department of Surgery, Kyung Hee University College of Medicine, Seoul, South Korea. 11. Department of Gastric Surgery, Shanghai Medical College of Fudan University, Shanghai, China. 12. Department of Surgery, Korea University College of Medicine, Seoul, South Korea. Electronic address: kugspss@korea.ac.kr.
Abstract
BACKGROUND: The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications. METHODS: PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95% confidence intervals (c.i.). RESULTS: Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancer patients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference. CONCLUSIONS: TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).
BACKGROUND: The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications. METHODS: PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95% confidence intervals (c.i.). RESULTS: Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancerpatients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference. CONCLUSIONS: TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).
Authors: Magdalena Tyczyńska; Paweł Kędzierawski; Kaja Karakuła; Jacek Januszewski; Krzysztof Kozak; Monika Sitarz; Alicja Forma Journal: J Gastrointest Cancer Date: 2021-03-24
Authors: Inhyuck Lee; Kwang Hee Kim; Sang Hyuk Seo; Min Sung An; HyungJoo Baik; Yo Han Park; Sang Hyun Kang; Sang Hoon Oh Journal: J Minim Invasive Surg Date: 2021-03-15