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Published in: Surgical Endoscopy 8/2021

01-08-2021 | Gastrectomy

A randomized controlled trial of single-port versus multi-port laparoscopic distal gastrectomy for gastric cancer

Authors: Takeshi Omori, Kazuyoshi Yamamoto, Hisashi Hara, Naoki Shinno, Masaaki Yamamoto, Keijirou Sugimura, Hiroshi Wada, Hidenori Takahashi, Masayoshi Yasui, Hiroshi Miyata, Masayuki Ohue, Masahiko Yano, Masato Sakon

Published in: Surgical Endoscopy | Issue 8/2021

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Abstract

Objective

This prospective randomized trial compared the invasiveness of laparoscopic gastrectomy using a single-port approach with that of a conventional multi-port approach in the treatment of gastric cancer.

Summary Background Data

The benefit of single-port laparoscopic gastrectomy (SLG) over multi-port laparoscopic gastrectomy (MLG) has yet to be confirmed in a well-designed study.

Methods

One hundred and one patients who were scheduled to undergo laparoscopic distal gastrectomy for histologically confirmed clinical stage I gastric cancer between April 2016 and September 2018 were randomly allocated to SLG (n = 50) or MLG (n = 51). The primary endpoints were the postoperative visual analog scale pain scores. Secondary endpoints were frequency of use of analgesia, short-term outcomes, such as operating time, intraoperative blood loss, inflammatory reactions, postoperative morbidity, and 90-day mortality.

Results

The postoperative pain score was significantly lower in the SLG group than in the MLG group (p < 0.001) on the operative day and the postoperative day 1–7. Analgesics were administered significantly less often in the SLG group than in the MLG group (1 vs. 3 days, p = 0.0078) and the duration of use of analgesics was significantly shorter in the SLG group (2 vs. 3 days, p = 0.0171). The operating time was significantly shorter in the SLG group than in the MLG group (169 vs. 182 min, p = 0.0399). Other surgical outcomes were comparable between the study groups.

Conclusions

SLG was shown to be safe and feasible in the treatment of gastric cancer with better short-term results in terms of less severe pain and may be suitable for treatment of cStage I gastric cancer.

Clinical trial registration:

