RESUMEN
BACKGROUND: To investigate the short-term and long-term outcomes of preserving the celiac branch of the vagus nerve during laparoscopic distal gastrectomy. METHODS: A total of 149 patients with prospective diagnosis of gastric cancer who underwent laparoscopic-assisted distal gastrectomy (LADG) combined with Billroth-II anastomosis and D2 lymph node dissection between 2017 and 2018 were retrospectively analyzed. The patients were divided into the preserved LADG group (P-LADG, n = 56) and the resected LADG group (R-LADG, n = 93) according to whether the vagus nerve celiac branch was preserved. We selected 56 patients (P-LADG, n = 56) with preservation of the celiac branch of the vagus nerve and 56 patients (R-LADG, n = 56) with removal of the celiac branch of the vagus nerve by propensity-matched score method. Postoperative nutritional status, weight change, short-term and long-term postoperative complications, and gallstone formation were evaluated in both groups at 5 years of postoperative follow-up. The status of residual gastritis and bile reflux was assessed endoscopically at 12 months postoperatively. RESULTS: The incidence of diarrhea at 5 years postoperatively was lower in the P-LADG group than in the R-LADG group (p < 0.05). In the multivariate logistic analysis, the removal of vagus nerve celiac branch was an independent risk factor for the occurrence of postoperative diarrhea (odds ratio = 3.389, 95% confidential interval = 1.143-10.049, p = 0.028). In the multivariate logistic analysis, the removal of vagus nerve celiac branch was an independent risk factor for the occurrence of postoperative diarrhea (odds ratio = 4.371, 95% confidential interval = 1.418-13.479, p = 0.010). CONCLUSIONS: Preservation of the celiac branch of the vagus nerve in LADG reduced the incidence of postoperative diarrhea postoperatively in gastric cancer. TRIAL REGISTRATION: This study was registered with the Ethics Committee of the First Affiliated Hospital of Dalian Medical University in 2014 under the registration number: LCKY2014-04(X).
Asunto(s)
Laparoscopía , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/patología , Estudios de Cohortes , Estudios Retrospectivos , Estudios Prospectivos , Incidencia , Gastrectomía/efectos adversos , Gastrectomía/métodos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Nervio Vago/patología , Nervio Vago/cirugía , Diarrea/epidemiología , Diarrea/etiología , Diarrea/prevención & control , Resultado del TratamientoRESUMEN
PURPOSE: We aimed to evaluate the clinical outcomes and determine the degree of postoperative pain associated with the location of mini-laparotomy sites in gastric cancer patients who underwent laparoscopic-assisted distal gastrectomy (LADG) or totally laparoscopic distal gastrectomy (TLDG). METHODS: Between November 2011 and December 2016, 153 patients who underwent surgery for gastric cancer at Kyung Hee University Hospital at Gangdong were reviewed retrospectively. We divided the patients into LADG with epigastric incision, TLDG with umbilical incision (TLDG_U), and TLDG with Pfannenstiel incision (TLDG_P) groups according to the location of incision for anastomosis and specimen removal. There were 37 cases in the LADG group, 85 in the TLDG_U group, and 31 in the TLDG_P group. The clinical characteristics, numeric rating scale (NRS) scores, and postoperative analgesic usage for 7 days of the three groups were compared. RESULTS: There was no statistically significant difference in clinical characteristics including age, sex, body mass index (BMI), TNM staging, and complications among the three groups. There was no significant difference in the amount of total analgesics received; however, the TLDG_P group received more analgesics (5.26±5.053, p=0.412) during the first 7 postoperative days. The TLDG_P group showed higher NRS scores on postoperative days 0, 2, 3, 4, and 5 (p=0.04, 0.001, 0.003, 0.006, and 0.002 respectively). CONCLUSION: Laparoscopic distal gastrectomy can be performed through various incision sites for increasing the safety of mini-laparotomy. However, a Pfannenstiel incision was shown to be more painful than other incisions.
