Laparoscopic D2 Radical Gastrectomy Research Articles

Comparative efficacy of uncut Roux-en-Y and Billroth II anastomosis in gastrointestinal reconstruction following laparoscopic radical gastrectomy for distal gastric cancer.

This study retrospectively analyzed the clinical efficacy of Uncut Roux-en-Y and Billroth II anastomoses in gastrointestinal reconstruction following laparoscopic D2 radical gastrectomy for distal gastric cancer. The primary objective was to compare the postoperative outcomes, including quality of life and complication rates, between the 2 surgical techniques. One hundred patients diagnosed with distal gastric cancer were enrolled between June 2020 and May 2023. Patients underwent laparoscopic D2 gastrectomy and were categorized into either the Uncut Roux-en-Y or Billroth II anastomosis groups based on the technique used for gastrointestinal reconstruction. The inclusion and exclusion criteria were strictly followed. Surgical parameters, quality of life assessed using the Visick grading index, and postoperative complications were also evaluated. Statistical analyses were performed using SPSS version 27.0. The groups were comparable in terms of demographic and baseline clinical parameters. The Uncut Roux-en-Y group had a significantly longer duration of surgery (P < .001). However, there were no statistically significant differences in other surgical parameters. According to the Visick grading index, patients in the Uncut Roux-en-Y group reported a significantly better quality of life than those in the Billroth II group (P < .05). Additionally, Uncut Roux-en-Y was associated with a significantly lower incidence of dumping syndrome and bile reflux (P < .05). Although Uncut Roux-en-Y anastomosis requires longer surgical time, it offers significant advantages in terms of postoperative quality of life and reduced rates of dumping syndrome and bile reflux. Our findings suggest that Uncut Roux-en-Y may be a superior option for gastrointestinal reconstruction after laparoscopic D2 gastrectomy for distal gastric cancer.

Effect of methylene blue labeling on therapeutic effect and prognosis of gastric cancer patients in D2 radical gastrectomy under laparoscope

Objective: To investigate the effect of methylene blue tracing on the effect of surgical resection and the prognosis of gastric cancer patients in D2 radical surgery under laparoscope. Methods: In this retrospective cohort study, 160 patients with advanced gastric cancer who underwent surgical treatment in Xinxiang Central Hospital, the 4th Clinical College of Xinxiang Medical College from January 2016 to January 2019 were selected for retrospective analysis. Among them, 84 patients underwent laparoscopic D2 radical gastrectomy for gastric cancer combined with methylene blue labeling operation (labeling group), and the other 76 patients underwent only laparoscopic D2 radical gastrectomy for gastric cancer (control group). The difference of intraoperative and postoperative recovery, lymph node dissection, and postoperative 3-year cumulative survival rate between the two groups were analyzed. Results: The age of patients in the labeled group and the control group were (64.9±7.8) and (66.0±8.3) years old, respectively (P=0.389); And the male patients accounted for 61.9% (52 cases) and 55.3% (42 cases), respectively (P=0.394); The operation time in the labeled group was (218.5±19.6) min, which was shorter than that in the control group (230.1±17.4) min (P<0.001). There was no significant difference between the labeled group and the control group in the amount of bleeding during operation, the time of anal exhaust after operation, the time of eating after operation, the time of hospitalization after operation, and the average diameter of lymph nodes (P>0.05). The total number of dissected lymph nodes, D1 lymph nodes and D2 lymph nodes in the labeled group were significantly higher than those in the control group (all P values<0.05). The operative complication rate in the labeled group was 11.9% (10 cases), which was lower than that in the control group (25.0%, 19 cases) (P=0.032); There was no statistical significance in 3-year cumulative survival rates of patients between the labeled group (61.9%) and the control group (52.6%) (χ2=3.46,P=0.065). Conclusion: The use of methylene blue tracing in laparoscopic D2 radical surgery for gastric cancer is beneficial to reduce the operation time, improve the lymph node clearance rate, and reduce surgical complications.

Retracted: Effect of Double-Channel Anastomosis and Esophagojejunal Anastomosis on Postoperative Recovery and Complications of Laparoscopic D2 Radical Gastrectomy for Gastric Cancer.

[This retracts the article DOI: 10.1155/2022/8281558.].

Efficacy and safety of laparoscopic distal D2 radical gastrectomy for advanced gastric cancer patients.

