Recent Status of Laparoscopic Distal Gastrectomy in Korea: A Multicenter Retrospective Cohort Study (Pre-study Survey of KLASS-07 Trial).

Chang In Choi,Han Hong Lee,Sungsoo Park,Ye Seob Jee,Chang Min Lee,Oh Jeong,Ji Ho Park

doi:10.3389/fonc.2019.00982

Abstract

Purpose: To analyze the surgical trend and brief postoperative results of laparoscopic distal gastrectomy (LDG) in Korea on the basis of a multicenter cohort.Materials and Methods: Data of 812 patients who underwent LDG between January and December 2016 were collected from 14 surgeons at 7 institutions. Patients were divided into laparoscopy-assisted distal gastrectomy (LADG) group and totally laparoscopic distal gastrectomy (TLDG) group. Perioperative and clinicopathologic outcomes were compared retrospectively.Results: Among the patients [n = 222 (27.3%) LADG; n = 590 (72.7%) TLDG], there are no significant differences in patient's demographics (sex, age, body mass index, and American Society of Anesthesiologists score). Billroth-I anastomosis (84.7%) was most performed in the LADG group, but Billroth-II anastomosis (59.0%) in the TLDG group (p < 0.001). The mean operative time was longer in the TLDG group (197.3 ± 44.4 min vs. 222.0 ± 60.2 min, p < 0.001), and there was no statistical difference in the hospital stay between the two groups (9.6 ± 4.8 days vs. 8.9 ± 7.1 days, p = 0.149). There were no significant differences in morbidity and mortality between the two groups. The length of proximal margin was longer in the TLDG group (4.3 ± 3.1 cm vs. 6.0 ± 3.4 cm, p < 0.001), but the distal margin was longer in the LADG group (6.5 ± 3.7 cm vs. 5.5 ± 3.1 cm, p < 0.001). The distribution of operations among each institution was shown very heterogeneously.Conclusion: There was no significant difference related to surgical outcome between LADG and TLDG in pre-study survey prior to KLASS-07 trial. Therefore, to obtain more reliable data, well designed prospective randomized controlled study is needed.

Highlights

Since the first report of laparoscopic gastrectomy for gastric cancer by Kitano et al minimally invasive surgery has been developed steadily in the recent two decades
Laparoscopy-assisted gastrectomy required a minilaparotomy on the epigastrium for gastric division and anastomosis after laparoscopic gastric mobilization
According to accumulated laparoscopic surgical experience, the recent surgical trend shifted from laparoscopy-assisted gastrectomy to totally laparoscopic gastrectomy [12]

Summary

Introduction

Since the first report of laparoscopic gastrectomy for gastric cancer by Kitano et al minimally invasive surgery has been developed steadily in the recent two decades. In cases that a patient is obese or has short duodenum, the anastomosis could not be easy under the narrow working space of the mini-incision, whereas in the totally laparoscopic gastrectomy, the whole procedure from the gastric division including lymphadenectomy to the anastomosis is performed intracorporeally. It has various advantages, such as the superiority of the cosmetic result due to umbilical incision and convenient anastomosis under good operative view even in obese patients. According to accumulated laparoscopic surgical experience, the recent surgical trend shifted from laparoscopy-assisted gastrectomy to totally laparoscopic gastrectomy [12]

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Results