Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer

Abstract

PurposeIn laparoscopic distal gastrectomy for gastric cancer, most surgeons prefer extra-corporeal anastomosis because of technical challenges and unfamiliarity with intra-corporeal anastomosis. Herein, we report the feasibility and safety of intra-corporeal Billroth-II anastomosis in gastric cancer.MethodsFrom April 2004 to March 2011, 130 underwent totally laparoscopic distal gastrectomy with intra-corporeal Billroth-II reconstruction, and 269 patients underwent laparoscopy-assisted distal gastrectomy with extra-corporeal Billroth-II reconstruction. Surgical efficacies and outcomes between two groups were compared.ResultsThere were no differences in demographics and clinicopathological characteristics. The mean operation and reconstruction times of totally laparoscopic distal gastrectomy were statistically shorter than laparoscopy-assisted distal gastrectomy (P = 0.019; P < 0.001). Anastomosis-related complications were observed in 11 (8.5%) totally laparoscopic distal gastrectomy and 21 (7.8%) laparoscopy-assisted distal gastrectomy patients, and the incidence of these events was not significantly different. Post-operative hospital stays for totally laparoscopic distal gastrectomy were shorter than laparoscopy-assisted distal gastrectomy patients (8.3 ± 3.2 days vs. 9.9 ± 5.3 days, respectively; P = 0.016), and the number of times parenteral analgesic administration was required in laparoscopy-assisted distal gastrectomy patients was more frequent after surgery.ConclusionIntra-corporeal Billroth-II anastomosis is a feasible procedure and can be safely performed with the proper experience for laparoscopic distal gastrectomy. This method may be less time consuming and may produce a more cosmetic result.

Comparison of Laparoscopy-Assisted and Totally Laparoscopic Distal Gastrectomy: The Short-Term Outcome at a Low Volume Center

“…But morbidity especially anastomosis leakage were more prevalent in our study. The ratio of anastomosis leakage in other reports ranges from 0 to 4.0% 3,6,12. The oncologic outcomes including proximal resection margin, number of harvested lymph nodes and lymph node station were comparable with the data of large volume centers 3,4,6,12.…”

“…Also, many authors have reported that intracorporeal anastomosis of the TLDG wound be feasible and safe 6,12. In this study, there was no significant difference in operation time, estimated blood loss, or surgical complication between LADG and TLDG.…”

“…The amount of stapler cartridge usage was less than in other study. The number of cartridges used in other studies was on average 4.9 to 10.2 6,12,22…”

Totally Laparoscopic Distal Gastrectomy after Learning Curve Completion: Comparison with Laparoscopy-Assisted Distal Gastrectomy

“…However, these issues were not observed when we performed the intra-corporeal anastomosis. Lee et al23 also reported that the intracorporeal Billroth II anastomosis time of TLDG was statistically shorter than that of LADG.…”

Reconstruction of the Digestive Tract After Laparoscopic Gastrectomy for Gastric Cancer

“…When a tumor has invaded the pyloric canal or duodenum, Billroth-II anastomosis can be performed to achieve R0 resection [ 25 ]. In distal gastrectomy, two-thirds to three-quarters of the distal stomach should be resected, including the distal gastric body, antrum, pylorus, and proximal duodenal bulb.…”