Efficacy and safety of laparoscopic distal D2 radical gastrectomy for advanced gastric cancer patients.

Effect of Double-Channel Anastomosis and Esophagojejunal Anastomosis on Postoperative Recovery and Complications of Laparoscopic D2 Radical Gastrectomy for Gastric Cancer.

The aim of this study was to investigate the effects of double-channel anastomosis versus esophagojejunostomy on postoperative recovery and complications after laparoscopic D2 radical gastrectomy for early proximal gastric cancer. The cases were collected from 100 patients with early proximal gastric cancer admitted to our hospital from January 2017 to January 2021. According to different surgical methods, they were divided into control group (total gastrectomy + esophagojejunal anastomosis) and experimental group (D2 radical resection + double-channel anastomosis). The two groups were compared in terms of clinical outcomes (operative time, intraoperative blood loss, number of lymph nodes dissected, digestive tract anastomosis time, postoperative exhaust, and hospitalization days), postoperative complications, and nutritional status; the expression of T lymphocyte subsets in peripheral blood of the two groups was detected to reflect the recovery of immune ability. There was no significant difference between the observation group and the control group in clinical operation effect indexes (P < 0.05). The incidence of complications of dumping syndrome and reflux esophagitis in the observation group was significantly lower than that in the control group (P < 0.05). In terms of postoperative nutritional status, the ratio of plasma albumin level and body weight restored to operation at 12 and 24 weeks after operation in the observation group was significantly higher than that in the control group (P < 0.05). 3 months after the operation, the levels of CD3 +, CD4 + cell subsets, and CD4+/CD8+ index reflecting the recovery of immune ability in the observation group were significantly higher than those in the observation group (P < 0.05). The application of double-channel anastomosis in laparoscopic D2 radical gastrectomy for early proximal gastric cancer has a better effect on reducing complications and promoting postoperative recovery, which is of great application value.

Reverse rolling-mat type lymph node dissection is the key step to solve the operative difficulties in hand-assisted laparoscopic D2 radical gastrectomy

BackgroundWe have improved and named a new reverse rolling-mat type lymph node dissection, which effectively solves the dilemma faced by the traditional lymph node dissection in hand-assisted laparoscopic D2 radical gastrectomy through the optimization of the surgical procedure. However, the relevant clinical data are still scarce. The study aims to compare the clinical effects of two surgical procedure and explore the safety and feasibility of “reverse procedure”.Study designThe clinicopathological data of 195 patients who underwent hand-assisted D2 radical total gastrectomy (HALTG) in our hospital from January 2011 to September 2017 were collected. A retrospective case–control study was used to compare the clinical outcomes of the two patterns of lymph node dissection. Among them, 89 patients underwent “cabbage type” lymph node dissection and 106 patients underwent the “reverse procedure” lymph node dissection.ResultsThere were no significant differences between the two groups of patients in terms of gender, age, tumor location, incision length, postoperative hospitalization duration, pathological classification, recent complications, long-term recurrence and metastasis. The operation time of “cabbage type” group was shorter than that of “reverse procedure” group (178.35 ± 31.52 min vs 191.25 ± 32.77 min; P = 0.006). While, in the “reverse procedure” group, intraoperative blood loss was less (249.4 ± 143.12 vs 213.58 ± 101.43; P = 0.049), and there were more numbers of lymph nodes dissected (18.04 ± 7.00 vs 32.25 ± 14.23; P < 0.001).ConclusionThe pattern of reverse rolling-mat type lymph node dissection in HALTG perform well in terms of safety and feasibility.

Assessment of indocyanine green tracer-guided lymphadenectomy in laparoscopic gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer: results from a multicenter analysis based on propensity matching.

