Abstract

BackgroundTo evaluate feasibility and benefits of intracorporeal anastomosis, we compared short-term surgical outcomes between laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) with Billroth-II (B-II) anastomosis for gastric cancer.MethodsSixty patients underwent attempted B-II TLDG from 2011 through 2013. Patients who underwent B-II LADG prior to 2011 were matched to TLDG cases for demographics, comorbidities, tumor characteristics, and TNM stage. Perioperative and short-term surgical outcomes were compared between the two groups.ResultsClinicopathological characteristics of both groups were comparable. The B-II TLDG group had a shorter hospital stay (9.4 vs. 12.0 days, P = 0.038) and average incision size was smaller (3.5 vs. 5.4 cm, P = 0.030) than in the B-II LADG group. Anastomotic leakage was not recorded in either group, and there were no differences in the rates of perioperative complications and in inflammatory parameters between the two groups.ConclusionsThis study suggests that B-II TLDG is feasible, compared to B-II LADG, and that it has several advantages over LADG, including a smaller incision, a shorter hospital stay, and more convenience during surgery. However, prospective randomized controlled studies are still needed to confirm that B-II TLDG can be used as a standard procedure for LDG.

Highlights

  • To evaluate feasibility and benefits of intracorporeal anastomosis, we compared short-term surgical outcomes between laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) with Billroth-II (B-II) anastomosis for gastric cancer

  • Matched-pair control patients were selected from 318 patients who underwent B-II LADG prior to the use of intracorporeal anastomosis (2008–2011)

  • Patients’ demographics Patient demographics, tumor characteristics, and TNM stage were comparable between TLDG and matched-pair LADG groups (Table 1)

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Summary

Introduction

To evaluate feasibility and benefits of intracorporeal anastomosis, we compared short-term surgical outcomes between laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) with Billroth-II (B-II) anastomosis for gastric cancer. Laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer is widely accepted because many clinical studies demonstrated its minimal invasiveness and comparable outcomes to those of open distal gastrectomy (ODG) [1, 2]. In LADG, lymph node dissection is performed laparoscopically. Subsequent resection and reconstruction of the stomach are performed extracorporeally, through a minilaparotomy. Most surgeons prefer LADG to totally laparoscopic distal gastrectomy (TLDG) because of the technical difficulties of intracorporeal anastomosis and concern over complications associated with anastomosis [5]. TLDG enables better visualization during anastomosis compared with LADG, overcoming those difficulties

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