Estimation of Physiologic Ability and Surgical Stress Scoring System Appraises Laparoscopy-Assisted and Open Distal Gastrectomy in Treatment of Early Gastric Cancer

Hideki Bou,Masanori Watanabe,Hideyuki Suzuki,Eiji Ushida,Hidetsugu Hanawa,Kentaro Maejima

doi:10.4236/jct.2013.49a001

Abstract

Laparoscopy-assisted distal gastrectomy (LADG) has been widely used to treat early gastric cancer (EGC). The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system predicts the risk of fatal postoperative complications by quantifying the patient’s reserve and degree of surgical stress, but there have been a few reports of use of the E-PASS scoring system to assess the risk of mortality following special types of surgical procedures such as LADG. In this study we assessed the feasibility of LADG versus open distal gastrectomy (ODG) by the E-PASS scoring system. The subjects of this study consisted of 69 stage IA gastric cancer patients who underwent LADG (LADG group) and 69 stage IA gastric cancer patients who underwent ODG (ODG group). The mean age of the patients in the LADG group was 68.6 years, which was significantly higher than the mean age of 63.4 years in the ODG group. There were no statistically significant differences between the groups in operation time or preoperative risk score, but there were statistically significant differences in blood loss, surgical stress score, comprehensive risk score, and duration of postoperative hospital stay. We conclude that using the E-PASS scoring system, LADG appreciates a more beneficial procedure for the treatment of EGC than ODG.

Highlights

In recent years laparoscopic surgery has become the main surgical treatment for early gastric cancer (EGC) [1,2,3,4,5], and the reasons have been standardization of the procedure, including lymph node dissection [6,7,8], reduced blood loss, and the rapid postoperative recovery associated with the reduction in size of the wound [5,6,7, 9]
We used the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system to conduct a comparative study of the cases in which EGC treatment was performed to treat stage IA gastric cancer during the 6-year period from 1999 to 2004 and the cases in which laparoscopy-assisted distal gastrectomy (LADG) was performed to treat stage IA gastric cancer cases during the period from 2005, when we introduced laparoscopic surgery, to 2010
The advantages of laparoscopic surgery have certainly been said to lie in the small size of the surgical wound and the small volume of blood loss, and there was significantly less blood loss in the Laparoscopy-assisted distal gastrectomy (LADG) group according to the results of the present study as well

Summary

Introduction

In recent years laparoscopic surgery has become the main surgical treatment for early gastric cancer (EGC) [1,2,3,4,5], and the reasons have been standardization of the procedure, including lymph node dissection [6,7,8], reduced blood loss, and the rapid postoperative recovery associated with the reduction in size of the wound [5,6,7, 9]. Surgical stress greatly exceeding a patient’s reserve capacity often disrupts the homeostasis of the respiratory, circulatory, metabolic, or immune systems, causing numerous postoperative complications. These postoperative complications may result from three major factors, namely, the quality of surgical performance, the patient’s physiological status, and the degree of surgical stress applied. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) was reported by Haga et al [10]. The Estimation of Physiologic Ability and Surgical Stress (EPASS) scoring system is used to evaluate surgical risk after elective digestive system surgery [10], and it predicts postoperative fatal complications [11,12,13,14].

Methods

Results

Conclusion