This study evaluated the safety, effectiveness, and feasibility of indocyanine green (ICG) tracing in guiding lymph-node (LN) dissection during laparoscopic D2 radical gastrectomy in patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NAC). We retrospectively analyzed data on 313 patients with clinical stage of cT1-4N0-3M0 who underwent laparoscopic radical gastrectomy after NAC between February 2010 and October 2020 from two hospitals in China. Grouped according to whether ICG was injected. For the ICG group (n = 102) and non-ICG group (n = 211), 1:1 propensity matching analysis was used. After matching, there was no significant difference in the general clinical pathological data between the two groups (ICG vs. non-ICG: 94 vs. 94). The average number of total LN dissections was significantly higher in the ICG group and lower LN non-compliance rate than in the non-ICG group. Subgroup analysis showed that among patients with LN and tumor did not shrink after NAC, the number of LN dissections was significantly more and LN non-compliance rate was lower in the ICG group than in the non-ICG group. Intraoperative blood loss was significantly lesser in the ICG group than in the non-ICG group, while the recovery and complications of the two groups were similar. For patients with poor NAC outcomes, ICG tracing can increase the number of LN dissections during laparoscopic radical gastrectomy, reduce the rate of LN non-compliance, and reduce intraoperative bleeding. Patients with AGC should routinely undergo ICG-guided laparoscopic radical gastrectomy.

Anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale and Ramsay sedation score after operation

Objective To analyze the anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale (VAS) and Ramsay sedation score after operation. Methods A total of 86 patients who received laparoscopic D2 radical gastrectomy under general intravenous anesthesia in Shanxi Provincial Cancer Hospital from March 2017 to June 2017 were enrolled, and all the patients were divided into two groups by using random number table method. The observation group (43 cases) was intravenously injected with dexmedetomidine (0.6 μg/kg) before induction of general anesthesia, and the dose was changed to 0.4 μg/kg after 15 min with drug withdrawal till 30 minutes before surgery, the control group (43 cases) was given an equal volume of 0.9% normal saline. The mean arterial pressure (MAP) and heart rate change before anesthetic induction (T1), tracheal intubation time (T2), after intubation (T3), section time (T4) and the immediate time after intubation (T5) were compared between the two groups. The VAS and Ramsay scores at 1 h and 4 h after surgery and the intraoperative doses of anesthesia maintenance drugs were also compared between the two groups. Results The heart rate and MAP of the observation group were lower than those of the control group at the time of T1, T3-T5, the differences were statistically significant (all P < 0.05). The VAS and Ramsay scores of the observation group were better than those of the control group at 1 h and 4 h after operation, and the differences were statistically significant (all P < 0.05). The intraoperative doses of propofol and remifentanil in the observation group were (964±251) mg and (3.1±0.8) mg, respectively, which were less than those in the control group [(1 485±425) mg and (4.8±0.8) mg], the differences were statistically significant (t = 9.913, P < 0.01; t = 9.834, P < 0.01). Conclusion Dexmedetomidine can reduce the stress response of patients with laparoscopic D2 radical anesthesia, enhance the sedative effect, and reduce the dosage of propofol and remifentanil, therefore, it has high clinical application value. Key words: Stomach neoplasms; Gastrectomy; Laparoscopy; Lymph node excision; Hemodynamics; Dexmedetomidine; Pain measurement; Ramsay sedation score

Early postoperative complications and risk factors in laparoscopic D2 radical gastrectomy for gastric cancer

