Comparative Study of Short-Term Outcomes Between Total Laparoscopic Gastrectomy and Laparoscopy-Assisted Gastrectomy for Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CAIXun , YEJia-xin , MADan-dan ,  JINWei-dong , ZHANGJian-xin

Department of General Surgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, Hubei Province, China;

Corresponding?author：

JINWei-dong, Email: ptwkhero@163.com

Keywords：

Stomach neoplasm; Digestive tract reconstrunction; Totally laparoscopic anastomosis; Laparoscopy-assisted anastomosis; Clinical effect

DOI：

10.7507/1007-9424.20160049

Video：

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Objective To compare clinical efficacy of totally laparoscopic gastrectomy (TLG) and conventional laparoscopy-assisted gastrectomy (LAG) and to explore safety and feasibility of total laparoscopic anastomosis in laparoscopic gastrectomy. Method The clinical data of 64 patients who received TLG and another 70 patients who received conventional LAG in our department from January 2013 to March 2014 were retrospectively analyzed. Results All procedures were completed successfully. There were no significant differences in the time of anastomosis〔(73.8±10.3) min versus (72.7±8.9) min, t=0.693, P=0.489〕 and the number of dissected lymph nodes (32.4±9.7 versus 33.6±9.6, t=-0.700, P=0.485) between the patients underwent TLG and the patients underwent LAG. However there were obvious differences in the blood loss〔(275.0±66.3) mL versus (364.3±75.7) mL, t=-7.419, P=0.000〕, the incision length〔(3.0±0.8) cm versus (7.3±1.7) cm, t=-19.354, P=0.000〕, the time to fluid diet〔(4.9±0.8) d versus (6.0±0.7) d, t=-8.750, P=0.000〕 and the time to flatus 〔(2.8±0.8) d versus (3.9±0.8) d, t=-8.388, P=0.000〕, the off-bed time〔(1.3±0.5) d versus (3.4±1.2) d, t=-14.118, P=0.000〕, and the hospital stay〔(9.8±1.2) d versus (13.0±1.5) d, t=-17.471, P=0.000〕 between the patients underwent TLG and the patients underwent LAG. Meanwhile it was found that the postoperative pain score〔On day 1 postoperatively: (3.4±0.8) points versus (6.2±1.3) points, t=-15.509, P=0.000; on day 3 postoperatively: (1.7±0.6) points versus (4.0±0.8) points, t=-18.799, P=0.000〕 and the dosage of pain killers (1.7±0.7 versus 4.0±2.1, t=-8.912, P=0.000) in the patients underwent TLG were significantly lower than those in the patients underwent LAG. One patient developed anastomotic leakage and 3 patients developed anastomotic stenosis in the patients underwent LAG, the complication rate related to the anastomosis was 5.7% (4/70). While there were no complications related to the anastomosis in including anastomotic leakage, stenosis, and bleeding in the patients underwent TLG. Conclusions Total laparoscopic anastomosis is safe and feasible in laparoscopic gastrectomy for gastric cancer. Compared with small incision-assisted anastomosis, totally laparoscopic anastomosis is associated with minimal trauma, less blood, quicker postoperative recovery, shorter time, slighter pain and satisfactory short-term efficacy.

Citation： CAIXun, YEJia-xin, MADan-dan, JINWei-dong, ZHANGJian-xin. Comparative Study of Short-Term Outcomes Between Total Laparoscopic Gastrectomy and Laparoscopy-Assisted Gastrectomy for Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(2): 186-191. doi: 10.7507/1007-9424.20160049 Copy

