Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer

Kim, Wook; Kim, Hyung‐Ho; Han, Sang Uk; Kim, Min Chan; Hyung, Woo Jin; Ryu, Seung Wan; Cho, Gyu Seok; Kim, Chan Young; Yang, Han Kwang; Park, Do Joong; Song, Kyo Young; Lee, Sang Il; Ryu, Seunghyong; Lee, Joo Ho; Lee, Hyuk Joon

doi:10.1097/sla.0000000000001346

Cited by 549 publications

(418 citation statements)

References 26 publications

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“…7 In our study, wound complications were more common in the ODG group. In obese patients, the risk of wound infections is likely to increase due to abundant subcutaneous fat.…”

Section: Discussionsupporting

confidence: 42%

“…13,14 However, a longer operation time has been noted in obese patients. 7 This study evaluated the postoperative complication rate after laparoscopic distal gastrectomy and the safety of laparoscopic distal gastrectomy in patients with a high BMI. The overall complication rate was higher in the ODG than in the LDG group in both cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…Large amounts of intra-abdominal fat can obscure vascular [4][5][6] In the recently published KLASS-01 trial morbidity and mortality report, laparoscopic gastrectomy showed advantages in terms of estimated blood loss, length of hospital stay, and overall complication rate, especially for wound complication. 7 However, laparoscopic gastrectomy requires a longer operation time than that of open gastrectomy. Recently, the discrepancy in operation time has decreased due to technical improvements.…”

Section: Introductionmentioning

confidence: 99%

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Comparison Surgical Outcomes between Laparoscopic and Conventional Distal Gastrectomy for Early Gastric Cancer in Obese Patients

Choi

Kim

Yoo

et al. 2017

J Minim Invasive Surg

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Purpose:In this study, we explored the safety of laparoscopic gastrectomy in obese gastric cancer patients compared with conventional open gastrectomy based on early surgical outcomes. Methods:A total of 462 patients who underwent curative gastrectomy for early gastric adenocarcinoma from January 2000 to December 2014 were enrolled. Two obesity cohorts were defined according to a body mass index (BMI) of ≥25 kg/m 2 versus ≥30 kg/m 2 . Those cohorts were further divided into the laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) groups, and clinicopathologic characteristics were compared with early surgical results.Results: There were no significant differences in clinicopathologic characteristics between the LDG and ODG groups in the BMI ≥25 or BMI ≥30 cohorts. For the overall complication rate, fewer complications were observed in the LDG than ODG group in both cohorts. Among the overall complications, significant differences were observed in the minor complication rates (Clavien-Dindo I or II), but no significant difference was observed in the rate of Clavien-Dindo III or higher complications. For risk factor analysis of postoperative complications, open distal gastrectomy, age >60 years, and BMI ≥30 were independent risk factors for postoperative morbidity among all obese patients. Conclusion:LDG may be a better procedure to improve surgical outcomes in patients with obesity undergoing surgery for early gastric cancer in terms of less excessive blood loss, shorter operation time, and lower complication rates.

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“…7 In our study, wound complications were more common in the ODG group. In obese patients, the risk of wound infections is likely to increase due to abundant subcutaneous fat.…”

Section: Discussionsupporting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison Surgical Outcomes between Laparoscopic and Conventional Distal Gastrectomy for Early Gastric Cancer in Obese Patients

Choi

Kim

Yoo

et al. 2017

J Minim Invasive Surg

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“…Kim et al . have reported a decrease in morbidity after laparoscopic distal gastrectomy for stage I gastric cancer 43. However, the only significant factor was wound complication.…”

Section: Resultsmentioning

confidence: 99%

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Shimada

Fukagawa

Haga

et al. 2017

Annals of Gastroent Surgery

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PurposeThe impact of postoperative complications on survival after radical surgery for esophageal, gastric, and colorectal cancers remains controversial. We conducted a systematic review of recent publications to examine the effect of postoperative complications on oncological outcome.MethodsA literature search of PubMed/MEDLINE was performed using the keywords “esophageal cancer,” “gastric cancer,” and “colorectal cancer,” obtaining 27 reports published online up until the end of April 2016. Articles focusing on (i) postoperative morbidity and oncological outcome; and (ii) body mass index (BMI), postoperative morbidity, and oncological outcome, were selected. Univariate and multivariate analyses (Cox proportional hazards model) were performed.ResultsPatients with postoperative complications had significantly poorer long‐term survival than those without complications. Complications were associated with impaired oncological outcomes. The hazard ratios for overall survival were 1.67 (95% confidence interval [CI], 1.31‐2.12), 1.59 (95% CI, 1.13‐2.24), and 1.55 (95% CI, 1.28‐1.87) in esophageal, gastric, and colorectal cancers, respectively. High BMI was associated with postoperative morbidity rate but not with poor oncological outcome. Low BMI was significantly associated with inferior oncological outcome.ConclusionsComplications after radical surgery for esophageal, gastric, and colorectal cancers are associated with patient prognosis. Avoiding such complications might improve the outcomes.

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“…More clinically significant, however, was the finding of a lower overall complication rate associated with LADG compared to ODG (13% vs. 19.9%, P=0.001). The mortality rate was similar between the two groups and was not found to be statistically significant (26).…”

Section: Early Gastric Cancermentioning

confidence: 67%

Minimally invasive surgery for gastric cancer in USA: current status and future perspectives

Russo¹,

Strong²

2017

Transl. Gastroenterol. Hepatol.

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Abstract:The World Health Organization (WHO) has declared gastric carcinoma a global health concern and gastric cancer remains the third leading cause of cancer deaths worldwide. With the rising incidence of gastric cancer, a body of both retrospective and randomized data has emerged since the early 1990's evaluating the role of minimally invasive platforms in the management of gastric cancer. While Eastern studies have shown that the laparoscopic approach is safe and feasible for advanced gastric cancer in Eastern patients, it is not clear whether this is true for patients in the West. Differences in tumor biology, stage at presentation, institutional volume, and surgeon experience all may impact the efficacy and widespread utilization of minimally invasive approaches in regions where gastric cancer is less prevalent. The majority of studies have pointed to a number of improvements associated with minimally invasive approaches including decreased blood loss, shorter length of hospital stay, lower analgesic requirements, decreased minor complications, and faster recovery without any significant difference in overall or disease specific survival (DSS). The benefits associated with minimally invasive approaches and evidence supporting similar oncologic outcomes compared to the traditional open approach will hopefully expand the indications for minimally invasive surgery in the management of gastric cancer. In the United States, results following initial experiences with minimally invasive techniques, including robotic platforms, have revealed promising results.Well-established laparoscopic and robotic techniques are emerging, particularly from high volume United States institutions, which will hopefully pave the way for increased utilization of minimally invasive surgery for gastric cancer in the West.

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Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer

Abstract: LADG for patients with clinical stage I gastric cancer is safe and has a benefit of lower occurrence of wound complication compared with conventional ODG.

Cited by 549 publications

References 26 publications

Comparison Surgical Outcomes between Laparoscopic and Conventional Distal Gastrectomy for Early Gastric Cancer in Obese Patients

Comparison Surgical Outcomes between Laparoscopic and Conventional Distal Gastrectomy for Early Gastric Cancer in Obese Patients

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Minimally invasive surgery for gastric cancer in USA: current status and future perspectives

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