Annals of Surgical Treatment and Research

The Korean Surgical Society (대한외과학회)
권호 표지

Comparison of Laparoscopy-assisted Distal Gastrectomy with Open Distal Gastrectomy for Early Gastric Cancer -The Experience of a Group that Have Overcame a Learning Curve-

조기위암의 복강경 보조 원위부 위절제술과 개복술의 비교 -학습곡선을 극복한 그룹에서-

Lee, Sang-Il;Yoon, Yoo-Seok;Choi, Yoo-Shin;Kim, Hyung-Ho;Han, Ho-Seong;Yang, Han-Kwang
이상일;윤유석;최유신;김형호;한호성;양한광

  • Published : 20050300
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Abstract

Purpose: Due to the increasing number of early gastric cancer (EGC) cases, laparoscopic procedures have focused on in the quality of life. Although several studies have compared the surgical results of laparoscopic and open gastric resections, these are only the early initial experiences of the laparoscopic procedure. However, there has been no study following the overcoming of the learning curve. Between October 1998 and April 2003, we performed 83 laparoscopic radical gastrectomies, and compared the laparoscopyassisted distal gastrectomy (LADG) with the conventional open subtotal gastrectomy after obtaining the learning curve. Methods: Between May 2003 and February 2004, 35 patients who diagnosed with EGC by gastroscopy underwent LADG with lymph node dissection. Conventional open gastrectomy were performed in 14 patients preoperatively diagnosed advanced gastric cancer, but confirmed to EGC inform the pathology. Various clinicopathological parameters were retrospectively evaluated from the medical records. Results: Statistically significant differences (P＜0.05) were present between the laparoscopy-assisted and conventional open gastrectomies; white blood cell count on day 2 (10687 vs. 13053, P=0.033), liquid diet start day (4.0 vs. 6.0, P＜ 0.001) and days of hospital stay (7.6 vs 12.1, P=0.005). For the LADG without complication, the group with more than a 7 day hospital stay had a delayed liquid diet start day (4.19 vs. 3.18, P=0.006). A strong positive correlation was found between the day of hospital stay and the start of a liquid diet for LADG without complication there is strong poitive correlation (correlation coefficient=0.77). Conclusion: A LADG with lymph node dissection for EGC has several advantage compared with a conventional open gastrectomy; less inflammatory reactions, a rapid return of gastrointestinal function, and a shorter hospital stay with no decrease in operative curability.

Keywords

References

  1. Ahn YO. Epidemiology of stomach cancer. In: Kim JP, editors. Stomach cancer. 1st ed. Seoul: Uihak Moonwhasa; 1999. p.1-9
  2. Morita M, Baba H, Fukuda T. Submucosal gastric cancer with lym node metastasis. J Surg Oncol 1998;68:5-10 https://doi.org/10.1002/(SICI)1096-9098(199805)68:1<5::AID-JSO3>3.0.CO;2-B
  3. Suzuki H, Miho O, Watanabe Y, Kohyama M, Nagao F. Endoscopic laser therapy in the curative and palliative treatment of upper gastrointestinal cancer. World J Surg 1989;13:158-64 https://doi.org/10.1007/BF01658393
  4. Clinical outcomes of surgical therapy study group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050-9 https://doi.org/10.1056/NEJMoa032651
  5. Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S, et al. Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 1999;229:49-54 https://doi.org/10.1097/00000658-199901000-00006
  6. Ha TW, Kim IH, Sohn SS. Analysis of prognostic factors and outcome of early gastric cancer with and without lymph node metastasis. J Korean Surg Soc 2001;60:413-9
  7. Azagra JS, Goergen M, De Simone P, Ibanez-Aguirre J. Minimally invasive surgery for gastric cancer. Surg Endosc 1999; 13:351-7 https://doi.org/10.1007/s004649900988
  8. Korean Gastric Cancer Association. Nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc 2002;2: 105-14 https://doi.org/10.5230/jkgca.2002.2.2.105
  9. Shiraishi N, Adachi Y, Kitano S, Bandoh T, Katsuta T, Morimoto A. Indication for and outcome of laparoscopy-assisted Billroth I gastrectomy. Br J Surg 1999;86:541-4 https://doi.org/10.1046/j.1365-2168.1999.01083.x
  10. Goh PMY, Alpnat A, Mak K, Kum CK. Early international result of laparoscopic gastrectomies. Surg Endosc 1997;11: 650-2 https://doi.org/10.1007/s004649900413
  11. Adachi Y, Shiraishi N, Shiriomizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 2000; 135:806-10 https://doi.org/10.1001/archsurg.135.7.806
  12. Azagra JS, Goergen M, De Simone P, Ibanez-Aguirre J. Minimally invasive surgery for gastric cancer. Surg Endosc 1999; 13:351-7 https://doi.org/10.1007/s004649900988
  13. Yi NJ, Han HS, Kim YW, Min SK, Kim EG. Laparoscopy-assisted Billroth I gastrectomy compared with open gastrectomy. J Korean Surg Soc 2001;61:164-71
  14. Hur YS, Yang HK, Kim JP. Factor analysis associated with lymph noe metastasis in 1301 early gastric cancers. J Korean Surg Soc 1995;49:68-76
  15. Lee HK, Kim YH, Cho SJ, Yang HK, Lee KU, Choe KJ, et al. Influence of nodal yields on staging of gastric cancer and on survival. J Korean Surg Soc 2001;60:172-9
  16. Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y. Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years' experience. Surg Laparosc Endosc Percutan Tech 2002;12:204-7 https://doi.org/10.1097/00129689-200206000-00021
  17. Lee TM, Kwon Y, Kim MC, Jung GJ, Kim HH. Operative outcome of Laparoscopy-assisted Gastrectomy with lymph node dissection in 117 consecutive patients with gastric cancer: A single-center experience. J Korean Surg Soc 2004;67: 106-11