Top

Published in:

01-10-2013

Laparoscopy-Assisted Distal Gastrectomy Versus Open Distal Gastrectomy. A Prospective Randomized Single-Blind Study

Authors: Shuji Takiguchi, Yoshiyuki Fujiwara, Makoto Yamasaki, Hiroshi Miyata, Kiyokazu Nakajima, Mitsugu Sekimoto, Masaki Mori, Yuichiro Doki

Published in: World Journal of Surgery | Issue 10/2013

Abstract

Background

Laparoscopy-assisted distal gastrectomy (LADG) is generally considered superior to open distal gastrectomy (ODG) with regard to postoperative quality-of-life. Differences in postoperative pain may exist due to recent pain control techniques including epidural anesthesia. There is little evidence for this difference. In this article we report the results of our randomized single-blind study in LADG versus ODG. The aim of the present study was to evaluate differences in postoperative physical activity between LADG and ODG.

Methods

Forty patients with early gastric cancer (stage IA and IB) were registered in this randomized study. For strict evaluation, patients were not told about the type of operation until postoperative day 7. Postoperative physical activity was evaluated objectively by Active Tracer, which records the cumulative acceleration over a 24 h period to investigate differences in postoperative recovery. Questionnaire and visual analog scale score related to postoperative pain were also investigated.

Results

Significant differences were observed with a more favorable outcome noted in the LADG group with respect to intraoperative blood loss (P < 0.001), total amount of pain rescue (P < 0.001), wound size (P < 0.001), postoperative hospital stay (P < 0.001), and inflammatory parameters (C-reactive protein, SaO₂, and duration of febrile period) (P < 0.001). Cumulative physical recovery to 70 % of the preoperative level was significantly shorter (by 3 days, P < 0.001) in the LADG group.

Conclusions

Comparison of LADG and ODG for patients with early gastric cancer showed favorable outcome and earlier recovery of physical activity in the LADG group.

Kitano S, Iso Y, Moriyama M et al (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMed

Adachi Y, Shiraishi N, Shiromizu A et al (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135:806–810PubMedCrossRef

Reyes CD, Weber KJ, Gagner M et al (2001) Laparoscopic vs open gastrectomy: a retrospective review. Surg Endosc 15:928–931PubMedCrossRef

Shimizu S, Uchiyama A, Mizumoto K et al (2000) Laparoscopically assisted distal gastrectomy for early gastric cancer: is it superior to open surgery? Surg Endosc 14:27–31PubMedCrossRef

Yano H, Monden T, Kinuta M et al (2001) The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer. Gastric Cancer 4:93–97PubMedCrossRef

Hayashi H, Ochiai T, Shimada H et al (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176PubMedCrossRef

Kitano S, Shiraishi N, Fujii K et al (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–S311PubMedCrossRef

Wong DL, Baker CM (1988) Pain in children: comparison of assessment scales. Pediatr Nurs 14:9–17PubMed

Squirrell DM, Majeed AW, Troy G et al (1998) A randomized, prospective, blinded comparison of postoperative pain, metabolic response, and perceived health after laparoscopic and small incision cholecystectomy. Surgery 12:485–495CrossRef

10.

Majeed AW, Troy G, Nicholl JP et al (1996) Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy. Lancet 13(347):989–994CrossRef

11.

Kawamura H, Homma S, Yokota R et al (2008) Assessment of pain by face scales after gastrectomy: comparison of laparoscopically assisted gastrectomy and open gastrectomy. Surg Endosc 23:991–995PubMedCrossRef

12.

Nomura A, Kakinoki S, Takechi S et al (1996) Physical activity affects ambulatory blood pressure in normotensive and hypertensive elderly people. Cardiol Elderly 4:101–104

13.

Tsukioka M, Kamo C, Kaneko M et al (1995) The effect of nipradilol on essential hypertension with cerebrovascular disease assessed by 24-hour ambulatory blood pressure monitoring [in Japanese]. Ther Res 16:1161–1169

14.

Steele BG, Holt L, Belza B et al (2000) Quantitating physical activity in COPD using a triaxial accelerometer. Chest 117:1359–1367PubMedCrossRef

15.

Inoue Y, Kimura T, Noro H et al (2003) Is laparoscopic colorectal surgery less invasive than classical open surgery? Surg Endosc 17:1269–1273PubMedCrossRef

16.

Kim YW, Baik YH, Yun YH et al (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727PubMedCrossRef

17.

Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef

18.

Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRef

19.

Weeks JC, Nelson H, Gelber S et al (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328PubMedCrossRef

20.

Huscher CG, Mingoli A, Sgarzini G et al (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237PubMedCrossRef

21.

Mochiki E, Kamiyama Y, Aihara R et al (2005) Laparoscopic assisted distal gastrectomy for early gastric cancer: five years’ experience. Surgery 137:317–322PubMedCrossRef

Title: Laparoscopy-Assisted Distal Gastrectomy Versus Open Distal Gastrectomy. A Prospective Randomized Single-Blind Study
Authors: Shuji Takiguchi
Yoshiyuki Fujiwara
Makoto Yamasaki
Hiroshi Miyata
Kiyokazu Nakajima
Mitsugu Sekimoto
Masaki Mori
Yuichiro Doki
Publication date: 01-10-2013
Publisher: Springer US
Published in: World Journal of Surgery / Issue 10/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2121-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopy-Assisted Distal Gastrectomy Versus Open Distal Gastrectomy. A Prospective Randomized Single-Blind Study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2013

Quality of Life (QoL) in Patients With Benign Thyroid Goiters (Pre- and Post-Thyroidectomy): A Prospective Study

A Randomized, Prospective, Double-blind, Placebo-Controlled Trial of the Effect of Diltiazem Gel on Pain After Hemorrhoidectomy

Impact of an Acute Care Surgery Model with a Dedicated Daytime Operating Room on Outcomes and Timeliness of Care in Patients with Biliary Tract Disease

Short- and Long-term Outcomes After Laparoscopic Versus Open Emergency Resection for Colon Cancer: An Observational Propensity Score-matched Study

Evaluation of Trauma Care in a Mature Level I Trauma Center in The Netherlands: Outcomes in a Dutch Mature Level I Trauma Center

Two-day Hospital Stay After Laparoscopic Colorectal Surgery under an Enhanced Recovery after Surgery (ERAS) Pathway