Objective: To investigate the morbidity and treatment of early postoperative complications after laparoscopic D2 radical gastrectomy for gastric cancer, and to explore the risk factors. Methods: A case-control study was performed to retrospectively collect clinicopathological data of 764 patients undergoing laparoscopic D2 radical gastrectomy for gastric cancer at our department between January 2015 and December 2017. Patient inclusion criteria: (1) gastric cancer diagnosed by preoperative electronic gastroscopy and biopsy, and confirmed by postoperative pathology; (2) without invasion into adjacent organs by preoperative evaluation of tumors; (3) tumors without definite liver and distant metastasis; (4) R0 resection of gastric cancer and standard D2 lymph node dissection; (5) patients with informed consent. Exclusion criteria: (1) unperformed laparoscopic D2 radical resection; (2) other types of gastric tumor confirmed by pathology; (3) cases with incomplete clinical data. Complication occurring within two weeks after laparoscopic D2 gastrectomy was defined as early postoperative complication. Patients were divided into two groups: non-complication group (693 cases) and complication group (71 cases) according to the occurrence of complications after operation. The clinicopathological data of two groups were analyzed and compared with t test and χ(2) test, and the factors of P < 0.2 were included in the multivariate logistic regression model to analyze the risk factors of postoperative complications. Results: Of 764 patients, 71 (9.3%) developed early postoperative complications, with median onset time of 3 (1 to 11) days. Surgical complications accounted for 7.9% (60/764), including 13 cases (1.7%) of abdominal hemorrhage, 12 cases (1.6%) of anastomotic leakage, 10 cases (1.3%) of incision infection, 8 cases (1.0%) of anastomotic bleeding, 7 cases (0.9%) of gastric stump weakness, 4 cases (0.5%) of abdominal infection, 4 cases (0.5%) of duodenal stump leakage and 2 cases (0.3%) of small intestinal obstruction. Non-surgical complications accounted for 1.4% (11/764), including 6 cases (0.8%) of pulmonary infection and 5 cases (0.7%) of cardiovascular disease. Two cases (0.3%) died of sepsis caused by severe abdominal infection; 9 cases (1.2%) recovered after receiving the second operation, among whom 5 cases were abdominal hemorrhage, 2 cases were anastomotic leakage and 2 cases were duodenal stump leakage; the remaining patients were healed with conservative treatment. Compared with patients without complications, patients with complications had higher proportions of BMI ≥24 kg/m(2) [42.3% (30/71) vs. 24.2%(168/693), χ(2)=10.881, P=0.001], comorbity [64.8% (46/71) vs. 33.5% (232/693), χ(2)=27.277, P<0.001], combined organ resection [70.4% (50/71) vs. 20.5% (142/693), χ(2)=85.338, P<0.001], and pTNM stage of III [70.4% (50/71) vs. 40.1% (278/693), χ(2)=24.196, P<0.001], meanwhile had longer time to postoperative flatus [(4.2±2.1) days vs. (2.9±1.2) days, t=4.621, P=0.023], longer hospital stay [(34.6±12.6) days vs. (14.2±6.2) days, t=9.862, P<0.001] and higher hospitalization cost [(126.8±64.5) thousand yuan vs. (85.2±35.8) thousand yuan, t=11.235, P<0.001]. Multivariate analysis showed that BMI ≥24 kg/m(2) (OR=3.762, 95% CI: 1.960-8.783, P=0.035), accompanying disease (OR=8.620, 95% CI: 1.862-29.752, P<0.001), combined organ resection (OR=6.210, 95% CI: 1.357-21.568, P=0.026), and pTNM stage (OR=4.752, 95% CI: 1.214-12.658, P<0.001) were the independent risk factors of postoperative complications. Conclusions: Laparoscopic D2 radical gastrectomy is a safe and effective approach for gastric cancer. Most early postoperative complications can obtain satisfactory efficacy after conservative treatment. Perioperative management should be strengthened for those patients with high BMI, accompanying diseases, combined organ resection, and advanced pTNM stage.

Replication of 3D laparoscopic membrane anatomic radical gastrectomy for gastric cancer

According to the current evidence-based medicine researches, the eastern and western countries have reached a consensus that D2 operation is a standardized procedure for advanced gastric cancer.However, the postoperative five-year survival rate is still not satisfactory. Professor Gong Jianping of Tongji Hospital, Tongji Medical Gollege of Huazhong University of Science and Technology proposed a theory of membrane anatomy (the third element of surgical anatomy) and the concept of cancer leakage-an epoch-making concept in surgical anatomy. The Department of Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University was honored to be selected as one of the first domestic replication units of 3D laparoscopic radical gastrectomy under membrane anatomy. Professor Gong Jianping has visited our hospital several times for surgical demonstration, explanation of membrane anatomy theory and replication training. Through the understanding of membrane anatomy theory, we found that 3D laparoscopic radical gastrectomy guided by membrane anatomy can achieve good results, e.g less bleeding, complete resection, complete lymph node dissection and avoidance of side damage, meanwhile the operation is simple and safe. At the same time, it can avoid the shedding of cancer cells, so as to reduce the iatrogenic leakage of cancer and improve the efficacy of radical gastrectomy. In addition, the standardized procedure of laparoscopic radical gastrectomy makes it scientific, reproducible and easy to be popularized.

