Han-Kwang Yang1, Woo Jin Hyung2, Sang-Uk Han3, Young-Jun Lee4, Joong-Min Park5, Gyu Seok Cho6, Oh Kyoung Kwon7, Seong-Ho Kong1, Hyoung-Il Kim2, Hyuk-Joon Lee1, Wook Kim8, Seung Wan Ryu9, Sung-Ho Jin10, Sung Jin Oh11, Keun Won Ryu12, Min-Chan Kim13, Hye Seong Ahn14, Young Kyu Park15, Yong Ho Kim16, Sun-Hwi Hwang17, Jong Won Kim5, Jin-Jo Kim18. 1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 3. Department of Surgery, Ajou University School of Medicine, Suwon, Korea. 4. Department of Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea. 5. Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea. 6. Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea. 7. Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea. 8. Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. 9. Department of Surgery, Keimyung University School of Medicine, Daegu, Korea. 10. Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea. 11. Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. 12. Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea. 13. Department of Surgery, Dong-A University College of Medicine, Busan, Korea. 14. Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea. 15. Department of Surgery, Chonnam National University Hwasoon Hospital, Hwasun, Korea. 16. Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea. 17. Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea. 18. Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, 56 Dongsuro, Bupyong-Gu, Inchon, 21431, Korea. kjj@catholic.ac.kr.
Abstract
BACKGROUND:Laparoscopic distal gastrectomy for early gastric cancer has been widely accepted, but laparoscopic total gastrectomy has still not gained popularity because of technical difficulty and unsolved safety issue. We conducted a single-arm multicenter phase II clinical trial to evaluate the safety and the feasibility of laparoscopic total gastrectomy for clinical stageI proximal gastric cancer in terms of postoperative morbidity and mortality in Korea. The secondary endpoint of this trial was comparison of surgical outcomes among the groups that received different methods of esophagojejunostomy (EJ). METHODS: The 160 patients of the full analysis set group were divided into three groups according to the method of EJ, the extracorporeal circular stapling group (EC; n = 45), the intracorporeal circular stapling group (IC; n = 64), and the intracorporeal linear stapling group (IL; n = 51). The clinicopathologic characteristics and the surgical outcomes were compared among these three groups. RESULTS: There were no significant differences in the early complication rates among the three groups (26.7% vs. 18.8% vs. 17.6%, EC vs. IC vs. IL; p = 0.516). The length of mini-laparotomy incision was significantly longer in the EC group than in the IC or IL group. The anastomosis time was significantly shorter in the EC group than in the IL group. The time to first flatus was significantly shorter in the IL group than in the EC group. The long-term complication rate was not significantly different among the three groups (4.4% vs. 12.7% vs. 7.8%; EC vs. IC vs. IL; p = 0.359), however, the long-term incidence of EJ stenosis in IC group (10.9%) was significantly higher than in EC (0%) and IL (2.0%) groups (p = 0.020). CONCLUSIONS: The extracorporeal circular stapling and the intracorporeal linear stapling were safe and feasible in laparoscopic total gastrectomy, however, intracorporeal circular stapling increased EJ stenosis.
RCT Entities:
BACKGROUND: Laparoscopic distal gastrectomy for early gastric cancer has been widely accepted, but laparoscopic total gastrectomy has still not gained popularity because of technical difficulty and unsolved safety issue. We conducted a single-arm multicenter phase II clinical trial to evaluate the safety and the feasibility of laparoscopic total gastrectomy for clinical stage I proximal gastric cancer in terms of postoperative morbidity and mortality in Korea. The secondary endpoint of this trial was comparison of surgical outcomes among the groups that received different methods of esophagojejunostomy (EJ). METHODS: The 160 patients of the full analysis set group were divided into three groups according to the method of EJ, the extracorporeal circular stapling group (EC; n = 45), the intracorporeal circular stapling group (IC; n = 64), and the intracorporeal linear stapling group (IL; n = 51). The clinicopathologic characteristics and the surgical outcomes were compared among these three groups. RESULTS: There were no significant differences in the early complication rates among the three groups (26.7% vs. 18.8% vs. 17.6%, EC vs. IC vs. IL; p = 0.516). The length of mini-laparotomy incision was significantly longer in the EC group than in the IC or IL group. The anastomosis time was significantly shorter in the EC group than in the IL group. The time to first flatus was significantly shorter in the IL group than in the EC group. The long-term complication rate was not significantly different among the three groups (4.4% vs. 12.7% vs. 7.8%; EC vs. IC vs. IL; p = 0.359), however, the long-term incidence of EJ stenosis in IC group (10.9%) was significantly higher than in EC (0%) and IL (2.0%) groups (p = 0.020). CONCLUSIONS: The extracorporeal circular stapling and the intracorporeal linear stapling were safe and feasible in laparoscopic total gastrectomy, however, intracorporeal circular stapling increased EJ stenosis.
Entities:
Keywords:
Esophagojejunostomy; Laparoscopy; Stomach neoplasms; Total gastrectomy
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