Laparoscopy-assisted Gastrectomy Group Research Articles

A risk prediction system of postoperative hemorrhage following laparoscopy-assisted radical gastrectomy with D2 lymphadenectomy for primary gastric cancer.

ObjectivesTo investigate risk factors of postoperative hemorrhage (PH) following laparoscopy-assisted radical gastrectomy (LARG) with D2 lymphadenectomy for primary gastric cancer (PGC) and to use those risk factors to develop a scoring system for risk assessment.Materials and MethodsA total of 1789 PGC patients were enrolled in our study. We analyzed the risk factors of PH and constructed a scoring system using 75% of the cases as the experimental group and 25% of the cases as a verification group to demonstrate the effectiveness.ResultsAmong these 1789 patients, 46 (2.6%) developed PH. Univariate and multivariate analysis in the experimental group indicated that having more than 41 lymph node excisions, combined organ resection, stage III tumor and postoperative digestive fistula were independent risk factors of PH. According to the independent risk factors, we constructed a scoring system to separate patients into low-risk (0–2 points) and high-risk (≥ 3 points) groups. The area under the ROC curve for this scoring system was 0.748. In the verification group, the risk of PH predicted by the scoring system was not significantly different from the actual incidence observed.ConclusionsThis scoring system could simply and effectively predict the occurrence of PH following LARG with D2 lymphadenectomy for PGC. The predictive system will help surgeons evaluate risk and select risk-adapted interventions to improve surgical safety.

Efficacy analysis of laparoscopy-assisted total gastrectomy and proximal gastrectomy in treatment of adenocarcinoma of esophagogastric junction

Objective To investigate the clinical efficacy of laparoscopy-assisted total gastrectomy (LATG) and laparoscopy-assisted proximal gastrectomy (LAPG) in treatment of adenocarcinoma of esophago-gastric junction (AEG). Methods The retrospective cohort study was conducted. The clinicopathological data of 130 patients with AEG who underwent laparoscopy-assisted radical gastrectomy at the Peking University Cancer Hospital between May 2009 and February 2016 were collected. Among 130 patients, 91 undergoing LATG were allocated into the LATG group and 39 undergoing LAPG were allocated into the LAPG group. D2 lymph node dissection was applied to patients in the 2 groups according to the Japanese gastric cancer treatment guidelines. Patients received digestive tract reconstruction though a small midline incision in the epigastric region after laparoscopy-assisted lymph node dissection: patients in the LATG group and LAPG group received respectively Roux-en-Y esophagojejunostomy and residual stomach-esophagus anastomosis. Observation indicators included: (1) intra- and post-operative situations: overall surgical situation, number of patients with conversion to open surgery, operation time, volume of intraoperative blood loss, number of patients with intraoperative blood transfusion, number of lymph node dissected, time to anal exsufflation and duration of postoperative hospital stay. (2) Occurrence of complications: overall complications, surgery-related complications (slight and severe complications), reoperation, medical complications and death from surgery-related complication within 30 days postoperatively. Severity of complications was evaluated according to Clavien-Dindo classification. (3) Follow-up situations. Patients were followed up by outpatient examination, telephone interview and correspondence up to August 31, 2016. Follow-up included the tumor recurrence and metastasis. Overall survival time was counted from operation date to end of follow-up or time of death. Because follow-up time of 48 patients who underwent surgery from September 2014 to February 2016 was less than 2 years, survival analysis of the other 82 patients who underwent surgery from May 2009 to August 2014 was done. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the independent-sample t test. Measurement data with skewed distribution were represented as M (range) and comparison between groups was analyzed using the nonparametric test. Comparison of count data was analyzed using the chi-square test, and ranked data was analyzed using the nonparametric test. Survival curve was drawn by the Kaplan-Meier method, and survival analysis was done using the Log-rank test. Results (1) Intra- and post-operative situations: all the 130 patients underwent successful radical gastrectomy, and 7 patients converted to open surgery due to local tumor progression invading adjacent organs, abdominal adhesions and obesity. Operation time and number of lymph node dissected were (280±46)minutes, 28 (range, 14-80) in the LATG group and (258±57)minutes, 23 (range, 14-46) in the LAPG group, respectively, with statistically significant differences between the 2 groups (t=-2.305, Z=-4.168, P 0.05). The same patients may have multiple complications. Patients with complications received reoperation or corresponding treatment, 1 with anastomotic bleeding and 1 with intra-abdominal bleeding died and other patients had a smooth recovery. (3) Follow-up situations: 128 of 130 patients were followed up for 1-82 months with a median time of 39 months. During the follow-up, 28 patients died, including 25 dying of tumor recurrence and 3 dying of non-tumor causes. Of 82 patients in survival analysis, 3-year overall survival rate was 77.9% in 45 patients of LATG group and 72.2% in 37 patients of LAPG group, showing no statistically significant difference between the 2 groups (χ2=1.432, P>0.05). Conclusion Safety of LATG in treatment of AEG is equal to that of LAPG, and LATG can dissect more lymph nodes. Key words: Esophagogastric junction neoplasms, adenocarcinoma; Gastrectomy; Laparoscopy; Safety; Long-term outcomes

Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer: A retrospective study in a single minimally invasive surgery center.

Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79.70%, 57.81%, 34.60% and 88.31%, 75.49%, 56.84%, 33.08% in patients with stage Ib, IIa, IIb, and IIIa, respectively, in the LAG and OG groups. There were no statistically significant differences in the OS rate for patients with the same TNM stage between the 2 groups. LAG with radical LN dissection is a safe and technically feasible procedure for the treatment of AGC staged below T3.

Clinical efficacy of neoadjuvant chemotherapy combined with laparoscopy-assisted radical gastrectomy for advanced gastric cancer

Objective To explore the clinical efficacy of neoadjuvant chemotherapy combined with laparoscopy-assisted radical gastrectomy for advanced gastric cancer. Methods The retrospective cohort study was adopted. The clinical data of 112 patients with advanced gastric cancer who were admitted to the Wuhan Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2012 to June 2015 were collected. The neoadjuvant chemotherapy was selectively performed based on patients' decisions. Of 112 patients, 42 receiving neoadjuvant chemotherapy combined with laparoscopy-assisted radical gastrectomy (NCLAG) were allocated into the NCLAG group and 70 receiving laparoscopy-assisted radical gastrectomy (LAG) without neoadjuvant chemotherapy were allocated into the LAG group. Patients in the NCLAG group underwent LAG at 4 weeks after neoadjuvant chemotherapy of 2-4 cycles FOLFOX6 regimen. The efficacy of neoadjuvant chemotherapy was divided into the complete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD) based on the Response Evaluation Criteria in Solid Tumors (RECIST). Clinical response rate=[(number of patients with CR+ number of patients with PR)/number of measurable patients]×100%, disease control rate=[(number of patients with CR+ number of patients with PR+ number of patients with SD)/number of measurable patients]×100%. The adverse reactions were observed during neoadjuvant chemotherapy and were divided into the grade 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ based on the grading standards for common adverse drug reactions of anticancer drugs issued by World Health Organization (WHO). The distal or total gastrectomy was selected according to tumor location. Observation indicators included (1) efficacy of neoadjuvant chemotherapy and grading of adverse reaction, (2) surgical situations, (3) postoperative recovery, (4) prognosis. The follow-up of outpatient examination and telephone interview was performed to detect the survival of patients and tumors recurrence and metastasis up to December 2015. The measurement data with normal distribution was presented as ±s. The comparison between groups was evaluated with the t test, and the count data were analyzed using the chi-square test and nonparametric test. Results (1) Efficacy of neoadjuvant chemotherapy and adverse reaction: of 42 patients in the NCLAG group, 12 had tumor down-staging, and 2, 16, 20 and 4 had respectively CR, PR, SD and PD, with the clinical response rate of 42.9%(18/42) and disease control rate of 90.5%(38/42). Five, 23, 12, 2 and 0 patients had respectively grade 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ of adverse reactions and were improved after symptomatic treatment, without occurrence of chemotherapy-related death. (2) Surgical situations: number of patients with palliative operation, number of patients with R0 resection and with R1 or R2 resection were 3, 34 , 5 in the NCLAG group and 11, 44, 15 in the LAG group, respectively, with significant difference between the 2 groups (χ2=4.066, P 0.05). Of 112 patients, 103 were followed up for a median time of 22 months (ranges, 6-45 months), 5 in the NCLAG group and 11 in the LAG group were dead, 9 in the NCLAG group and 17 in the LAG group had tumors recurrence and metastasis. Conclusion Neoadjuvant chemotherapy is safe and feasible after LAG for advanced gastric cancer, and it can effectively reduce the clinical stage of gastric cancer and improve the R0 resection rate. Key words: Stomach neoplasms, advanced; Gastrectomy; Neoadjuvant chemotherapy; Laparoscopy; Efficacy

