Comparison of Laparoscopy-assisted Distal Gastrectomy with Open Distal Gastrectomy for Early Gastric Cancer

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance as a minimally invasive treatment for early gastric cancer. Generally; LADG, with extraperigastric lymph node dissection, is considered a technically more complicated procedure for gastric cancer than a conventional open distal gastrectomy (CODG). LADG, with extraperigastric lymph node dissection, for gastric cancers has previously been described, but the safety, efficacy and clinical benefits of these types of surgery are still unclear. To evaluate the short-term surgical validity, surgical outcome of a LADG, with extraperigastric lymph node dissection, was compared with that of a CODG in early gastric cancer patients. METHODS: A retrospective study of 80 patients with early gastric cancer (EGC), who underwent a LADG, with extraperigastric lymph node dissection, between September 2004 and August 2006, at Keimyung University Dongsan Medical Center, was performed. Over the same period, conventional open gastrectomies were performed in 97 patients, confirmed to have EGC from their pathology. Various clinicopathological parameters were evaluated from the medical records. RESULTS: The baseline characteristics, including gender, age, body mass index (BMI) and tumor size, were similar between the two groups. In the LADG group, the operation time was longer (P=0.000), but the blood loss was less (P=0.000) than in the CODG group. The postoperative recovery in the LADG group was faster, as reflected by the shorter time to pass gas and the shorter hospital stay, which resulted in significantly lower serum white blood cell count amylase and C-reactive protein levels on day 1. Pathological examinations showed the surgery to be equally radical in the two groups. CONCLUSION: According to this study; LADG, with extraperigastric lymph node dissection, is a safe and technically feasible procedure for the treatment of early gastric cancer. The LADG procedure provides several advantages to that of a conventional open distal gastrectomy; less inflammatory reactions, a rapid return of gastrointestinal function and a shorter hospital stay, with no decrease in the operative curability.

Analysis of the Perioperative Outcomes after Surgical Resection for 145 Patients with Hepatocellular Carcinoma

PURPOSE: Surgical resection for the hepatocellular carcinoma (HCC) is the only proven curative treatment modality. Most of these patients have chronic hepatitis with or without cirrhosis; therefore, curative resection with enough of a safety margin is always challenging for hepatic surgeons. The aim of our retrospective study was to analyze the correlation of the complications with the patient factors, the tumor factors and the surgical factors. MATERIALS & METHOD: A total of 145 patients who had hepatocellular carcinoma were resected surgically during the five year and nine months period between September 2000 and June 2006. We collected the database prospectively and we analyzed the perioperative outcomes from the accumulated database. RESULT: Anatomical resection, standard hemihepatectomy or systematic segmentectomy after injection of methylene blue dye into the portal vein branch was performed in 89 patients, and nonanatomical resection was done in 56 patients. The number of major resections that was more than two sections was 72, and the number of minor resection less than two sections was 73. The mean operative time was 270 minutes, the amount of bleeding was 669ml and the mean time of performing the Pringle maneuver was 31.5 minutes. Perioperative complication were noted in 20.0% of the patients and there were five mortalities (3.4%). The only one significant factor that affected a higher complication rate was the ICG15 and the significant factor that affected the mortality rate was the duration of the Pringle maneuver. CONCLUSION: Type oriented hepatic resection that achieves an adequate surgical resection volume is dependent on the status of the tumor and the hepatic reservoir function with limited bleeding, and these factors will help selected patients obtain a very good outcome with an acceptable complication rate and low mortality.