UMIN000022218
Appendix
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Literature
1.
go back to reference Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMed Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMed
2.
go back to reference Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311CrossRef Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311CrossRef
3.
go back to reference Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, Terashima M, Misawa K, Teshima S, Koeda K, Nunobe S (2017) Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage ia/ib gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer 20:699–708CrossRef Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, Terashima M, Misawa K, Teshima S, Koeda K, Nunobe S (2017) Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage ia/ib gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer 20:699–708CrossRef
4.
go back to reference Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 255:446–456CrossRef Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 255:446–456CrossRef
5.
go back to reference Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Kim W, Kim HH, Ong KY, Lee SI, Ryu SY, Lee JH, Lee HJ, Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35CrossRef Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Kim W, Kim HH, Ong KY, Lee SI, Ryu SY, Lee JH, Lee HJ, Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35CrossRef
6.
go back to reference Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727CrossRef Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727CrossRef
7.
go back to reference Ziqiang W, Feng Q, Zhimin C, Miao W, Lian Q, Huaxing L, Peiwu Y (2006) Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management. Surg Endosc 20:1738–1743CrossRef Ziqiang W, Feng Q, Zhimin C, Miao W, Lian Q, Huaxing L, Peiwu Y (2006) Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management. Surg Endosc 20:1738–1743CrossRef
8.
go back to reference Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH (2009) Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23:1252–1258CrossRef Hwang SI, Kim HO, Yoo CH, Shin JH, Son BH (2009) Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc 23:1252–1258CrossRef
9.
go back to reference Katai H, Mizusawa J, Katayama H, Morita S, Yamada T, Bando E, Ito S, Takagi M, Takagane A, Teshima S, Koeda K, Nunobe S, Yoshikawa T, Terashima M, Sasako M (2020) Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol 5:142–151CrossRef Katai H, Mizusawa J, Katayama H, Morita S, Yamada T, Bando E, Ito S, Takagi M, Takagane A, Teshima S, Koeda K, Nunobe S, Yoshikawa T, Terashima M, Sasako M (2020) Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol 5:142–151CrossRef
10.
go back to reference Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Hyung WJ, Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) Group (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 5:506–513CrossRef Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Hyung WJ, Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) Group (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 5:506–513CrossRef
11.
go back to reference Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T (2011) Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc 25:2400–2404CrossRef Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T (2011) Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc 25:2400–2404CrossRef
12.
go back to reference Park DJ, Lee J-H, Ahn SH, Eng AKH, Kim H-H (2012) Single-port laparoscopic distal gastrectomy with D1+β lymph node dissection for gastric cancers: report of 2 cases. Surg Laparosc Endosc Percutan Tech 22:e214–e216CrossRef Park DJ, Lee J-H, Ahn SH, Eng AKH, Kim H-H (2012) Single-port laparoscopic distal gastrectomy with D1+β lymph node dissection for gastric cancers: report of 2 cases. Surg Laparosc Endosc Percutan Tech 22:e214–e216CrossRef
13.
go back to reference Omori T, Masuzawa T, Akamatsu H, Nishida T (2014) A simple and safe method for Billroth I reconstruction in single-incision laparoscopic gastrectomy using a novel intracorporeal triangular anastomotic technique. J Gastrointest Surg 18:613–616CrossRef Omori T, Masuzawa T, Akamatsu H, Nishida T (2014) A simple and safe method for Billroth I reconstruction in single-incision laparoscopic gastrectomy using a novel intracorporeal triangular anastomotic technique. J Gastrointest Surg 18:613–616CrossRef
14.
go back to reference Ahn SH, Son SY, Jung DH, Park DJ, Kim HH (2014) Pure single-port laparoscopic distal gastrectomy for early gastric cancer: comparative study with multi-port laparoscopic distal gastrectomy. J Am Coll Surg 219:933–943CrossRef Ahn SH, Son SY, Jung DH, Park DJ, Kim HH (2014) Pure single-port laparoscopic distal gastrectomy for early gastric cancer: comparative study with multi-port laparoscopic distal gastrectomy. J Am Coll Surg 219:933–943CrossRef
15.
go back to reference Omori T, Fujiwara Y, Moon J, Sugimura K, Miyata H, Masuzawa T, Kishi K, Miyoshi N, Tomokuni A, Akita H, Takahashi H (2016) Comparison of single-incision and conventional multi-port laparoscopic distal gastrectomy with D2 lymph node dissection for gastric cancer: a propensity score-matched analysis. Ann Surg Oncol 23:817–824CrossRef Omori T, Fujiwara Y, Moon J, Sugimura K, Miyata H, Masuzawa T, Kishi K, Miyoshi N, Tomokuni A, Akita H, Takahashi H (2016) Comparison of single-incision and conventional multi-port laparoscopic distal gastrectomy with D2 lymph node dissection for gastric cancer: a propensity score-matched analysis. Ann Surg Oncol 23:817–824CrossRef
16.
go back to reference Omori T, Nishida T (2014) Distal gastrectomy. In: Mori T, Dapri G (eds) Reduced port laparoscopic surgery. Springer, Tokyo, pp 183–195 Omori T, Nishida T (2014) Distal gastrectomy. In: Mori T, Dapri G (eds) Reduced port laparoscopic surgery. Springer, Tokyo, pp 183–195
