Abstract
Background
Short-term outcomes of laparoscopy-assisted distal gastrectomy (LADG) and open DG (ODG) have been investigated in previous clinical trials, but operative techniques and concomitant treatments have evolved, and up-to-date evidence produced by expert surgeons is required to provide an accurate image of the relative efficacies of the treatments. The purpose of this study was to compare laparoscopic versus ODG with respect to specific primary and secondary short-term outcomes.
Methods
From October 2005 to February 2008, a total of 64 patients with early gastric cancer were randomly assigned to the LADG or the ODG group. One patient was excluded due to concurrent illness unrelated to the intervention, so the data from 63 patients were analyzed. The primary short-term outcome was the 4-day postoperative use of analgesics. Secondary short-term outcomes were postoperative residual pain, complications, days hospitalized, blood data, days with fever, and days to first flatus.
Results
There was a significant difference in favor of LADG for postoperative use of analgesics (P = 0.022). Unexpectedly, there was no significant difference in degree of pain in the immediate postoperative period, putatively due to the optimal use of analgesics. Of the secondary outcomes, residual pain at postoperative day 7 (P = 0.003) and days to first flatus (P = 0.001) were significantly better with LADG. Postoperative complications, number of days hospitalized, and number of days with fever were also better with LADG, but the differences were not significant. Blood data representing inflammation (WBC and CRP) showed marked differences, especially on postoperative day 7 (P = 0.0016 and P = 0.0061, respectively).
Conclusions
LADG performed by expert surgeons results in less postoperative pain accompanied by decreased surgical invasiveness and is associated with fewer postoperative inconveniences. No preliminary suggestions of changes in long-term curability were observed. LADG for early gastric cancer is a feasible and safe procedure with short-term clinical results superior to those of ODG.
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References
Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3(4):219–225
Tanabe S, Koizumi W, Mitomi H, Nakai H, Murakami S, Nagaba S, Kida M, Oida M, Saigenji K (2000) Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer. Gastrointest Endosc 56(5):708–713
Ohashi S, Yoden Y, Kanno H, Tei K, Akashi A, Haque M (1996) Laparoscopic gastrotomy in intragastric surgery for early gastric cancer: a new technique. Surg Technol Int 5:157–159
Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23(2):187–192 discussion 192–193
Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(2):146–148
Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Soga R, Wakayama A, Okamoto K, Ohyama A, Hasumi A (1999) Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer 2(3):186–190
Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y (2002) Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years’ experience. Surg Laparosc Endosc Percutan Tech 12(3):204–207
Fujiwara M, Kodera Y, Misawa K, Kinoshita M, Kinoshita T, Miura S, Ohashi N, Nakayama G, Koike M, Nakao A (2008) Long-term outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery. J Am Coll Surg 206(1):138–143
Japanese Society for Endoscopic Surgery (2008) Ninth nationwide survey of endscopic surgery in Japan. Jpn Soc Endosc Surg 13:525–529
Fujiwara M, Kodera Y, Miura S, Kanyama Y, Yokoyama H, Ohashi N, Hibi K, Ito K, Akiyama S, Nakao A (2005) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a phase II study following the learning curve. J Surg Oncol 91(1):26–32
Kunisaki C, Makino H, Yamamoto N, Sato T, Oshima T, Nagano Y, Fujii S, Akiyama H, Otsuka Y, Ono HA, Kosaka T, Takagawa R, Shimada H (2008) Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer. Surg Laparosc Endosc Percutan Tech 18(3):236–241
Yoo CH, Kim HO, Hwang SI, Son BH, Shin JH, Kim H (2009) Short-term outcomes of laparoscopic-assisted distal gastrectomy for gastric cancer during a surgeon’s learning curve period. Surg Endosc 23(10):2250–2257
Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S, Akazawa K (1999) Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 229(1):49–54
Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asao T, Kuwano H (2002) Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg 26(9):1145–1149
Kawamura H, Okada K, Isizu H, Masuko H, Yamagami H, Honma S, Ueki S, Noguchi K, Kondo Y (2008) Laparoscopic gastrectomy for early gastric cancer targeting as a less invasive procedure. Surg Endosc 22(1):81–85
Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131(1 Suppl):S306–S311
Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19(9):1172–1176
Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241(2):232–237
Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19(2):168–173
Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248(5):721–727
Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report–a phase III multicenter, prospective, randomized trial (KLASS Trial). Ann Surg 251(3):417–420
Yamashita K, Sakuramoto S, Shibata T, Nemoto M, Mieno H, Katada N, Kikuchi S, Watanabe M (2012) Survival outcome of laparoscopic gastrectomy for clinical early (cT1) gastric cancer. Surg Today. doi:10.1007/s00595-012-0388-1
Japanese Gastric Cancer Association (1998) Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1(1):10–24
Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13(4):227–236
Lee SW, Nomura E, Bouras G, Tokuhara T, Tsunemi S, Tanigawa N (2010) Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. J Am Coll Surg 211(1):33–40
Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K, ACTS-GC Group (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357(18):1810–1820 Erratum 358(18):1977
Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345(10):725–730
Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245(1):68–72
Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L (2012) Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256(1):39–52
Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 255(3):446–456
Kikuchi S, Katada N, Sakuramoto S, Kobayashi N, Shimao H, Watanabe M, Hiki Y (2004) Survival after surgical treatment of early gastric cancer: surgical techniques and long-term survival. Langenbecks Arch Surg 389(2):69–74
Yamashita K, Sakuramoto S, Kikuchi S, Katada N, Kobayashi N, Watanabe M (2008) Validation of staging systems for gastric cancer. Gastric Cancer 11(2):111–118
Disclosures
Shinichi Sakuramoto, Keishi Yamashita, Shiro Kikuchi, Nobue Futawatari, Natsuya Katada, Masahiko Watanabe, Toshiyuki Okutomi, and Leon Bax have no conflicts of interest or financial ties to disclose.
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Sakuramoto, S., Yamashita, K., Kikuchi, S. et al. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc 27, 1695–1705 (2013). https://doi.org/10.1007/s00464-012-2658-9
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DOI: https://doi.org/10.1007/s00464-012-2658-9