Clinical efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer

Objective To investigate the clinical efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer. Methods The retrospective cohort study was adopted. The clinical data of 210 patients with gastric cancer who underwent laparoscopy-assisted radical gastrectomy at the Peking University Cancer Hospital between May 2009 and December 2012 were collected. Fifty-two, 43 and 115 patients were respectively detected in stage Ⅰ, Ⅱ and Ⅲ of postoperative pathological stage. Laparoscopy-assisted radical distal, proximal and total gastrectomies were selectively performed according to the location and extent of tumors. (1) Overall treatment indicators were observed, including surgical procedure, with or without conversion to open surgery, operation time, volumes of intraoperative blood loss and transfusion, number of lymph node dissected, time to anal exsufflation, duration of hospital stay, occurrence of complications, radical degree of tumors of pathological examination. (2) Other indicators were observed, including pathological features of patients in stage Ⅰ, Ⅱ and Ⅲ [gender, age, body mass index (BMI), scores of American Society of Anesthesiologists (ASA), medicinal complication, location of tumors, degree of tumor differentiation and with or without vascular tumor thrombi], intraoperative and postoperative situations (surgical procedure, conversion to open surgery, operation time, volumes of intraoperative blood loss and transfusion, number of lymph node dissected, time to anal exsufflation, duration of hospital stay and radical degree of tumors), postoperative complications, reoperation, death within postoperative day 30 and during follow-up, 3- and 5- year survival rates. (3) Evaluation criteria: stages and classification of tumors were evaluated according to the tumor node metastasis (TNM) classification of malignant tumours (Seventh Edition) published by American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC). Severity of complications was evaluated according to Clavien-Dindo classification. Patients were followed up by outpatient examination, telephone interview and correspondence once every half a year up to December 31, 2015, abdominal / pelvic CT, chest X-ray and blood test were performed once every half a year within 2 years and once every year within 2-5 years postoperatively, and gastroscopy was performed once every year. Overall survival time was counted from operation date to end of follow-up or time of death. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed using the ANOVA. Measurement data with skewed distribution were presented as M (range) and comparison between groups was analyzed using nonparametric test. Comparisons of count data were analyzed using the chi-square test. Survival curve was drawn by the Kaplan-Meier method, and survival analysis was done using the Log-rank test. Results (1) Overall treatment: all the 210 patients underwent successful radical gastrectomy, including 100 undergoing distal gastrectomy, 35 undergoing proximal gastrectomy and 75 undergoing total gastrectomy. There were 198 patients undergoing radical gastrectomy and 12 patients converted to open surgery. Operation time, volume of intraoperative blood loss, number of patients with blood transfusion and number of lymph node dissected were (258±54)minutes, (103±86)mL, 19 and 29±12, respectively. Postoperative recovery: time to anal exsufflation and duration of hospital stay were (3.8±0.9)days and (17±7)days. Forty-five patients had postoperative complications and 2 were dead within 30 days postoperatively. R0 and R1 resections were respectively applied to 209 and 1 patients. (2) Comparisons among the patients with the different pathological stage: numbers of patients in stage Ⅰ, Ⅱ and Ⅲ were 9, 17 and 36 with tumor located in the upper stomach, 3, 9 and 22 with tumor located in the middle stomach, 40, 16 and 47 with tumor located in the lower stomach, 0, 1 and 10 with tumor located in the cross-region stomach, 30, 23 and 23 in G1 and G2 of tumor differentiation, 21, 19 and 92 in G3 and G4 of tumor differentiation, 7, 13 and 69 with vascular tumor thrombi, respectively, with significant differences in above indicators among the patients in stage Ⅰ, Ⅱ and Ⅲ (χ2=25.990, 32.928, 35.027, P 0.05). (5) Of 210 patients, 203 were followed up for a median time of 43 months (range, 1-80 months) with a follow-up rate of 96.67%(203/210). Sixty-eight patients were dead till the end of follow-up, including 60 died of recurrence of tumor, 2 died of surgical complications and 6 died of other causes. Postoperative 3-, 5- year overall survival rates were 96.1%, 87.8%, 62.4% and 92.9%, 77.5%, 52.7% in patients with stage Ⅰ, Ⅱ and Ⅲ, respectively, with a significant difference (χ2=29.071, P<0.05). Conclusion Laparoscopy-assisted radical gastrectomy for advanced gastric cancer is at least equivalent to early gastric cancer in the safety, with the satisfactory long-term outcomes. Key words: Gastric neoplasms; Gastrectomy; Laparoscopy; Safety; Long-term outcomes