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Humanos , Analgésicos , Índice de Masa Corporal , Gastrectomía , Estadificación de Neoplasias , Dolor Postoperatorio , Estudios Retrospectivos , Neoplasias GástricasRESUMEN
OBJECTIVES: Laparoscopy-assisted distal gastrectomy (LADG) is a common surgical procedure that has recently been accepted as safe and feasible for the treatment of early gastric cancer. There have been many efforts to expand the indications of LADG to include the treatment of advanced gastric cancer. The aim of this study was to determine the usefulness of noncompliance rate as an indicator for D2 lymph node dissection (LND) validation in LADG. METHODS: The subjects were 48 patients who underwent distal gastrectomy with D2 LND at Kosin University Gospel Hospital from October to December 2010. Of them, 28 underwent LADG and 20 underwent open distal gastrectomy (ODG). We compared several factors including noncompliance rate to validate D2 LND. RESULTS: There were no significant differences in clinicopathologic factors except for BMI and tumor depth between the two groups. The average number of retrieved lymph nodes was significantly greater in the ODG group (45.9 +/- 2.9) than in the LADG group (35.5 +/- 2.0). The noncompliance rate was 43% in the LADG group and 40% in the ODG group with no significant difference. CONCLUSIONS: In terms of no difference of noncompliance rate, LADG with D2 lymph node dissection is a safe, feasible and oncologicallycamparable with open gastrectomy. A large scaled prospective randomized trial should be needed to confirm the benefit of LADG.
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Humanos , Gastrectomía , Escisión del Ganglio Linfático , Ganglios Linfáticos , Neoplasias GástricasRESUMEN
PURPOSE: There is still debate regarding the suitability of extension of laparoscopic gastrectomy to advanced gastric cancer. Due to the development of new instruments and techniques, several studies are being conducted to extend the range of laparoscopic gastrectomy. This study was conducted to investigate the appropriateness of laparoscopic D2 lymph node dissection for the treatment of gastric cancer from an oncology perspective. METHODS: A total of 109 patients, 50 of whom had undergone laparoscopy assisted distal gastrectomy (LADG) and 59 patients who underwent open distal gastrectomy (ODG), that were operated on by a single surgeon in the surgery department of Sanggye Paik Hospital from April 2009 to May 2011 were analyzed. All patients underwent D2 lymph node dissection. The clinical characteristics of patients, surgical outcomes and clinicopathologic findings were then compared and analyzed. RESULTS: There was no significant difference in the operation time between the two groups (252.70+/-40.81 vs. 252.20+/-45.22, p=0.698). The day 1 post operation hemoglobin was higher in the LADG group than the ODG group (12.52+/-1.53 vs. 10.54+/-1.57, p=0.011). There were nosignificant differences in resection margin (6.89+/-2.25 vs. 7.20+/-3.42, p=0.254, 4.05+/-2.57 vs. 3.68+/-2.74, p=0.254) or total number of harvested lymph nodes (30.36+/-10.67 vs. 35.44+/-12.56, p=0.508) between groups. CONCLUSION: In stomach cancer surgery, both ODG and LADG can be used to conduct lymph node dissection. Therefore, if the stability and feasibility of LADG is confirmed by prospective studies at multiple centers, laparoscopic gastrectomy may be extended to advanced gastric cancer as well.
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Humanos , Gastrectomía , Hemoglobinas , Laparoscopía , Escisión del Ganglio Linfático , Ganglios Linfáticos , Neoplasias GástricasRESUMEN
We report our case of laparoscopy-assisted distal gastrectomy with D1 + beta lymph node dissection for a patient with early gastric cancer and laparoscopic cholecystectomy for gallstone with situs inversus totalis. A superficial elevated lesion was found on the lesser curvature of the antrum. The preoperative diagnosis was cStage IA (cT1, cN0, cH0, cP0, cM0). A 1 cm-sized gallstone was found in the fundus through upper abdominal ultrasound. A laparoscopy-assisted distal gastrectomy with standard D2 lymph node dissection for early gastric cancer and laparoscopic cholecystectomy was successfully performed by not shifting the monitor to the left and right and not changing operator's position without additional blood loss and time. The number of retrieved lymph nodes was 36. We have not found any abnormal course of blood vessels except for the right/left inversion. Billroth I reconstruction was performed through end-to-side anastomosis. Based on a histopathological examination, a 1.5 x 1.5 cm, submucosal (sm3), moderately differentiated adenocarcinoma (pT1, pN0, sH0, sP0, sM0, stage IA) was diagnosed. The postoperative course was favorable and the patient was discharged on postoperative day 7.
