Comparing a Right- Versus Left-Side Approach in Laparoscopy-Assisted D2 Radical Gastrectomies in Overweight Patients with Gastric Cancer: A Retrospective Case-Controlled Study

Abstract

Background: The safety and efficacy of the surgical path used in laparoscopy-assisted radical gastrectomies (LARGs) is still unknown in obese patients. This study aimed to compare the value of a right-side (R-LARG) versus a left-side (L-LARG) approach in LARGs in overweight patients (defined as a body mass index (BMI) ≥ 25 kg/m²). Methods: 213 patients with gastric cancer were divided into 2 groups: an overweight group and a normal-weight group (BMI < 25 kg/m²). Clinical characteristics and perioperative outcomes were compared in the 2 groups. Results: In the overweight group, patients who underwent R-LARG had a shorter operating time (204 ± 15 vs. 248 ± 21 min), less intraoperative blood loss (66 ± 8 vs. 78 ± 7 ml), less painkiller usage (2.0 ± 0.2 vs. 2.5 ± 0.3 days), shorter time to mobility (2.1 ± 0.3 vs. 2.7 ± 0.5 days), faster recovery of peristalsis (3.4 ± 0.3 vs. 4.1 ± 0.5 days) and more lymph node dissection per patient (37 ± 4 vs. 31 ± 2) compared with the patients who underwent L-LARG. No statistically significant differences in postoperative complications (11.9% vs. 10.8%), postoperative hospital stays or hospitalization expenses were found between the groups. In the normal-weight group, perioperative outcomes were similar between the R-LARG and L-LARG groups. Conclusion: R-LARG has obvious advantages in overweight patients with gastric cancer.