The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer

Abstract

Generally, LN metastases are seen in a small percentage of patients with early gastric cancer with mucosal or submucosal invasion [7]. In recent years, the technique of laparoscopy-assisted distal gastrectomy (LADG) with regional LN dissection has been developed and employed for early gastric cancer [8]. In March, 1997, we began to perform LADG as a minimally invasive surgery for early gastric cancer. However, the feasibility of LADG for early gastric cancer and the associated clinical outcome of patients who undergo LADG for early gastric cancer remain unclear.We therefore conducted a review of patients who underwent LADG for early gastric cancer, in an effort to compare the operative times, intra-operative blood loss, number of removed lymph nodes, postoperative recovery, and morbidity and mortality rates of LADG and conventional open distal gastrectomy (ODG). Our research was aimed at determining whether the laparoscopic procedure of LADG for early gastric cancer is really safe and minimally invasive, and whether or not the LADG improves quality of life, compared with ODG. Patients and methods PatientsThe patients were preoperatively diagnosed as having an early gastric cancer located in the lower or middle third of the stomach, from the results of endoscopy, endoscopic ultrasonography (EUS), and examination of biopsy specimens. The indications for LADG were that: (1) the tumor was located in the middle or lower part of the stomach, (2) the invasion of the tumor was limited to the mucosal layer or the submucosal layers (SM1). Results. The clinical and pathological backgrounds of the patients in the two groups were similar. The duration of surgery was not significantly different between the two groups, but the blood loss in the LADG group was significantly less than that in the ODG group. The number of removed lymph nodes was not significantly different between the two groups. The times to the first passing of flatus, first walking, and the restarting of oral intake; the length of hospital stay; and the duration of epidural analgesia were significantly shorter in the LADG group. The morbidity rate in the LADG group was lower than that in the ODG group. Conclusions. LADG is a safe and minimally invasive surgical technique, after which we can expect a faster recovery.

Quality of life beyond the early postoperative period after laparoscopy-assisted distal gastrectomy: the level of patient expectation as the essence of quality of life

“…Many studies have shown the advantages of LADG over open distal subtotal gastrectomy (ODSG), such as cosmetic benefits, less pain, faster recovery, and shorter hospital stay [2][3][4][5][6][7]. The early postoperative quality of life (QoL) following LADG has been shown to be superior to that following ODSG [8,9].…”

Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

“…LAG provides many other advantages when compared with conventional open gastrectomy: less blood loss and inflammation, better post-operative pulmonary function, less postoperative pain, earlier first flatus and eating, shorter hospital stays, and better cosmesis [10]. With regard to operative curability, the surgical margins and the number of dissected lymph nodes in LAG are equivalent to those in conventional open gastrectomy [20].…”

Randomized controlled trials evaluating laparoscopic vs. open distal gastrectomy for gastric cancer in 2016: a trilogy finally!

“…Morbidity of laparoscopic gastrectomy ranges between 4.2% to 23.3% (4)(5)(6)(7)(8)(9)(10), and a meta-analysis of all randomized controlled trials and high-quality nonrandomized trials comparing LADG to ODG found an overall favorable response to the former (11).…”