17.
go back to reference Omori T, Fujiwara Y, Yamamoto K, Yanagimoto Y, Sugimura K, Masuzawa T, Kishi K, Takahashi H, Yasui M, Miyata H, Ohue M, Yano M, Sakon M (2019) The safety and feasibility of single-port laparoscopic gastrectomy for advanced gastric cancer. J Gastrointest Surg 23:1329–1339CrossRef Omori T, Fujiwara Y, Yamamoto K, Yanagimoto Y, Sugimura K, Masuzawa T, Kishi K, Takahashi H, Yasui M, Miyata H, Ohue M, Yano M, Sakon M (2019) The safety and feasibility of single-port laparoscopic gastrectomy for advanced gastric cancer. J Gastrointest Surg 23:1329–1339CrossRef
18.
go back to reference Kim SM, Ha MH, Seo JE, Kim JE, Choi MG, Sohn TS, Bae JM, Kim S, Lee JH (2016) Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer. Surg Endosc 30:3950–3957CrossRef Kim SM, Ha MH, Seo JE, Kim JE, Choi MG, Sohn TS, Bae JM, Kim S, Lee JH (2016) Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer. Surg Endosc 30:3950–3957CrossRef
19.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef
20.
go back to reference Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma 3rd English Edition. Gastric Cancer 14(101–112):17 Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma 3rd English Edition. Gastric Cancer 14(101–112):17
21.
go back to reference Omori T, Tanaka K, Tori M, Ueshima S, Akamatsu H, Nishida T (2012) Intracorporeal circular-stapled billroth I anastomosis in single-incision laparoscopic distal gastrectomy. Surg Endosc 26:1490–1494CrossRef Omori T, Tanaka K, Tori M, Ueshima S, Akamatsu H, Nishida T (2012) Intracorporeal circular-stapled billroth I anastomosis in single-incision laparoscopic distal gastrectomy. Surg Endosc 26:1490–1494CrossRef
22.
go back to reference Ushimaru Y, Omori T, Fujiwara Y, Yanagimoto Y, Sugimura K, Yamamoto K, Moon JH, Miyata H, Ohue M, Yano M (2019) The feasibility and safety of preoperative fluorescence marking with indocyanine green (ICG) in laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg 23:468–476CrossRef Ushimaru Y, Omori T, Fujiwara Y, Yanagimoto Y, Sugimura K, Yamamoto K, Moon JH, Miyata H, Ohue M, Yano M (2019) The feasibility and safety of preoperative fluorescence marking with indocyanine green (ICG) in laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg 23:468–476CrossRef
23.
go back to reference Hamabe A, Omori T, Tanaka K, Nishida T (2012) Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc 26:1702–1709CrossRef Hamabe A, Omori T, Tanaka K, Nishida T (2012) Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc 26:1702–1709CrossRef
24.
go back to reference Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, Nakahara M, Nishida T (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197:e13–e17CrossRef Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, Nakahara M, Nishida T (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197:e13–e17CrossRef
25.
go back to reference Omori T, Nakajima K, Nishida T, Uchikoshi F, Kitagawa T, Ito T, Matsuda H (2005) A simple technique for circular-stapled billroth I reconstruction in laparoscopic gastrectomy. Surg Endosc 19:734–736CrossRef Omori T, Nakajima K, Nishida T, Uchikoshi F, Kitagawa T, Ito T, Matsuda H (2005) A simple technique for circular-stapled billroth I reconstruction in laparoscopic gastrectomy. Surg Endosc 19:734–736CrossRef
26.
go back to reference Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nakahara M, Toshirou N (2010) A simple and safe method for gastrojejunostomy in laparoscopic distal gastrectomy using the hemidouble-stapling technique: efficient purse-string stapling technique. Dig Surg 26:441–445CrossRef Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nakahara M, Toshirou N (2010) A simple and safe method for gastrojejunostomy in laparoscopic distal gastrectomy using the hemidouble-stapling technique: efficient purse-string stapling technique. Dig Surg 26:441–445CrossRef
27.
go back to reference Liu Q, Ding Li, Jiang H, Zhang C, Jin J (2018) Efficacy of fast track surgery in laparoscopic radical gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials. Int J Surg 50:28–34CrossRef Liu Q, Ding Li, Jiang H, Zhang C, Jin J (2018) Efficacy of fast track surgery in laparoscopic radical gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials. Int J Surg 50:28–34CrossRef
28.
go back to reference Morales-Conde S, del Agua IA, Moreno AB, Macías MS (2017) Postoperative pain after conventional laparoscopic versus single-port sleeve gastrectomy: a prospective, randomized, controlled pilot study. Surg Obes Relat Dis 13:608–613CrossRef Morales-Conde S, del Agua IA, Moreno AB, Macías MS (2017) Postoperative pain after conventional laparoscopic versus single-port sleeve gastrectomy: a prospective, randomized, controlled pilot study. Surg Obes Relat Dis 13:608–613CrossRef
29.
go back to reference Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K, JCOG Gastric Cancer Surgical Study Group (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244CrossRef Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K, JCOG Gastric Cancer Surgical Study Group (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244CrossRef
Metadata
Title
A randomized controlled trial of single-port versus multi-port laparoscopic distal gastrectomy for gastric cancer
Authors
Takeshi Omori
Kazuyoshi Yamamoto
Hisashi Hara
Naoki Shinno
Masaaki Yamamoto
Keijirou Sugimura
Hiroshi Wada
Hidenori Takahashi
Masayoshi Yasui
Hiroshi Miyata
Masayuki Ohue
Masahiko Yano
Masato Sakon
Publication date
01-08-2021
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 8/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07955-0

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