Clinical Comparative Study of Laparoscopic D2 Radical Gastrectomy and Open Operation for Gastric Cancer

This study aims to evaluate the clinical curative effect of laparoscopic D2 radical gastrectomy for distal gastric cancer, investigate the advantages of this surgical method in clinic, and analyze its related complications. In the First Affiliated Hospital of Dali University, 51 laparoscopic and 51 open-radical operation patients were selected from April 2012 to August 2016. These patients were compared under the following parameters: incision length, intra-operative blood loss, recovery time of postoperative intestinal function, hospitalization duration, and postoperative leukocyte count on the first day. The incision length was 7.3 cm and 17.2 cm for patients in the laparoscopic group and open group, respectively (P < 0.01). Intraoperative blood loss was significantly lesser in the laparoscopic group than in the open group (202.3 ml vs. 405.5 ml, P < 0.01). Gastrointestinal function recovered more quickly in the laparoscopic group than in the open group (exhaust time: 3.5 days vs. 5.0 days, P < 0.01; solid food taking time: 5.0 days vs. 6.0 days, P < 0.01). Hospitalization duration was shorter in the laparoscopic group than in the open group (12 days vs. 16 days, P < 0.01). Postoperative leukocyte count on the first day was lower in the laparoscopic group than in the open group (8.08 × 109 vs. 11.51 × 109, P < 0.01).Laparoscopic D2 radical gastrectomy may be as beneficial as open operation for patients with gastric cancer, as previously suggested.

Discussion on standardized implementation of laparoscopic radical lymphadenectomy for distal gastric cancer

Laparoscopic radical gastrectomy for gastric cancer has been widely applied in clinical practice, and its indications have been extended from early gastric cancer to advanced gastric cancer. It is acknowledged that laparoscopic radical gastrectomy is technically challenging because of the complexity of anatomy, rich blood supply, and extensive lymph node dissection. This paper primarily intends to share the experience of laparoscopic radical D2 gastrectomy for distal gastric cancer with details of choosing the location of Trocar, surgical approaches and the sequence of lymph node dissection. All the surgeries were performed at Department of General Surgery and Gastrointestinal Surgery, Guangdong General Hospital. The finding suggests that a correct laparoscopic Trocar placement is the foundation of adequate surgical field visualization. Under most circumstances, the observation hole should be around 2 cm below the umbilicus and the operating hole should be close to the bilateral clavicle midline. Furthermore, proper surgical approach and sequence of lymph node dissection are the prerequisites for successful laparoscopic radical D2 gastrectomy, as well as the reassurance of dissecting lymph node safely and comprehensively. The position of surgical team adopted in our center is that the surgeon stands to the left of the patient, with laparoscope operator stands in between patient's legs while the first assistant positions himself opposite the surgeon on the right side of the patient. This position correlates to the rules of sequential lymph node dissection, which is "from left to right", "from proximal to distal" and "from inferior to superior". Therefore, it is conductive to inferior and superior pylorus region dissection and it can effectively prevent subsidiary-injury. In our center, the procedure of lymph node dissection has been standardized: the initial step is to undergo station 4sb dissection and greater gastric curvature clearance; then change the patient's position to clean the sub-pyloric lymph node region and cut off the duodenum by linear stapler; followed by the clearance of inferior region of the pylorus and the upper margin of the pancreas; in the final step, the first and the third groups of lymph node dissection is performed. Although varied surgical approaches and sequences of lymph node dissection are applied in different hospitals, the techniques required for laparoscopic D2 radical gastrectomy for gastric cancer are sophisticated and advanced in general. Radical lymph node dissection is complicated, urging surgeons to familiarize themselves with the anatomy of gastric peripheral vascular system and characteristics of lymph node drainage. By designing and implementing effective strategies, such as formulating a regular team, positioning surgical team reasonably, changing a patient's posture during operation, choosing an appropriate surgical approach and following a logically sequence of lymph node dissection, surgeons can standardize the complete surgical procedure, which ultimately reduces bleeding during surgery and shortens the operative time.

Clinical value of three-dimensional laparoscopic radical gastrectomy for gastric cancer