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Humanos , Adenocarcinoma , Vasos Sanguíneos , Colecistectomía Laparoscópica , Cálculos Biliares , Gastrectomía , Gastroenterostomía , Escisión del Ganglio Linfático , Ganglios Linfáticos , Compuestos Organotiofosforados , Situs Inversus , Neoplasias GástricasRESUMEN
PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) has become a feasible and acceptable surgical technique for treating early gastric cancer. However, there are no reports about the role of the first assistant on LADG. The aim of this study is to compare between an experienced first assistant and an inexperienced first assistant surgeon for conducting LADG to treat early gastric cancer. METHODS: The data from 32 consecutive patients with early gastric cancer and who underwent LADG by one surgeon between May 2008 and December 2008 was reviewed. The operation times of 32 consecutive patients were reviewed. Other indicators such as the transfusion requirements, the time to first flatus, and the postoperative hospital stay were also evaluated between an experienced first assistant and an inexperienced first assistant surgeon. RESULTS: No significant differences between an experienced first assistant and an inexperienced first assistant surgeon in terms of the patients' clinicopathologic characteristics and surgical outcomes were found, but there was a statistically significant difference in the operation times between the two groups. CONCLUSION: After the operator has overcome the learning curve and standardization has been established, LADGs are minimally affected by the role of the first assistant.
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Humanos , Flatulencia , Gastrectomía , Curva de Aprendizaje , Tiempo de Internación , Neoplasias GástricasRESUMEN
PURPOSE: Laparoscopy assisted distal gastrectomy (LADG) has been accepted as the best standard operative technique in early gastric cancer. But, no predictive indicators of reconstructive procedure were reported. Analyzing the reconstructive procedure after LADG according to location of the lesion, we, herein, suggest an alternative. METHODS: From May 2008 to May 2009, 55 patients with distal gastric cancer who underwent LADG were examined retrospectively. The group of 55 patients were assigned to two groups according to the reconstructive procedure undertaken: 41, Billroth I (BI); 14, Billroth II (BII). After measuring the distance between esophagogastric junction and tumor (ET) and between pyloric ring and tumor (PT), we found ET/(ET+PT). RESULTS: The mean+/-standard error time of ET in BI and BII group was 20.5+/-7.9 cm (5~38) and 13.9+/-6.7 cm (6~30). The mean+/-standard error time of PT in BI and BII group was 15.1+/-8.2 cm (2~36) and 22.6+/-9.1 cm (8~40). The mean+/-standard error time of ET/(ET+PT) in BI and BII group was 57.0+/-21.1% (16.1~95.0) and 39.1+/-19.0% (13.0~75.0). ET, PT and ET/(ET+PT) were correlated with reconstructive procedure (P=0.007, 0.006, 0.005). In comparative analysis of correlation between ET and reconstructive procedure, 95% confidence level in BI and BII group is 18.0~22.9 cm and 10.0~17.7 cm; between PT and reconstructive procedure, 12.5~17.7 cm and 17.4~27.8 cm; and between ET/(ET+PT) and reconstructive procedure, 51.1~64.4% and 28.1~50.0%. CONCLUSION: In our study, predictive indicators of decision for reconstructive procedure in ET, PT, ET/(ET+PT) is 17.8~18.0 cm, 17.4~17.7 cm, 50.0~51.1%.
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Humanos , Unión Esofagogástrica , Gastrectomía , Gastroenterostomía , Laparoscopía , Estudios Retrospectivos , Neoplasias GástricasRESUMEN
The occurrence of a pneumothorax during laparoscopy-assisted distal gastrectomy (LADG) is rare. A pneumothorax was developed during a LADG under general anesthesia in a 67-year-old woman with gastric cancer. About 140 minutes after CO2 insufflation, sudden hemodynamic collapse occurred. A defect was noted in the diaphragm. After immediate repair under laparoscopy, hemodynamic stability was achieved within several minutes. In the anesthetic management of a LADG, the anesthesia provider should be aware of the possible occurrence of a pneumothorax.
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Anciano , Femenino , Humanos , Anestesia , Anestesia General , Diafragma , Gastrectomía , Hemodinámica , Insuflación , Laparoscopía , Neumotórax , Neoplasias GástricasRESUMEN
Around two-thirds of all abdominal aortic aneurysms (AAA) are incidentally discovered. Open surgical repair of these aneurysms is considered the standard, traditional method of treatment. This report details the minimal invasive approach for a patient who presented with early gastric cancer and an AAA, and the patient underwent endovascular repair of the aneurysm prior to laparoscopic assisted distal gastrectomy. Esophagogastroduodenoscopy identified a malignant ulcer in the antrum and preoperative abdominal computer-tomography incidentally revealed a large AAA. The abdominal aortic aneurysm was the infra-renal type and the estimated size was 65 mm. Compared to open surgical intervention, the treatment of abdominal aortic aneurysm via endovascular aneurysm repair (EVAR) shortens the period of recovery. Also, intra-abdominal adhesion is avoided so that minimal invasive surgical intervention through the laparoscopic approach is possible for treating malignancy. EVAR is the recommended treatment for asymptomatic abdominal aortic aneurysm when this is associated with intra-abdominal malignancy.