1.	?Sakuramoto S, Yamashita K, Kikuchi S, et al. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc, 2013, 27(5): 1695-1705.
2.	Kawamura H, Tanioka T, Kuji M, et al. The initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy. Gastric Cancer, 2013, 16(4): 602-608.
3.	黃昌明, 林建賢. 腹腔鏡胃癌手術消化道重建的難點與決策. 中華胃腸外科雜志, 2013, 16(2): 121-124.
4.	牟一平. 完全腹腔鏡胃癌根治術消化道重建方式的選擇及技巧.腹腔鏡外科雜志, 2012, 17(5): 339-341.
5.	臧潞. 腹腔鏡胃癌手術的消化道重建. 中華胃腸外科雜志, 2012, 15(8): 787-789.
6.	趙永亮, 余佩武. 腹腔鏡全胃切除術后消化道重建方式的探討. 第三軍醫大學學報, 2013, 17(18): 1907-1909.
7.	余佩武. 努力提高我國腹腔鏡胃癌手術水平的幾點思考. 中國普外基礎與臨床雜志, 2015, 22(4): 385-387.
8.	中華醫學會外科學分會腹腔鏡與內鏡外科學組. 腹腔鏡胃癌手術操作指南 (2007版). 中華消化外科雜志, 2007, 6(6): 476-480.
9.	余佩武. 腹腔鏡胃癌根治術的原則與評價. 中國普外基礎與臨床雜志, 2009, 16(1): 1-5.
10.	蔡遜, 葉家欣, 馬丹丹, 等. 反穿刺器技術在腹腔鏡食管胃交界部腺癌中的應用. 腹部外科, 2015, 28(1): 26-29.
11.	陳丹磊, 丁丹, 柯重偉. 反穿刺器在腹腔鏡食管-殘胃(空腸)吻合術中的應用. 中華胃腸外科雜志, 2013, 16(10): 956-959.
12.	Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc, 2009, 23(11): 2624-2630.
13.	Kunisaki C, Makino H, Oshima T, et al. Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc, 2011, 25(4): 1300-1305.
14.	Liao GQ, Ou XW, Liu SQ, et al. Laparoscopy-assisted total gastrectomy with trans-orally inserted anvil (OrVilTM): a single institution experience. World J Gastroenterol, 2013, 19(5): 755-760.
15.	Takiguchi S, Fujiwara Y, Yamasaki M, et al. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study. World J Surg, 2013, 37(10): 2379-2386.
16.	Fukunaga T, Hiki N, Kubota T, et al. Oncologic outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer. Ann Surg Oncol, 2013, 20(8): 2676-2682.
17.	Mochizuki Y, Kodera Y, Fujiwara M, et al. Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma. Gastric Cancer, 2012, 15(2): 124-130.
18.	Kitano S, Tomikawa M, Iso Y, et al. Laparoscopy-assisted devascularization of the lower esophagus and upper stomach in the management of gastric varices. Endoscopy, 1994, 26(5): 470-473.
19.	朱甲明, 劉晶晶, 文大成, 等. 全腔鏡下吻合技術在腹腔鏡胃癌根治術中的應用. 中華胃腸外科雜志, 2013, 16(9): 881-884.
20.	Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc, 2005, 19(2): 168-173.
21.	Kojima K, Yamada H, Inokuchi M, et al. A comparison of Rouxen-Y and Billroth-Ⅰ Reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg, 2008, 247(6): 962-967.
22.	Kim JJ, Song KY, Chin HM, et al. Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc, 2008, 22(2): 436-442.
23.	Kanaya S, Gomi T, Momoi H, et al. Delta-shaped anastomosis in totally laparoscopic BillrothⅠ gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg, 2002, 195(2): 284-287.
24.	Oki E, Sakaguchi Y, Ohgaki K, et al. Feasibility of delta-shaped anastomoses in totally laparoscopic distal gastrectomy. Eur Surg Res, 2011, 47(4): 205-210.
25.	Kim MG, Kawada H, Kim BS, et al. A totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG) for improvement of the early surgical outcomes in high BMI patients. Surg Endosc, 2011, 25(4): 1076-1082.
26.	蘭遠志, 余佩武, 錢鋒. 腹腔鏡胃癌根治術團隊中助手的配合與體會. 中華胃腸外科雜志, 2012, 15(2): 185-186.