Objective To investigate the clinical value of three-dimensional (3D) laparoscopic radical gastrectomy for gastric cancer. Methods The retrospective and descriptive study was adopted. The clinical data of 28 patients who underwent 3D laparoscopic radical gastrectomy for gastric cancer at the First Affiliated Hospital of Nanjing Medical University from October 2014 to March 2016 were collected. Trocar placement and surgical procedures were the same as 2D laparoscopic radical gastrectomy. Observation indicators included (1) surgical situations: operation time, volume of intraoperative blood loss, number of lymph node dissected, (2) postoperative situations: time for out-of-bed activity, time to anal exsufflation, time for fluid diet intake, occurrence of complications and duration of hospital stay, (3) follow-up situations. The follow-up was performed to detect postoperative survival of patients and tumor recurrence and metastasis by outpatient examination and telephone interview up to May 1st, 2016. Measurement data with normal distribution were presented as ±s. Results (1) Surgical situations: all the 28 patients underwent successful 3D laparoscopic radical gastrectomy, without conversion to open surgery and perioperative death. Seven patients received 3D laparoscopy assisted total gastrectomy with Roux-en-Y esophagojejunostomy, with operation time of (214±47)minutes. Twenty-one patients underwent 3D laparoscopic distal gastrectomy with uncut Roux-en-Y gastrojejunostomy, with operation time of (181±27)minutes. Volume of intraoperative blood loss and number of lymph node dissected in 28 patients were (53±29)mL and 34±10. (2) Postoperative situations: time for out-of-bed activity, time to anal exsufflation and time for fluid diet intake were (54±17)hours, (77±16)hours and (5.0±1.1)days, respectively. Of 28 patients, 1 complicated with gastrointestinal hemorrhage was cured by conservative treatment, and other patients had no complications. Duration of postoperative hospital stay was (8.8±1.6)days. (3) Follow-up situations: all the 28 patients were followed up for 2-18 months with a median time of 10 months, without occurrence of tumor recurrence and metastasis. One patient undergoing 3D laparoscopic distal gastrectomy with uncut Roux-en-Y gastrojejunostomy was complicated with afferent recanalization, without obvious discomfort, and received regular gastroscopy reexaminations to detect bile reflux. Conclusion 3D laparoscopic radical gastrectomy for gastric cancer is safe and feasible, with good short-term outcomes. Key words: Gastric neoplasms; Gastrectomy; Laparoscopy; Three-dimensional technique

Clinical efficacy of three-dimensional laparoscopic radical gastrectomy in patients with gastric cancer

Objective To investigate the feasibility and clinical efficacy of three-dimensional (3D) laparoscopic radical gastrectomy in patients with gastric cancer. Methods The clinical data of 21 patients who underwent 3D laparoscopic radical gastrectomy for gastric cancer at the Ruijin Hospital from December 2013 to November 2014 were retrospectively analyzed. The surgical indications and method of 3D laparoscopic radical gastrectomy were similar to that of two-dimensional laparoscopic radical gastrectomy. All the patients were followed up via outpatient examination and telephone interview till January 2015. Results All the 21 patients underwent successfully laparoscopic surgery without conversion to open surgery, intraoperative complications and perioperative death. Eight patients underwent 3D laparoscopic radical gastrectomy (1 received concomitant cholecystectomy) and 13 underwent 3D laparoscopic-assisted radical gastrectomy (1 received concomitant cholecystectomy and 1 received concomitant radical resection of sigmoid colon). The mean operation time, mean volume of intraoperative blood loss, mean number of lymph node dissection, mean time to anal exsufflation and mean duration of hospital stay were 240 minutes (range, 180-300 minutes) , 100 mL (range, 10-180 mL) ,29 (range, 10-48 ) , 3 days (range, 1-4 days) and 9 days (range, 7-15 days) , respectively. Among the 21 patients, 1 patient was complicated with pulmonary infection and cured by conservative treatment, and no occurrence of complication was detected in the other patients. R0 tumor resections in all the patients were done and the tumor resection margins were negative. Twenty-one patients were followed up for 2 -13 months with a median time of 7 months and without occurrence of surgery-related complications, tumor recurrence and death during the follow-up. Conclusion Three-dimensional laparoscopic radical gastrectomy is safe and feasible for the treatment of gastric cancer with the advantages of favorable short-term outcomes. Key words: Gastric neoplasms; Laparoscopy; Radical gastrectomy; Three-dimension

Three-step hand-assisted laparoscopic d2 radical gastrectomy for chinese obese patients: a highly efficient and feasible surgical approach.

Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical procedure that has achieved satisfactory results for obese patients in our surgical center. To fully elucidate the advantages of this procedure, in this study, comprehensive and in-depth comparative analyses were performed to assess clinical data from obese gastric cancer patients who underwent HALG, laparoscopic-assisted D2 radical gastrectomy (LAG), and open D2 radical gastrectomy (OG) in our surgical center during a specific time period. For the 3 groups, incision length was 1.25 cm longer for the HALG group than for the LAG group but was significantly shorter for the HALG group than for the OG group (P =0.00). The rate of conversion to laparotomy , the pneumoperitoneum time and the number of recovered lymph nodes were significantly better for the HALG group than for the LAG group (P <0.05). The pain score at day 2 after surgery, intestinal function recovery time, and duration of postoperative hospital stay were not significantly different for the HALG and LAG groups ( P >0.05) but were significantly better for the HALG group than for the OG group (P <0.05). There were significantly fewer postoperative complications for the HALG group than for the LAG and OG groups (P =0.049). According to the results, the “three-step HALG method” incorporates both the thoroughness of the radical OG approach and the minimal invasiveness of the LAG approach for obese patients. Thus, the HALG approach is a relatively safe and extremely feasible surgical procedure for the treatment of these patients.

Hand-assisted laparoscopic versus laparoscopy-assisted D2 radical gastrectomy: a prospective study.

The feasibility and safety of Hand-assisted laparoscopic D2 radical gastrectomy (HALG) have been seldom reported, also, benefits and outcomes are not defined. We performed a comprehensive and in-depth comparative analysis of the general information, the intraoperative data and postoperative data in the Group HALG and the Group laparoscopy-assisted D2 radical gastrectomy (LAG). The general data of HALG and LAG were no differences (P > 0.05); the blood loss and unexpected injury were similar(P > 0.05); the operative time, the incision length, the number of lymph nodes recovered, the rate of procedure conversion, the amount of postoperative complications, and the length of postoperative hospital stay of Group HALG were prior to that of Group LAG(P < 0.05); there were no differences for the pain score after day 2, the recovery time of intestinal function, the rate of reoperation, the 30-day hospital and readmission rate(P > 0.05); and there were significant linear correlations between the length of postoperative hospital stay and the operative time for both groups(P = 0.00). Compared with LAG, HALG had similar features of being minimally invasive and radical in treating gastric cancers, and HALG was safer than LAG.

手辅助与腹腔镜辅助胃癌D2根治术的临床比较研究

目的：通过比较手辅助与腹腔镜辅助胃癌D2根治术的临床近期疗效，拓展腹腔镜胃癌根治手术的技术手段。方法：回顾分析成都军区总医院胃肠外科2010年11月至2011年4月完成手辅助腹腔镜胃癌D2根治术(手辅助组)21例，以及该手术组同期完成的25例腹腔镜辅助的胃癌D2根治术(腹腔镜辅助组)的临床资料，进行比较分析。结果：手辅助组vs腹腔镜辅助组：腹腔镜下手术操作时间18~58 min(平均44 min) vs 70~100 min(平均91 min)；手术切口长度6~7 cm(平均6.81 cm) vs 5~8 cm(平均6.12 cm)；术中出血80~600 ml(平均225 ml) vs 100~500 ml(平均250 ml)。术后并发症：手辅助组，胃无力症1例；腹腔镜辅助组，术后切口感染1例；胃无力症2例。结论：手辅助腹腔镜胃癌D2根治术具有缩短腹腔镜下操作时间、降低镜下操作难度的优势，便于推广，可以作为腹腔镜胃癌D2根治术的选择术式之一，值得进一步研究。Purpose: Through evaluating hand assistant laparoscopic D2 radical gastrectomy, the methods of laparoscopic technique to cure gastric cancer are to be expanded. Methods: 21 cases of gastric cancer in General Hospital of Chengdu Military Region between Nov. 2010 and Apr. 2011, which underwent successfully by hand assistant laparoscopic D2 radical gastrectomy (HAL group) were reviewed and analyzed. 25 patients’ clinical data (LAT group) (operated by the same surgeon by laparoscopic assistant technique) were collected. An analysis was taken between the two groups. Result: Mean laparoscopic operating time of HAL group and LAT group was 44 min (18 - 58 min) and 91 min (70 - 100 min) respectively. Length of incision was 6.8 cm (6 - 7 cm) and 6.1 cm (5 - 8 cm) respectively. The mean blood loss was 225 ml (80 - 600) and 250 ml (100 - 500 ml) respectively. Postoperative complications: One case of gastric atony was found in hand assistant group, and two cases were found in laparoscopic group. One wound infection was found in laparoscopic group. Conclusions: Hand assistant laparoscopic D2 radical gastrectomy can shorten the laparoscopic operating time and reduce the degree of difficulty of the laparoscopic operation, which is easy to popularize. Thus it can be an alternative laparoscopic technique. The further research is needed.