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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.	黄昌明, 林建贤. 腹腔镜胃癌手术消化道重建的难点与决策. 中华胃肠外科杂志, 2013, 16(2): 121-124.
4.	牟一平. 完全腹腔镜胃癌根治术消化道重建方式的选择及技巧.腹腔镜外科杂志, 2012, 17(5): 339-341.
5.	臧潞. 腹腔镜胃癌手术的消化道重建. 中华胃肠外科杂志, 2012, 15(8): 787-789.
6.	赵永亮, 余佩武. 腹腔镜全胃切除术后消化道重建方式的探讨. 第三军医大学学报, 2013, 17(18): 1907-1909.
7.	余佩武. 努力提高我国腹腔镜胃癌手术水平的几点思考. 中国普外基础与临床杂志, 2015, 22(4): 385-387.
8.	中华医学会外科学分会腹腔镜与内镜外科学组. 腹腔镜胃癌手术操作指南 (2007版). 中华消化外科杂志, 2007, 6(6): 476-480.
9.	余佩武. 腹腔镜胃癌根治术的原则与评价. 中国普外基础与临床杂志, 2009, 16(1): 1-5.
10.	蔡逊, 叶家欣, 马丹丹, 等. 反穿刺器技术在腹腔镜食管胃交界部腺癌中的应用. 腹部外科, 2015, 28(1): 26-29.
11.	陈丹磊, 丁丹, 柯重伟. 反穿刺器在腹腔镜食管-残胃(空肠)吻合术中的应用. 中华胃肠外科杂志, 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, 刘晶晶, 文大成, 等. 全腔镜下吻合技术在腹腔镜胃癌根治术中的应用. 中华胃肠外科杂志, 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.	兰远志, 余佩武, 钱锋. 腹腔镜胃癌根治术团队中助手的配合与体会. 中华胃肠外科杂志, 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. 黄昌明, 林建贤. 腹腔镜胃癌手术消化道重建的难点与决策. 中华胃肠外科杂志, 2013, 16(2): 121-124.
4. 牟一平. 完全腹腔镜胃癌根治术消化道重建方式的选择及技巧.腹腔镜外科杂志, 2012, 17(5): 339-341.
5. 臧潞. 腹腔镜胃癌手术的消化道重建. 中华胃肠外科杂志, 2012, 15(8): 787-789.
6. 赵永亮, 余佩武. 腹腔镜全胃切除术后消化道重建方式的探讨. 第三军医大学学报, 2013, 17(18): 1907-1909.
7. 余佩武. 努力提高我国腹腔镜胃癌手术水平的几点思考. 中国普外基础与临床杂志, 2015, 22(4): 385-387.
8. 中华医学会外科学分会腹腔镜与内镜外科学组. 腹腔镜胃癌手术操作指南 (2007版). 中华消化外科杂志, 2007, 6(6): 476-480.
9. 余佩武. 腹腔镜胃癌根治术的原则与评价. 中国普外基础与临床杂志, 2009, 16(1): 1-5.
10. 蔡逊, 叶家欣, 马丹丹, 等. 反穿刺器技术在腹腔镜食管胃交界部腺癌中的应用. 腹部外科, 2015, 28(1): 26-29.
11. 陈丹磊, 丁丹, 柯重伟. 反穿刺器在腹腔镜食管-残胃(空肠)吻合术中的应用. 中华胃肠外科杂志, 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, 刘晶晶, 文大成, 等. 全腔镜下吻合技术在腹腔镜胃癌根治术中的应用. 中华胃肠外科杂志, 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. 兰远志, 余佩武, 钱锋. 腹腔镜胃癌根治术团队中助手的配合与体会. 中华胃肠外科杂志, 2012, 15(2): 185-186.

Previous Article
Significance and Techniques of Assessment and Treatment of the Tricuspid Valve Regurgitation
Next Article
Application Development of Gastric Tube in Esophagectomy

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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content