1. ?Sakuramoto S, Yamashita K, Kikuchi S, et al. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc, 2013, 27(5): 1695-1705.
2. Kawamura H, Tanioka T, Kuji M, et al. The initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy. Gastric Cancer, 2013, 16(4): 602-608.
3. 黃昌明, 林建賢. 腹腔鏡胃癌手術消化道重建的難點與決策. 中華胃腸外科雜志, 2013, 16(2): 121-124.
4. 牟一平. 完全腹腔鏡胃癌根治術消化道重建方式的選擇及技巧.腹腔鏡外科雜志, 2012, 17(5): 339-341.
5. 臧潞. 腹腔鏡胃癌手術的消化道重建. 中華胃腸外科雜志, 2012, 15(8): 787-789.
6. 趙永亮, 余佩武. 腹腔鏡全胃切除術后消化道重建方式的探討. 第三軍醫大學學報, 2013, 17(18): 1907-1909.
7. 余佩武. 努力提高我國腹腔鏡胃癌手術水平的幾點思考. 中國普外基礎與臨床雜志, 2015, 22(4): 385-387.
8. 中華醫學會外科學分會腹腔鏡與內鏡外科學組. 腹腔鏡胃癌手術操作指南 (2007版). 中華消化外科雜志, 2007, 6(6): 476-480.
9. 余佩武. 腹腔鏡胃癌根治術的原則與評價. 中國普外基礎與臨床雜志, 2009, 16(1): 1-5.
10. 蔡遜, 葉家欣, 馬丹丹, 等. 反穿刺器技術在腹腔鏡食管胃交界部腺癌中的應用. 腹部外科, 2015, 28(1): 26-29.
11. 陳丹磊, 丁丹, 柯重偉. 反穿刺器在腹腔鏡食管-殘胃(空腸)吻合術中的應用. 中華胃腸外科雜志, 2013, 16(10): 956-959.
12. Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc, 2009, 23(11): 2624-2630.
13. Kunisaki C, Makino H, Oshima T, et al. Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc, 2011, 25(4): 1300-1305.
14. Liao GQ, Ou XW, Liu SQ, et al. Laparoscopy-assisted total gastrectomy with trans-orally inserted anvil (OrVilTM): a single institution experience. World J Gastroenterol, 2013, 19(5): 755-760.
15. Takiguchi S, Fujiwara Y, Yamasaki M, et al. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study. World J Surg, 2013, 37(10): 2379-2386.
16. Fukunaga T, Hiki N, Kubota T, et al. Oncologic outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer. Ann Surg Oncol, 2013, 20(8): 2676-2682.
17. Mochizuki Y, Kodera Y, Fujiwara M, et al. Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma. Gastric Cancer, 2012, 15(2): 124-130.
18. Kitano S, Tomikawa M, Iso Y, et al. Laparoscopy-assisted devascularization of the lower esophagus and upper stomach in the management of gastric varices. Endoscopy, 1994, 26(5): 470-473.
19. 朱甲明, 劉晶晶, 文大成, 等. 全腔鏡下吻合技術在腹腔鏡胃癌根治術中的應用. 中華胃腸外科雜志, 2013, 16(9): 881-884.
20. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc, 2005, 19(2): 168-173.
21. Kojima K, Yamada H, Inokuchi M, et al. A comparison of Rouxen-Y and Billroth-Ⅰ Reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg, 2008, 247(6): 962-967.
22. Kim JJ, Song KY, Chin HM, et al. Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc, 2008, 22(2): 436-442.
23. Kanaya S, Gomi T, Momoi H, et al. Delta-shaped anastomosis in totally laparoscopic BillrothⅠ gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg, 2002, 195(2): 284-287.
24. Oki E, Sakaguchi Y, Ohgaki K, et al. Feasibility of delta-shaped anastomoses in totally laparoscopic distal gastrectomy. Eur Surg Res, 2011, 47(4): 205-210.
25. Kim MG, Kawada H, Kim BS, et al. A totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG) for improvement of the early surgical outcomes in high BMI patients. Surg Endosc, 2011, 25(4): 1076-1082.
26. 蘭遠志, 余佩武, 錢鋒. 腹腔鏡胃癌根治術團隊中助手的配合與體會. 中華胃腸外科雜志, 2012, 15(2): 185-186.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative Study of Short-Term Outcomes Between Total Laparoscopic Gastrectomy and Laparoscopy-Assisted Gastrectomy for Gastric Cancer

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