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European Surgery
Published in: European Surgery 6/2017

01-12-2017 | original scientific paper

A propensity score matched case-control comparative study of totally laparoscopic distal gastrectomy and laparoscopic-assisted distal gastrectomy for early gastric cancer

Authors: Sung Don Oh, MD, Sung Jin Oh, MD, PhD, Byoung Jo Suh, MD, PhD, Jin Yong Shin, MD, PhD, Jong Kwon Park, MD, PhD

Published in: European Surgery | Issue 6/2017

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Summary

Background

Intracorporeal anastomosis remains a difficult procedure. This study was designed to clarify the advantage of totally laparoscopic distal gastrectomy (TLDG) compared with laparoscopic-assisted distal gastrectomy (LADG) regarding short-term surgical outcomes.

Methods

We retrospectively identified 273 patients who were preoperatively diagnosed with early gastric cancer and underwent LADG or TLDG between March 2010 and May 2016. A propensity score matching analysis was used to create patient groups matched for sex, age, body mass index, previous abdominal surgery history, and American Society of Anesthesiologist score.

Results

The TLDG group showed statistically shorter operative time (250.9 ± 4.6 min vs. 281.8 ± 7.3 min, p = 0.000), lower estimated blood loss (77.6 ± 3.3 ml vs. 122.4 ± 6.2 ml, p = 0.000), and shorter time to first flatus after surgery (2.9 ± 0.1 days vs. 3.2 ± 0.1 days, p = 0.001) compared with the LADG group. However, there was no specific superiority in terms of the inflammatory profiles on postoperative days 1, 2, 4, and 7 between the two groups. Complication rates were also similar in the two groups (13.3% LADG vs. 6.1% TLDG).