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Humanos , Aneurisma , Aneurisma de la Aorta Abdominal , Endoscopía del Sistema Digestivo , Gastrectomía , Neoplasias Gástricas , ÚlceraRESUMEN
PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) has become a viable alternative treatment for patients suffering with early gastric cancer. Surgeons have long thought that obesity might increase the rate of intraoperative or postoperative complications. This study was performed to evaluate the impact of obesity, according to the learning curve, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. METHODS: We retrospectively reviewed 100 patients who had undergone LADG for gastric cancer between September 2004 and May 2007 at Keimyung University Dongsan Medical Center. We measured the degree of obesity by using the body mass index (BMI: kg/m(2)), and we compared the surgical outcomes between the low BMI group (BMI 25 kg/m(2), n=28). We further subdivided the patients into the surgeons' number of cumulative LADG cases, the early learning curve group (from the first patient to the 50th patient) and the late learning curve group (from the 51th patient to the 100th patient). We analyzed them in terms of the operation time, the amount of intraoperative bleeding, the number of retrieved lymph nodes, the rate of operative morbidity and the length of the postoperative hospital stay. RESULTS: There no significant differences between the high and low BMI groups in terms of the patients' clinicopathologic characteristics and surgical outcomes, but there was a statistically significant difference in the operation times between the high BMI (303.3 min) and low BMI groups (269.3 min, P=0.029). The postoperative morbidity was not different between the high BMI (25%) and low BMI groups (12.5%, P=0.12). However, when we subdivided the patients by the learning curve, there was a statistically significant difference for the operation time (360 vs 297 minutes, respectively), postoperative morbidity (41.7 vs 10.5%, respectively) and the postoperative hospital stay (15.5 vs 8.6 day, respectively) between the high BMI and low BMI groups at the early learning curve period. Especially for male patients, the early learning curve period showed significant differences in the operation time, the postoperative morbidity and the postoperative hospital stay between the high BMI and low BMI groups, but in case of the female patients, there was no difference in postoperative morbidity and the length of the postoperative hospital stay. At the late learning curve period, there was no difference according to gender and obesity. CONCLUSION: Obesity itself does not increase operative morbidity when performing LADG in patients with gastric cancer. However, at a surgeon's initial period of performing LADG, a careful approach seems to be required for male obese patients.
Asunto(s)
Femenino , Humanos , Masculino , Índice de Masa Corporal , Gastrectomía , Hemorragia , Laparoscopía , Aprendizaje , Curva de Aprendizaje , Tiempo de Internación , Ganglios Linfáticos , Obesidad , Complicaciones Posoperatorias , Estudios Retrospectivos , Neoplasias Gástricas , Estrés PsicológicoRESUMEN
PURPOSE: The aim of this study was to assess the short-term results of conventional open distal gastrectomy (ODG) and laparoscopy-assisted distal gastrectomy (LADG) in obese patients with early gastric cancer. METHODS: This study included 28 consecutive patients who underwent LADG and 33 patients who underwent ODG for early gastric cancer. The patients were divided into two groups: obese (body mass index, BMI> or =25) and non-obese (BMI<25). Patient characteristics, operative details, and postoperative outcomes were analyzed and compared between the two groups. RESULTS: The operation time was longer in LADG patients than in ODG patients. In the LADG group, the high BMI subset required significantly longer operative time than the low BMI subset. The number of retrieved lymph nodes, average perioperative hemoglobin concentration, serum albumin, first flatus, and postoperative WBC count were similar between the two groups. Regarding ODG patients, the mean perioperative decrease in hemoglobin concentration was significantly greater in the high BMI subset. The difference in operative time between the ODG/high BMI subset and the ODG/low BMI subset was not statistically significant. CONCLUSION: Obesity has differing effects on LADG and on ODG, and this should be considered when deciding what procedure to utilize in patients with early gastric cancer. Further research is needed to better elucidate the relationship between obesity and gastrectomy for early gastric cancer.