Clinical application of internal or external reinforcement suture in gastrointestinal reconstruction after laparoscopic assisted radical gastrectomy for gastric cancer

Clinical application of internal or external reinforcement suture in gastrointestinal reconstruction after laparoscopic assisted radical gastrectomy for gastric cancer

A prospective randomized clinical trial comparing D2 dissection in laparoscopic and open gastrectomy for gastric cancer.

Laparoscopic surgery is an acceptable alternative to open surgery in colorectal cancer treatment. However, in gastric cancer, there is not much scientific evidence. Here, we proposed a prospective randomized clinical trial to evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. From October 2010 to September 2012, 300 patients with gastric cancer were randomized to undergo either laparoscopy-assisted gastrectomy (LAG) or conventional open gastrectomy (OG) with D2 dissection. Clinicopathological parameters, recovery and complications were compared between these two groups. Thirty cases were excluded because of refusing to be involved in the trial, having peritoneal seeding metastasis or LAG conversed to OG, and finally 270 cases were analyzed (128 in LAG and 142 in OG). No significant differences were observed in gender, age, body mass index, stages and types of radical resection [radical proximal gastrectomy (PG+D2), radical distal gastrectomy (DG+D2) and radical total gastrectomy (TG+D2)] (P>0.05). The number of harvested lymph nodes (HLNs) was similar (29.3±11.8 in LAG vs. 30.1±11.4 in OG, P=0.574). And in the same type of radical resection, no significant difference was found in the number of HLNs between the two groups (PG+D2, P=0.770; DG+D2, P=0.500; TG+D2, P=0.993). The morbidity of the LAG group (21.8%) was also comparable to the OG group (19.0%, P=0.560). However, the LAG group had significantly less blood loss and faster recovery, and a longer operation time (P<0.05). Laparoscopic D2 dissection is feasible, safe and capable of fulfilling oncologic criteria for the treatment of gastric cancer.

Application progress of different approaches splenic hilar lymph node dissection in laparoscopic radical gastrectomy for gastric cancer

Laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) is a operation conducted experimentally in the current. Current reports showed that it can be safely completed through different approach, such as the right, left, medial and retropancreatic approach. This paper summarized the steps and characteristics of different approaches LSPL and compared the differences between each other. The application status of LSPL in laparoscopy-assisted radical gastrectomy were reviewed. The security, feasibility and the problem to be solved of LSPL, improvement measure also be explored in this paper.

