Clinical comparison of hand assisted laparoscopic gastrectomy with laparotomy and laparoscopy assisted radical gastrectomy for distal gastric cancer

Abstract

Objective To evaluate the value of hand assisted laparoscopic radical resection for distal gastric cancer. Methods The clinical data of 80 patients with advanced gastric cancer from August 2015 to December 2017 were retrospectively analyzed. Among them, 30 patients underwent hand-assisted laparoscopic surgery, 25 patients underwent open surgery, and 25 patients underwent laparoscopic assisted surgery. The operative time, bleeding volume, number of recected lymph nodes, time to postoperative exhaust, postoperative complications, length of hospitalization, hospitalization expenses, length of incision and so on were compared among the three groups. The data were analyzed with SPSS 21.0 software. Measurement data are expressed as mean±standard deviation. ANOVA was used to compare measurement data, and the chi square test or Fisher exact test was used to compare count data. P<0.05 indicated that the difference was statistically significant. Results There was no significant difference in the number of recected lymph nodes, postoperative hospitalization expenses, or postoperative complications among the three groups (P>0.05). The hand-assisted laparoscopic surgery group, laparoscopy assisted surgery group, and open surgery group had significantly different operative time [(186.30±15.27) min vs (230.80±17.06) min vs (183.36±16.03) min] , intraoperative bleeding volume [(93.33±46.86) mL vs (98.80±55.10) mL vs (246.80±92.90) mL] , time to postoperative exhaust [(2.3±0.6) d vs (2.42±0.44) d vs (3.04±0.56) d] , length of stay [(8.90±1.19) d vs (9.40±1.44) d vs (10.92±1.73) d] , and incision length [(7.97±0.49) cm vs (8.04±0.61) cm vs (24.04±2.11) cm] (P<0.001 for all). The length of incision, blood loss, time to postoperative exhaust, and hospital stay were significantly lower in the hand-assisted laparoscopic operation group and laparoscopically assisted operation group than in the open operation group (P<0.001). The operative time was significantly shorter in the hand-assisted laparoscopic surgery group and laparotomy group than in the laparoscopically assisted operation group (P<0.001). Conclusion Hand assisted laparoscopic distal gastrectomy is safe and feasible, can achieve the radical effect of open surgery for tumor resection and lymph node dissection, and does not increase the economic burden of patients. Hand assisted laparoscopic surgery has the advantages of less intraoperative bleeding, faster postoperative recovery, and shorter operative time than laparoscopic assisted surgery. Key words: Hand assisted laparoscopy; Laparoscopy assisted; Traditional laparotomy; Advanced gastric cancer