Conclusion

This study shows that TLDG for early gastric cancer is a safe surgical procedure and superior in cosmesis compared with LADG.
Literature
1.
Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24(14):2137–50.CrossRefPubMed
2.
Chung SJ, Park MJ, Kang SJ, et al. Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea. Int J Cancer. 2012;131(10):2376–84.CrossRefPubMed
3.
Kong SH, Park DJ, Lee HJ, et al. Clinicopathologic features of asymptomatic gastric adenocarcinoma patients in Korea. Jpn J Clin Oncol. 2004;34(1):1–7.CrossRefPubMed
4.
Kitano S. Can an intramucosal undifferentiated-type gastric cancer become a candidate for endoscopic submucosal resection? Gastric Cancer. 2009;12(3):125–6.CrossRefPubMed
5.
6.
Endo S, Dousei T, Yoshikawa Y, et al. Prognosis of gastric carcinoma patients aged 85 years or older who underwent surgery or who received best supportive care only. Int J Clin Oncol. 2013;18(6):1014–9.CrossRefPubMed
7.
Nashimoto A. Current status of treatment strategy for elderly patients with gastric cancer. Int J Clin Oncol. 2013;18(6):969–70.CrossRefPubMed
8.
Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4(2):146–8.PubMed
9.
Hamabe A, Omori T, Tanaka K, Nishida T. Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc. 2012;26(6):1702–9.CrossRefPubMed
10.
Pak KH, Hyung WJ, Son T, et al. Long-term oncologic outcomes of 714 consecutive laparoscopic gastrectomies for gastric cancer: Results from the 7‑year experience of a single institute. Surg Endosc. 2012;26(1):130–6.CrossRefPubMed
11.
Kanaya S, Gomi T, Momoi H, et al. Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg. 2002;195(2):284–7.CrossRefPubMed
12.
Shinohara T, Kawano S, Tanaka Y, et al. Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison. Surg Endosc. 2016;30(8):3573–81.CrossRefPubMed
13.
Lee SH, Kim IH, Kim IH, Kwak SG, Chae HD. Comparison of short-term outcomes and acute inflammatory response between laparoscopy-assisted and totally laparoscopic distal gastrectomy for early gastric cancer. Ann Surg Treat Res. 2015;89(4):176–82.CrossRefPubMedPubMedCentral
14.
Chen K, Xu X, Mou Y, et al. Totally laparoscopic distal gastrectomy with D2 lymphadenectomy and Billroth II gastrojejunostomy for gastric cancer: short- and medium-term results of 139 consecutive cases from a single institution. Int J Med Sci. 2013;10(11):1462–70.CrossRefPubMedPubMedCentral
15.
D’Agostino RB Jr.. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17(19):2265–81.CrossRefPubMed
16.
17.
Ahn SH, Son SY, do Jung H, do Park J, Kim HH. Pure single-port laparoscopic distal gastrectomy for early gastric cancer: comparative study with multi-port laparoscopic distal gastrectomy. J Am Coll Surg. 2014;219(5):933–43.CrossRefPubMed
18.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.CrossRef
19.
20.
Koeda K, Nishizuka S, Wakabayashi G. Minimally invasive surgery for gastric cancer: the future standard of care. World J Surg. 2011;35(7):1469–77.CrossRefPubMed
21.
Bamboat ZM, Strong VE. Minimally invasive surgery for gastric cancer. J Surg Oncol. 2013;107(3):271–6.CrossRefPubMed
22.
Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized trial (KLASS trial). ann Surg. 2010;251(3):417–20.CrossRefPubMed
23.
Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245(1):68–72.CrossRefPubMedPubMedCentral
24.
Kim YW, Baik YH, Yun YH, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248(5):721–7.CrossRefPubMed
25.
Zhang YX, Wu YJ, Lu GW, Xia MM. Systematic review and meta-analysis of totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer. World J Surg Oncol. 2015;13:116.CrossRefPubMedPubMedCentral
26.
Guzman EA, Pigazzi A, Lee B, et al. Totally laparoscopic gastric resection with extended lymphadenectomy for gastric adenocarcinoma. Ann Surg Oncol. 2009;16(8):2218–23.CrossRefPubMed
27.
Postlewait LM, Maithel SK. The importance of surgical margins in gastric cancer. J Surg Oncol. 2016;113(3):277–82.CrossRefPubMed
28.
Han G, Park JY, Kim YJ. Comparison of short-term postoperative outcomes in totally laparoscopic distal gastrectomy versus laparoscopy-assisted distal gastrectomy. J Gastric Cancer. 2014;14(2):105–10.CrossRefPubMedPubMedCentral
29.
Kim SM, Ha MH, Seo JE, et al. Comparison of reduced port totally laparoscopic distal gastrectomy (duet TLDG) and conventional laparoscopic-assisted distal gastrectomy. Ann Surg Oncol. 2015;22(8):2567–72.CrossRefPubMed
30.
Yoo CH, Kim HO, Hwang SI, et al. Short-term outcomes of laparoscopic-assisted distal gastrectomy for gastric cancer during a surgeon’s learning curve period. Surg Endosc. 2009;23(10):2250–7.CrossRefPubMed
31.
Kim HG, Park JH, Jeong SH, et al. Totally laparoscopic distal gastrectomy after learning curve completion: comparison with laparoscopy-assisted distal gastrectomy. J Gastric Cancer. 2013;13(1):26–33.CrossRefPubMedPubMedCentral
32.
Ahn CW, Hur H, Han SU, Cho YK. Comparison of intracorporeal reconstruction after laparoscopic distal gastrectomy with extracorporeal reconstruction in the view of learning curve. J Gastric Cancer. 2013;13(1):34–43.CrossRefPubMedPubMedCentral
33.
Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol. 2005;11(47):7508–11.CrossRefPubMedPubMedCentral
34.
Ikeda O, Sakaguchi Y, Aoki Y, et al. Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc. 2009;23(10):2374–9.CrossRefPubMed
35.
Song KY, Park CH, Kang HC, et al. Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study. J Gastrointest Surg. 2008;12(6):1015–21.CrossRefPubMed
36.
Kim DG, Choi YY, An JY, et al. Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: a single surgeon’s experience and a rapid systematic review with meta-analysis. Surg Endosc. 2013;27(9):3153–61.CrossRefPubMed
37.
Lee J, Kim D, Kim W. Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. J Korean Surg Soc. 2012;82(3):135–42.CrossRefPubMedPubMedCentral
38.
Cianchi F, Qirici E, Trallori G, et al. Totally laparoscopic versus open gastrectomy for gastric cancer: A matched cohort study. J Laparoendosc Adv Surg Tech A. 2013;23(2):117–22.CrossRefPubMed
39.
Gao J, Li P, Li QG, et al. Comparison between totally laparoscopic and laparoscopically assisted distal gastrectomy for gastric cancer with a short follow-up: a meta-analysis. J Laparoendosc Adv Surg Tech A. 2013;23(8):693–7.CrossRefPubMed
40.
Chen K, Mou YP, Xu XW, et al. Comparison of short-term surgical outcomes between totally laparoscopic and laparoscopic-assisted distal gastrectomy for gastric cancer: a 10-y single-center experience with meta-analysis. J Surg Res. 2015;194(2):367–74.CrossRefPubMed
Metadata
Title
A propensity score matched case-control comparative study of totally laparoscopic distal gastrectomy and laparoscopic-assisted distal gastrectomy for early gastric cancer
Authors
Sung Don Oh, MD
Sung Jin Oh, MD, PhD
Byoung Jo Suh, MD, PhD
Jin Yong Shin, MD, PhD
Jong Kwon Park, MD, PhD
Publication date
01-12-2017
Publisher
Springer Vienna
Published in
European Surgery / Issue 6/2017
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-017-0495-8

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