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

Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas.

To study the efficacy of the enhanced recovery after surgery (ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas. From June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopic-assisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial. (Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed. The time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group (n = 30), compared to the conventional group (n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group (6.8 ± 1.1 d) compared to the conventional group (7.7 ± 1.1 d) (P = 0.002). There was no significant difference in postoperative complications between the ERAS (1/30) and conventional care groups (2/31) (P = 1.00). There were no readmissions or mortality during the 30-d follow-up period. The ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer.

Application of right-to-lateral approach in laparoscopic-assisted radical gastrectomy

To explore the technical feasibility, safety, and short-term clinical efficacy of right-to-lateral approach in laparoscopic-assisted radical gastrectomy. Clinicopathological data of 178 gastric cancer patients undergoing laparoscopic-assisted radical gastrectomy, including 92 patients with right-to-lateral approach(R-LG group) and 86 cases with left-to-lateral approach (L-LG group), in our department from October 2010 to September 2013 were analyzed retrospectively. Short-term efficacy and complication morbidity were compared between R-LG group and L-LG group according to body mass index (BMI). For those patients with BMI ≥ 24 kg/m², the R-LG group (35 cases) had shorter mean operation time, less intraoperative blood loss, shorter painkiller used time than L-LG group (31 cases)[(227 ± 17) min vs. (262 ± 23) min, (73 ± 9) ml vs. (84 ± 8) ml and (2.1 ± 0.1) d vs. (2.6 ± 0.4) d, all P<0.05]. The average time to ambulation and recovery time of peristalsis in the R-LG group were faster than those in L-LG group [(2.2 ± 0.2) d vs. (2.8 ± 0.6) d and (3.6 ± 0.3) d vs. (4.2 ± 0.5) d, all P<0.05]. The R-LG group had more dissected lymph nodes per patient (35 ± 4) than the L-LG group (30 ± 5) with significant difference (P<0.05). There were no significances in postoperative hospital stay, postoperative complication morbidity and hospitalization expenses between R-LG and L-LG group (all P>0.05). For those patients with BMI<24 kg/m², there were no significant differences in all above parameters between R-LG group (57 cases) and L-LG group (55 cases). No mortality and recurrence was observed during follow-up of 3 to 24 months. Right-to-lateral approach in laparoscopic-assisted radical gastrectomy is a safe and feasible procedure, especially for the obesity patients, which can shorten the operation time, decrease intraoperative blood loss, lead to a faster postoperative recovery and harvest more lymph nodes as compared to L-LG procedure.

Application of laparoscopic-assisted radical gastrectomy in elderly patients

Objective To study the application value of laparoscopic-assisted radical gastrectomy in elderly patients.Methods 114 elderly patients with gastric cancer were randomly divided into observation group and control group.55 patients in the observation group received laparoscopic-assisted radical gastrectomy ,59 patients in the con-trol group received traditional open radical gastrectomy .The operation time,blood loss,postoperative ambulation time, postoperative hospital stay and other information were compared .Results The operative time ,blood loss and postop-erative ambulation ,postoperative hospital stay in the observation group were significantly better than those in the con -trol group（t=12.195,8.562,8.072,10.252,all P〈0.05）.In the observation group,18 patients had marked effect, effective in 33 cases,ineffective in 4 cases,the total effective rate was 92.7%.In the control group,21 cases had marked effect,effective in 34 cases,ineffective in 4 cases,the total effective rate was 93.2%,the difference between the two groups was not significant （χ2 =0.069,P〉0.05）.Conclusion The efficacy of laparoscopic-assisted radical gastrectomy is similar with traditional open radical gastrectomy ,and laparoscopic-assisted radicalgastrectomy has ad-vantages of minimally invasive ,faster recovery ,especially suitable for elderly patients with gastric cancer . Key words: Laparoscopy; Radical gastrectomy; Stomach neoplasms; Aged

