Comparison of Early Outcomes of Intracorporeal and Extracorporeal Gastroduodenostomy After Laparoscopic Distal Gastrectomy for Gastric Cancer

Kim, Beom Su; Yook, Jeong Hwan; Choi, Youn Baik; Kim, Kab Choong; Kim, Min; Kim, So Yeon; Kawada, Hironori; Kim, Byung Sik

doi:10.1089/lap.2010.0515

Cited by 45 publications

(33 citation statements)

References 14 publications

(18 reference statements)

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“…The results showed that the method was safe, simple and less invasive. In the comparative studies between DSG and LADG with a circular anastomosis, the majority of results showed that there was no difference in the surgical time and postoperative complication rate [1, 8, 23], and the long-term outcomes were also comparable [10]. DSG was considered to be less invasive [1, 3], especially in obese patients [8, 24].…”

Section: Discussionmentioning

confidence: 99%

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Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer: a case–control and case-matched study

Zheng

Huang

et al. 2016

Surg Endosc

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ObjectiveTo evaluate the safety, feasibility and clinical results of the modified delta-shaped gastroduodenostomy (MDSG) in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer (GC).MethodsWe performed a case–control and case-matched study enrolling 642 patients with GC undergoing laparoscopic distal gastrectomy with Billroth-I anastomosis from January 2011 to December 2014. TLDG with MDSG was performed in 158 patients (Group TL), and laparoscopy-assisted distal gastrectomy with circular anastomosis was performed in 484 patients (Group LA). One-to-one propensity score matching (PSM) was performed to compare the clinicopathological characteristics between the two groups.ResultsPatients with smaller tumors or stage I cancer were more likely to receive TLDG (P < 0.05). In the propensity-matched analysis of 143 pairs, there were no differences in demographic and pathologic characteristics between groups (all P < 0.05). All patients successfully underwent laparoscopic radical distal gastrectomy. Before PSM, Group TL had more dissected lymph nodes (LNs), a longer time to first fluid diet and a longer postoperative length of stay than Group LA (all P < 0.05). After PSM, except for the fact that more dissected LNs were obtained in Group LA (P < 0.05), no difference was found in the intraoperative and postoperative outcomes between the groups (all P > 0.05). The postoperative complications were similar in both groups (all P > 0.05). Stratification analysis performed after PSM showed that in early GC, no difference was observed in intraoperative and postoperative outcomes between the groups (all P > 0.05). However, in locally advanced GC, Group TL had more dissected LNs and a higher rate of postoperative complications (both P < 0.05). Univariate analysis carried out in locally advanced cases after PSM showed that the body mass index (BMI), the method of digestive tract reconstruction and Charlson’s score were significant factors that affected postoperative morbidity (all P < 0.05). Multivariate analysis indicated that BMI was an independent risk factor for postoperative morbidity (P < 0.05).ConclusionsThe MDSG in TLDG is safe and feasible for early GC; however, it should be chosen with caution in advanced GC, particularly in patients with a high BMI.

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Section: Discussionmentioning

confidence: 99%

“…Enrolled patients with I stage GC represented more than 85 % of all patients. Patients with locally advanced GC were less common, and most of them had stage II or stage IIIA GC [5, 22, 23]. Stage IIIB and IIIC diseases were rarely reported.…”

Section: Discussionmentioning

confidence: 99%

Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer: a case–control and case-matched study

Zheng

Huang

et al. 2016

Surg Endosc

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“…With the rapid development of laparoscopic instruments and techniques, laparoscopy-assisted distal gastrectomy (LADG) can be used for AGC treatment [3]. Several retrospective studies have demonstrated that totally laparoscopic distal gastrectomy (TLDG) was safer, more feasible, and less invasive than LADG [4][5][6][7]. Additionally, Patriti et al [8] indicated that robot-assisted laparoscopic gastrectomy with D2 lymph node dissection for adenocarcinoma was feasible and safe.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Safety and Efficacy of Open, Laparoscopic-Assisted, Totally Laparoscopic, and Robotic Gastrectomy for Gastric Cancer:A Network Meta-Analysis

