Ann Surg Treat Res.  2015 Oct;89(4):176-182. 10.4174/astr.2015.89.4.176.

Comparison of short-term outcomes and acute inflammatory response between laparoscopy-assisted and totally laparoscopic distal gastrectomy for early gastric cancer

• Lee SH
• Kim IH
• Kim IH
• Kwak SG
• Chae HD

• KMID: 2166886
• DOI: http://doi.org/10.4174/astr.2015.89.4.176

Abstract

PURPOSE
Laparoscopic gastrectomy is widely used to treat early gastric cancer. The advantages of totally laparoscopic distal gastrectomy (TLDG) are unproven, and some concerns remain regarding the early surgical outcomes due to its technical difficulty. We compared the early surgical outcomes and acute inflammatory response between patients undergoing TLDG and laparoscopy-assisted distal gastrectomy (LADG) for treatment of early gastric cancer.
METHODS
We performed a retrospective study on 212 consecutive patients who underwent laparoscopic distal gastrectomy for gastric cancer between January 2008 and June 2014. A total of 179 LADG cases and 33 TLDG cases were included. After age, sex, body mass index, and American Society of Anesthesiologists physical status score were matched using propensity score matching (PSM), we compared the short-term surgical outcomes between the LADG and TLDG groups.
RESULTS
The TLDG group had a shorter hospital stay (9.5 days vs. 11.0 days, P = 0.046) and less blood loss (116.6 mL vs. 141.5 mL, P = 0.031) than those in the LADG group. There were no differences in the preoperative WBC count and CRP level and the other clinical data between the two groups after PSM. Postoperative WBC count, serum CRP level, and decrease rate of WBC count in the TLDG group were significantly lower than those in the LADG group.
CONCLUSION
The short-term outcomes of TLDG revealed better than that of LADG in this study. Therefore, TLDG is one of the safe and feasible procedure for the treatment of early gastric cancer.

Keyword

Stomach neoplams; Laparoscopy; Short-term outcome; Acute-phase reaction; Propensity score

MeSH Terms

Acute-Phase Reaction
Body Mass Index
Gastrectomy*
Humans
Laparoscopy
Length of Stay
Propensity Score
Retrospective Studies
Stomach Neoplasms*

Figure

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  Fig. 1 Age, sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) score were matched between the laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) groups using propensity score matching (PSM).

• 

  Fig. 2 Comparison of changes in inflammatory parameters between the laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) groups after propensity score matching (PSM). Both of WBC counts and serum CRP level were significant lower in TLDG group. (A) WBC counts in TLDG group showed earlier decline than that in LADG. (B) Decreasing rate of CRP level showed no significant difference between two groups. 1SE, 1 standard error; Preop, preoperation.

• 

  Fig. 3 Changes in operation time of totally laparoscopic distal gastrectomy (TLDG).

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