Abstract
Background:Laparoscopic surgery with a small laparotomy has several advantages over conventional open surgery, including less invasiveness, less pain, earlier recovery, and better cosmoses. The aim of this study was to compare technical feasibility and early clinical outcomes of laparoscopy-assisted distal gastrectomy in comparison with open distal gastrectomy for gastric cancer in a developing country. Patients and methods :In this retrospective study, patients with distal gastric cancer were divided into two groups (a) patients underwent laparoscopy assisted distal gastrectomy (LADG) (21 patients) and (b) open distal gastrectomy (ODG) (21 patients). For the postoperative pathologic results, the tumor-nodal-metastasis (TNM) stage, grade of tumor differentiation, distal and proximal margins, the number of harvested lymph nodes were evaluated. Staging was done according to the 7th edition of the UICC tumor, node, and metastasis (TNM) classification. D1/D2 lymphadenectomy with curative R0 intention was attempted in all cases. Perioperative mortality and morbidity were assessed. Results:The time to initiate oral intake, and postoperative hospital stay were significantly shorter in the LADG group than in the ODG group (P < 0.001). The operative time in the LADG group was significantly less than that of the ODG group (P = 0.05). Blood loss and blood transfusion frequency were significantly lower (P < 0.0001) in the LADG group in comparison to ODG group. Conclusion:Laparoscopic-assisted distal gastrectomy for distal gastric cancer could be safe and feasible technique alternative to open gastrectomy in a middle income country, with at least similar short term surgical and oncological results. However, laparoscopic gastric surgery is in need to adequate training and technical support especially in D2 lymphadenectomy.
Highlights
Laparoscopic gastrectomy for gastric cancer was reported for the first time by Kitano et al in 1994, and since the use of laparoscopy for gastrectomy in early gastric cancer (EGC) has increasing popularity for surgical treatment of EGC in Japan, Korea and China [1]
Patients and methods: In this retrospective study, patients with distal gastric cancer were divided into two groups (a) patients underwent laparoscopy assisted distal gastrectomy (LADG) (21 patients) and (b) open distal gastrectomy (ODG) (21 patients)
Most of the previous studies of LADG versus ODG showed the main advantages of laparoscopic gastrectomy over conventional open surgery were less blood loss, less postoperative pain, a minimal skin incision, a shorter time to ambulation, a shorter time to oral feeding and a shorter postoperative hospital stay [7, 24]
Summary
Laparoscopic gastrectomy for gastric cancer was reported for the first time by Kitano et al in 1994, and since the use of laparoscopy for gastrectomy in early gastric cancer (EGC) has increasing popularity for surgical treatment of EGC in Japan, Korea and China [1]. In comparison to open gastrectomy, minimally invasive laparoscopic gastrectomy has many advantages that include early recovery, minimal blood loss, reduced postoperative complications and a shortened hospital stay [2,3,4]. It maintains the short and long oncologic outcome as conventional open surgery [4, 5]. The aim of this study was to compare technical feasibility and early clinical outcomes of laparoscopy-assisted distal gastrectomy in comparison with open distal gastrectomy for gastric cancer in a developing country. Laparoscopic gastric surgery is in need to adequate training and technical support especially in D2 lymphadenectomy
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