Efficacy evaluation of laparoscopy-assisted radical gastrectomy in obese patients with gastric cancer

To investigate the influence of obesity on short-term outcomes after laparoscopy-assisted radical gastrectomy. Clinical data of 214 patients with gastric cancer, who underwent laparoscopy-assisted radical gastrectomy between May 2009 and December 2012 were analyzed retrospectively. Patients were divided into two groups, consisting of obese and non-obese patients. In the obese group, the BMI was ≥ 25.0 kg/m² (n=66), and in the non-obese group was <25.0 kg/m² (n=148). Operative procedure and postoperative recovery were compared between the two groups. The operative time was longer in obese group than that in non-obese group [(271.5 ± 51.2) min vs. (252.1 ± 53.6) min, P<0.05]. The number of retrieved lymph nodes in obese group was less than that in non-obese group (26.2 ± 10.3 vs. 30.3 ± 12.4, P<0.05). No significant differences were observed in terms of blood loss, blood transfusion rate, conversion to laparotomy and time to first flatus between these two groups (all P>0.05). There were no significant differences between the two groups with respect to postoperative complications rate (25.8% vs. 20.9%, P>0.05) and perioperative mortality (1.5% vs. 0.7%, P>0.05). However, minor surgery-related complication rate was higher in obese group(16.7% vs. 6.8%, P<0.05), mainly presented as delayed gastric emptying. There was no difference in perioperative mortality between the two groups (1.5% vs. 0.7%, P>0.05). Although obesity prolongs the duration of laparoscopy-assisted radical gastrectomy, and increases the risk of minor surgery-related complications, it has no influence on the surgical safety.

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.

Feasibility of radical laparoscopy-assisted gastrectomy for patients with chronic obstructive pulmonary disease

To assess the effect of radical laparoscopy-assisted gastrectomy(LG) for patients with chronic obstructive pulmonary disease (COPD). Clinical data of 340 gastric cancer patients with COPD undergoing radical gastrectomy with lymphadenectomy at Southwest Hospital, Third Military Medical University between January 2010 and October 2013 were analyzed retrospectively. The clinical outcomes for the 262 patients with COPD who underwent LG(LG group) were compared with those of 78 patients with COPD who underwent open gastrectomy(OG group). During LG, pneumoperitoneum was maintained at an insuffiation pressure of 8 mmHg to 10 mmHg. The primary endpoint was postoperative pulmonary complication(PPC). To predict factors related to PPC, univariate and multivariate logistic analyses were carried out. Intraoperative blood loss was significantly less in the LG group [(131.2±14.7) ml] than in the OG group [(246.7±49.0) ml; t=-13.445, P=0.000], but operation time was significantly longer [(220.4±19.1) min vs. (194.2±31.5) min; t=6.877, P=0.000]. The findings showed PPC to be significantly less frequent in the LG group(5.3%,14/262) than in the OG group (15.4%, 12/78)(χ(2)=8.581, P=0.003). The severity of COPD was independent risk factor for PPC(P=0.031, HR=1.456, 95%CI:1.306-1.789). No independent predictor of PPCs was found in type of operative approach (open vs laparoscopic; P=0.126). The LG procedure with insuffiation pressure of pneumoperitoneum is tolerated for gastric cancer patients with mild or moderate COPD.

Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymphadenectomy for advanced gastric cancer

BackgroundThe aim of this study was to compare surgical outcomes and oncologic efficacy of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy (OG) for advanced gastric cancer. MethodsFor this study, 87 consecutive advanced gastric cancer (AGC) patients who underwent LAG with D2 lymph node dissection between April 2005 and October 2009 were enrolled, compared with 87 AGC patients who underwent OG during the same period. ResultsOperative procedure and surgical margin were similar between the 2 groups. The operative time was significantly longer in the LAG group than the OG group, while the estimated blood loss was significantly less in the LAG group. There were no significant differences in postoperative complications and in the number of lymph nodes retrieved. The use of analgesic drugs was significantly less after LAG. Length of postoperative stay was significantly shorter in the LAG group. The 5-year overall survival rate and recurrence-free survival rate were comparative between the 2 groups. ConclusionThis 5-year case–control study presented that laparoscopy-assisted gastrectomy may be a safe and acceptable procedure in terms of long-term results for AGC.

