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

Lee, Sang Il; Yoon, Yoo Seok; Choi, Yoo Shin; Kim, Hyung Ho; Han, Ho Seong; Yang, Han Kwang

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 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.