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Humanos , Flatulencia , Gastrectomía , Hemoglobinas , Ganglios Linfáticos , Obesidad , Tempo Operativo , Albúmina Sérica , Neoplasias GástricasRESUMEN
PURPOSE: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). MATERIALS AND METHODS: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+beta lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a 2.5~3.0 cm pyloric cuff and maintaining a 3.0~4.0 cm distal margin for the resection. RESULTS: The mean age for patients who underwent LAPPG and LADGBI were 59.9+/-9.4 year-old and 64.1+/-10.0 year-old, respectively. The sex ratio was 1.3:1.0 (male 5, female 4) in the LAPPG group and 2.6:1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes (28.3+/-11.9 versus 28.1+/-8.9), operation time (269.0+/-34.4 versus 236.3+/-39.6 minutes), estimated blood loss (191.1+/-85.7 versus 218.3+/-150.6 ml), time to first flatus (3.6+/-0.9 versus 3.5+/-0.8 days), time to start of diet (5.1+/-0.9 versus 5.1+/-1.7 days), and postoperative hospital stay (10.1+/-4.0 versus 9.2+/-3.0 days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. CONCLUSION: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.
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Femenino , Humanos , Arterias , Dieta , Flatulencia , Gastrectomía , Gastroparesia , Corea (Geográfico) , Tiempo de Internación , Hígado , Escisión del Ganglio Linfático , Ganglios Linfáticos , Síndromes Posgastrectomía , Complicaciones Posoperatorias , Seroma , Razón de Masculinidad , Estómago , Neoplasias Gástricas , Nervio VagoRESUMEN
PURPOSE: Recently, laparoscopy assisted gastrectomy has taken its place as one of the main strategies for managing early gastric cancer (EGC). We conducted this study to evaluate its value from the point of view of initial experience. METHODS: Between June 2007 and May 2008, 63 patients who underwent laparoscopy assisted distal gastrectomy (LADG, n=43) or open distal gastrectomy (ODG, n=20) for EGC by a single surgeon, enrolled in this retrospective, non-randomized study. The operative procedure was decided on through patients' preferences. We compared several clicopathological factors and short-term postoperative outcomes between the two groups. RESULTS: There were no significant differences in the patients' demography and pathologic results between the two groups. The operation time was more shorter (167+/-23.2 vs. 268+/-68.6 mins, P<0.0001) in the ODG group, but the time to first flatus (2.8+/-0.6 vs. 3.1+/-0.4 days, P=0.033), the time to first diet (3.0+/-0.3 vs. 3.6+/-0.6 days, P<0.0001), and the duration of hospital stay (9.1+/-1.2 vs. 11.6+/-3.1 days, P<0.0001) were significantly shorter in the LADG group. Although there were no significant differences in postoperative morbidity and mortality between the two groups, one patient died of postoperative myocardiac infarction in the LADG group (P=0.6854). Comparison between before and after learning curve; there were statistically significant differences in the number of retrieved lymph nodes (31.2+/-13.7 vs. 42.2+/-13.4, P=0.0185) and the time of operation (295+/-63.8 vs. 208+/-30.5 mins, P<0.0001). CONCLUSION: Although our results represent initial experiences, we could find some advantages in LADG compared with ODG. We suggest that application of more restrictive indication is required at an earlier time on the learning curve.
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Humanos , Demografía , Dieta , Flatulencia , Gastrectomía , Hipogonadismo , Infarto , Laparoscopía , Aprendizaje , Curva de Aprendizaje , Tiempo de Internación , Ganglios Linfáticos , Enfermedades Mitocondriales , Oftalmoplejía , Estudios Retrospectivos , Neoplasias Gástricas , Procedimientos Quirúrgicos OperativosRESUMEN
PURPOSE: There is concern about the potential adverse effects on hepatic function due to increased intraabdominal pressure during pneumoperitoneum. The changes in hepatic function following a laparoscopy assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) for gastric cancer were compared. METHODS: Between July 2004 and May 2005, 60 patients diagnosed with early gastric cancer at Kangnam St' Mary's hospital; 30 each having undergone LADG and ODG were studied. The levels of alkaline phosphatase (ALP), total bilirubin (TB), aspartate transferase (AST) and alanine transferase (ALT) between the two groups were compared at 24 and 72 hours postoperatively. RESULTS: The age, sex, body mass index and preoperative hepatic function were not different between the two groups. The operative times were significantly longer in the LADG than the ODG group (298 vs. 184 minutes, P 0.05). CONCLUSION: After a LADG, the levels of hepatic transaminases were immediately elevated, but returned to normal levels within 72 hours. A LADG with prolonged pneumoperitoneum is considered safe in patients with normal liver function prior to the operation. In addition, to evaluate the safety of a LADG in the patients with decreased hepatic function, a large scaled randomized prospective trial will be required.
