Laparoscopic Distal Gastrectomy for Gastric Cancer

Abstract

To review the initial experience and compare the results of hand-assisted laparoscopic distal gastrectomy (HALDG), totally laparoscopic distal gastrectomy (TLDG), and open distal gastrectomy (ODG) in the treatment of gastric cancer in a regional hospital. Consecutive patients who received distal gastrectomy for stage 1 or 2 gastric cancer were reviewed retrospectively. Lymphatic dissection and intracorporeal anastomosis were initially performed using the HALDG approach, and subsequently the TLDG approach. The results were compared with those of the ODG approach, and the overall survival was compared between the laparoscopic and open surgery groups. Sixty-nine patients underwent distal gastrectomies and 28 gastrectomies were performed using the laparoscopic approach (HALDG=10; TLDG=18). Patients who underwent HALDG required less operative time (median, 212 min vs. 263 min; P=0.04), whereas patients who underwent TLDG had reduced complication rates and a shorter hospital stay (median, 16 d vs. 8 d, respectively; P=0.009). When compared with ODG, the laparoscopic approach required a longer operative time but incurred significantly less blood loss (median, 75 mL vs. 175 mL, respectively; P=0.004). There was no difference in overall operative morbidity, hospital stay, oncologic clearance, or overall survival between the laparoscopic and open approaches. TLDG is technical demanding and requires longer operation time. The use of the hand-assisted approach for beginner surgeons may serve as a bridge to acquire skill for TLDG.