Huang

Luo

et al. 2019

Preprint

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Background: Several techniques are used for surgical treatment of gastric cancer (GC), but the efficacy and safety of these approaches have not been compared. Methods: We systematically searched articles of randomized controlled trials (RCTs) through PubMed, Embase, Cochrane Library and ISI-Web of Science databases. The primary outcome was safety using overall morbidity as the main indicator of safety. The secondary outcome was efficacy using the number of harvested lymph nodes (HLNs) as an indicator of efficacy. Multiple surgical treatment comparisons based on Bayesian network integrated the safety and efficacy of all included approaches. The ranking probability was appraised by the probability of the surgical approaches. Results: The 19 eligible RCTs with 4309 patients were included in the network meta-analysis (NMA). There were no differences in overall morbidity between open gastrectomy (OG) and laparoscopic-assisted gastrectomy (LAG) odds ratio (OR) 1.09, 95% credible interval (Crl): 0.86-1.64, OG and robotic gastrectomy (RG) (OR 1.16, 95% Crl: 0.43-3.07), LAG and totally laparoscopic gastrectomy (TLG) (OR 2.85, 95% Crl: 0.67-12.52), RG and LAG (OR 0.96, 95% Crl: 0.36-2.93), TLG and OG (OR 0.32, 95% Crl: 0.07-1.38) and TLG and RG (OR Pharmacoeconomics and Outcomes Research Task Force on Indirect Treatment Comparisons Good Research Practices [11]. Institutional review board approval was not required. Search StrategyPubMed, Embase, ISI-Web of Science and Cochrane Library were searched for RCTs published between 1950 and 2019. The following terms were used in combinations: Gastric cancer, Stomach

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“…When gastroduodenostomy is performed during laparoscopic surgery, extracorporeal anastomosis through mini-laparotomy has been reported to be a safe procedure. However, the benefits of intracorporeal gastroduodenostomy have been reported recently 3,4. Gastrojejunostomy can easily be performed intracorporeally with a linear stapler.…”

Section: Introductionmentioning

confidence: 99%

Totally Laparoscopic Roux-en-Y Gastrojejunostomy after Laparoscopic Distal Gastrectomy: Analysis of Initial 50 Consecutive Cases of Single Surgeon in Comparison with Totally Laparoscopic Billroth I Reconstruction

Cho

Choi

et al. 2014

Yonsei Med J

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PurposeRoux-en-Y reconstruction (RY) in laparoscopic distal gastrectomy for gastric cancer is a more complicated procedure than Billroth-I (BI) or Billroth-II. Here, we offer a totally laparoscopic simple RY using linear staplers.Materials and MethodsEach 50 consecutive patients with totally laparoscopic distal gastrectomy with RY and BI were enrolled in this study. Technical safety and surgical outcomes of RY were evaluated in comparison with BI.ResultsIn all patients, RY gastrectomy using linear staplers was safely performed without any events during surgery. The mean operation time and anastomosis time were 177.0±37.6 min and 14.4±5.6 min for RY, respectively, which were significantly longer than those for BI (150.4±34.0 min and 5.9±2.2 min, respectively). There were no differences in amount of blood loss, time to flatus passage, diet start, length of hospital stay, and postoperative inflammatory response between the two groups. Although there was no significant difference in surgical complications between RY and BI (6.0% and 14.0%), the RY group showed no anastomosis site-related complications.ConclusionThe double stapling method using linear staplers in totally laparoscopic RY reconstruction is a simple and safe procedure.

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Comparison of Early Outcomes of Intracorporeal and Extracorporeal Gastroduodenostomy After Laparoscopic Distal Gastrectomy for Gastric Cancer

Abstract: TLDG with intracorporeal gastroduodenostomy is as safe and feasible as LADG for patients with gastric cancer. Moreover, TLDG is less invasive and more comfortable for patients than LADG.

Cited by 45 publications

References 14 publications

Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer: a case–control and case-matched study

Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer: a case–control and case-matched study

Comparison of Safety and Efficacy of Open, Laparoscopic-Assisted, Totally Laparoscopic, and Robotic Gastrectomy for Gastric Cancer:A Network Meta-Analysis

Totally Laparoscopic Roux-en-Y Gastrojejunostomy after Laparoscopic Distal Gastrectomy: Analysis of Initial 50 Consecutive Cases of Single Surgeon in Comparison with Totally Laparoscopic Billroth I Reconstruction

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