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Humanos , Alanina , Fosfatasa Alcalina , Ácido Aspártico , Bilirrubina , Índice de Masa Corporal , Gastrectomía , Laparoscopía , Hígado , Fallo Hepático , Mortalidad , Tempo Operativo , Neumoperitoneo , Estudios Prospectivos , Neoplasias Gástricas , Transaminasas , TransferasasRESUMEN
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.
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Humanos , Amilasas , Índice de Masa Corporal , Proteína C-Reactiva , Gastrectomía , Tiempo de Internación , Recuento de Leucocitos , Escisión del Ganglio Linfático , Registros Médicos , Patología , Estudios Retrospectivos , Neoplasias GástricasRESUMEN
PURPOSE: The laparoscopy assisted gastrectomy has been increasingly reported as the treatment of choice for early gastric cancer. However, expert surgeons, who have performed a conventional open gastrectomy for a long time, tend to have a negative attitude toward laparoscopic procedures. The aim of this study was to determine the learning curve of a laparoscopy assisted distal gastrectomy (LADG) for a surgeon expert in performing an open gastrectomy and to analyze the factors that have an effect on a LADG. MATERIALS AND METHODS: Between April 2005 and March 2006, 62 patients underwent a LADG with D1+beta lymph-node dissection. The 62 patients were divided into 10 sequential groups with 6 cases in each group (the last group was 8 cases), and the time required to reach the plateau of the learning curve was determined by examining the average operative times of these 10 groups. Other factors, such as sex, BMI, complications, transfusion requirements, the number of retrieved lymph nodes, and change of postoperative hemoglobin level, were also analyzed. RESULTS: With the 5th group (after 30 cases), the operative time reached a plateau (average: 170 min/operation). The differences between before the 30th case and after the 31st case with respect to changes in the postoperative hemoglobin level, the number of retrieved lymph nodes, the transfusion requirements, and the complications rate were not significant. CONCLUSION: According to an analysis of the operative time, experience with 30 LADGs in patients with early gastric cancer is the point at which the plateau of the learning curve (7 months) is reached. Abundant experience with a conventional open gastrectomy and a well-organized laparoscopic surgery team are important factors in overcoming the learning curve earlier.
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Humanos , Gastrectomía , Laparoscopía , Curva de Aprendizaje , Aprendizaje , Ganglios Linfáticos , Tempo Operativo , Neoplasias GástricasRESUMEN
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 laparoscopy-assisted 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.
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Humanos , Dieta , Gastrectomía , Gastroscopía , Curva de Aprendizaje , Aprendizaje , Tiempo de Internación , Recuento de Leucocitos , Escisión del Ganglio Linfático , Registros Médicos , Patología , Calidad de Vida , Estudios Retrospectivos , Neoplasias GástricasRESUMEN
Purpose: We compared the changes in the perioperative peripheral lymphocyte subsets and the acute inflammatory reactants (CRP and SAA) to compare the immune responses between a Laparoscopy-assisted distal gastrectomy (LADG) and a conventional open distal gastrectomy (CODG). METHODS: 23 patients, who underwent an operation for early gastric cancer, between Nov. 2003 and Feb. 2004, were enrolled in this study. The total WBC, lymphocytes, peripheral lymphocyte subsets and acute inflammatory reactants (CRP and SAA) were evaluated on the preoperative day, and 2, and 24 hrs and on the 4th postoperative day in 20 of the 23 cases. RESULTS: There were no significant differences in the preoperative total WBC, lymphocyte, peripheral lymphocyte subsets, CRP and SAA between the two groups (P 0.05). The postoperative CRP and SAA levels; however, gradually increased compared to the preoperative levels, and were significantly lower in the LADG than the CODG group (CRP: P=0.03 and SAA: P=0.01). Conclusion: No difference was detected in the immune-cell numbers in the gastric cancers between the LADG and CODG groups. The LADG was found to influence the acute inflammatory reaction less than the CODG.