Clinical effects of laparoscopic-assisted D2 radical gastrectomy for distal gastric carcinoma

Clinical effects of laparoscopic-assisted D2 radical gastrectomy for distal gastric carcinoma

Surgical outcomes in the newly introduced phase of intracorporeal anastomosis following laparoscopic distal gastrectomy is safe and feasible compared with established procedures of extracorporeal anastomosis

Totally laparoscopic distal gastrectomy (TLDG) with intracorporeal anastomosis has been introduced to achieve safer anastomosis with good vision, and a small wound. However, little is known about the surgical outcomes of newly introduced TLDG compared with established procedures of laparoscopy-assisted gastrectomy (LADG) with extracorporeal anastomosis. This retrospective study included 114 patients who underwent laparoscopic distal gastrectomy (LDG) between January 2010 and September 2012. The patients were classified into two groups according to the approach of reconstruction (LADG group: n = 74; TLDG group: n = 40). The parameters analyzed included patients, operation details, and operative outcomes. No complication was observed in the TLDG group. Surgical outcomes of the TLDG group, such as mean operation time, estimated blood loss, and rate of conversion to laparotomy were not inferior to the LADG group. Furthermore, postoperative hospital stay of the TLDG group was significantly shorter than the LADG group (p < 0.05). Surgical outcomes in the newly introduced phase of TLDG were safe as well as feasible compared with established LADG. TLDG has several advantages over LADG, such as shorter post-hospital stay, no incidence of operative complication, adequate working space, and small wound size. Although prospective, randomized control studies are warranted, we submit that TLDG can be used as a standard procedure for LDG.

Study on the application of laparoscopy-assisted radical gastrectomy for gastric cancer in the elderly

To evaluate the feasibility and efficacy of laparoscopy-assisted D2 radical gastrectomy for elderly patients with gastric cancer. From October 2007 to October 2012, 233 gastric cancer patients over 65 years underwent D2 lymph node dissection. Among them, 109 patients underwent laparoscopy-assisted radical gastrectomy(LAG group), while 124 patients underwent conventional open gastrectomy(OG group). Compared to the OG group, LAG group was associated with less bleeding [(102.5±34.3) ml vs. (181.7±73.8) ml, P<0.05], quicker postoperative recovery of bowel function[(2.8±0.6) d vs. (4.0±1.2) d, P<0.05], shorter postoperative length of hospital stay[(10.7±7.5) d vs.(14.2±6.5) d, P<0.05], longer operative time [(231.2±51.4) min vs. (208.5±53.6) min, P<0.05]. The postoperative complication rate of LAG group and OG group was 10.1%(11/109) and 21.0%(26/124) respectively(P<0.05). Short-term quality of life of LAG group was better than that of OG group(P<0.05). The 5-year survival rates were 54.5% and 59.2% in LAG and OG groups respectively, and there was no significant difference(P>0.05). Efficacy of laparoscopy-assisted D2 radical gastrectomy is similar to open gastrectomy in elderly gastric cancer patients with less invasiveness.

Station 10 lymph node dissections in laparoscopic-assisted spleen-preserving radical gastrectomy for advanced proximal gastric cancer.

D2 gastric resection has been increasingly recognized as the optimal surgical treatment for advanced gastric cancer. Dissection of the station 10 splenic lymph nodes is required in the treatment of advanced proximal gastric cancer. Based on vascular anatomy and anatomical plane of fascial space, integrated with our experience in station 10 splenic lymph node dissection in open surgery and proven skills of laparoscopic operation, we have successfully mastered the surgical essentials and technical keypoints in laparoscopic-assisted station 10 lymph node dissection.