Skip to main content
SpringerLink
Log in

Developing an Institutional Protocol Guideline for Laparoscopy-Assisted Distal Gastrectomy

  • Gastrointestinal tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The technical difficulty of lymph node dissection in laparoscopy-assisted distal gastrectomy (LADG) remains a barrier for extending the indication for this modality and limits its widespread clinical practice. The aim of this study was to evaluate our institutional guidelines for LADG, limiting the indications for this modality to only clinical stage T1N0 or T1N1 gastric cancer.

Methods

From January 2002 to October 2006, a total of 294 cases of LADG and 664 cases of open distal gastrectomy (ODG) for clinical T1N0 or T1N1 gastric cancer were performed at the National Cancer Center, Korea. The two groups’ clinicopathologic characteristics, surgical outcome, morbidity, and survival were compared.

Results

The mean operating time for the LADG group was significantly longer than that for the ODG group (265.8 ± 56.3 vs. 171.4 ± 43.1 minutes, P < .001). The mean number of retrieved lymph nodes in the LADG group was higher than that of the ODG group (39.5 ± 14.7 vs. 37.2 ± 12.9, P = .017). The postoperative hospital stay was shorter in the LADG group (8.0 ± 3.3 vs. 10.5 ± 4.1 days, P < .001). The complications rate was lower for the LADG group than that for the ODG group (6.8% vs. 11.3%, P = .032). The overall survival rate was not significantly different between the two groups (P = .880).

Conclusions

Before considering expanding the indications for LADG, developing a carefully thought-out guideline and conducting an audit are mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.

    Article  PubMed  Google Scholar 

  2. Shin HR, Jung KW, Won YJ. National cancer incidence for the year 2002 in Korea. Cancer Res Treat. 2007;39:139–49.

    Article  PubMed  Google Scholar 

  3. Korean Gastric Cancer. Association. 2004 nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc. 2007;7:47–54.

    Google Scholar 

  4. Lee JH, Kim YW, Ryu KW, et al. A phase-II clinical trial of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients. Ann Surg Oncol. 2007;14:3148–53.

    Article  PubMed  Google Scholar 

  5. Lee SI, Choi YS, Park DJ, et al. Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006;202:874–80.

    Article  PubMed  Google Scholar 

  6. Adachi Y, Suematsu T, Shiraishi N, et al. Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg. 1999;229:49–54.

    Article  PubMed  CAS  Google Scholar 

  7. Goh PM, Alponat A, Mak K, Kum CK. Early international results of laparoscopic gastrectomies. Surg Endosc. 1997;11:650–2.

    Article  PubMed  CAS  Google Scholar 

  8. Kim YW, Bae JM, Lee JH, et al. The role of hand-assisted laparoscopic distal gastrectomy for distal gastric cancer. Surg Endosc. 2005;19:29–33.

    Article  PubMed  CAS  Google Scholar 

  9. Shiraishi N, Adachi Y, Kitano S, et al. Indication for and outcome of laparoscopy-assisted Billroth I gastrectomy. Br J Surg. 1999;86:541–4.

    Article  PubMed  CAS  Google Scholar 

  10. Kim YW, Baik YH, Yun YH, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.

    Article  PubMed  Google Scholar 

  11. Mathew G, Watson DI, Ellis T, et al. The effect of laparoscopy on the movement of tumor cells and metastasis to surgical wounds. Surg Endosc. 1997;11:1163–6.

    Article  PubMed  CAS  Google Scholar 

  12. Lee JH, Ryu KW, Lee JH, et al. Learning curve for total gastrectomy with D2 lymph node dissection: cumulative sum analysis for qualified surgery. Ann Surg Oncol. 2006;13:1175–81.

    Article  PubMed  Google Scholar 

  13. Ryu KW, Lee JH, Choi IJ, Bae JM. Preoperative endoscopic clipping: localizing technique of early gastric cancer. J Surg Oncol. 2003;82:75–7.

    Article  PubMed  Google Scholar 

  14. Lee JH, Ryu KW, Doh YW, et al. Liver lift: a simple suture technique for liver retraction during laparoscopic gastric surgery. J Surg Oncol. 2007;95:83–5.

    Article  PubMed  Google Scholar 

  15. Japanese Gastric Cancer. Association. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1:10–24.

    Article  PubMed  Google Scholar 

  16. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002;5:1–5.

    Article  PubMed  Google Scholar 

  17. Uyama I, Sugioka A, Matsui H, et al. Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach. Gastric Cancer. 2000;3:50–5.

    Article  PubMed  Google Scholar 

  18. Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.

    Article  PubMed  Google Scholar 

  19. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.

    Article  PubMed  CAS  Google Scholar 

  20. Miura S, Kodera Y, Fujiwara M, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. J Am Coll Surg. 2004;198:933–8.

    Article  PubMed  Google Scholar 

  21. Hur J, Park MS, Lee JH, et al. Diagnostic accuracy of multidetector row computed tomography in T- and N staging of gastric cancer with histopathologic correlation. J Comput Assist Tomogr. 2006;30:372–7.

    Article  PubMed  Google Scholar 

  22. Lee JH, Ryu KW, Kook MC, et al. Feasibility of laparoscopic sentinel basin dissection for limited resection in early gastric cancer. J Surg Oncol. 2008;98:331–5.

    Article  PubMed  Google Scholar 

  23. Willis S, Truong S, Gribnitz S, et al. Endoscopic ultrasonography in the preoperative staging of gastric cancer: accuracy and impact on surgical therapy. Surg Endosc. 2000;14:951–4.

    Article  PubMed  CAS  Google Scholar 

  24. Kitano S, Shiraishi N, Fujii K, et al. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:S306–11.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by the National Cancer Center (grant No. 0310060).

Author information

Author notes

  1. Sang Eok Lee MD

    Present address: Department of Surgery, Konyang University Hospital, Daejon, Korea

Authors and Affiliations

  1. Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea

    Sang Eok Lee MD, Young-Woo Kim MD, Jun Ho Lee MD, Keun Won Ryu MD, Soo Jeong Cho MD, Jong Yeul Lee MD, Chan Gyoo Kim MD, Il Ju Choi MD, Myeong-Cherl Kook MD, Sook Ryun Park MD, Min Ju Kim MD & Jong Seok Lee MD

  2. Cancer Biostatistics Branch, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Korea

    Byung-Ho Nam PhD

Authors
  1. Sang Eok Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young-Woo Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jun Ho Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keun Won Ryu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Soo Jeong Cho MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jong Yeul Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chan Gyoo Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Il Ju Choi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Myeong-Cherl Kook MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Byung-Ho Nam PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sook Ryun Park MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Min Ju Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jong Seok Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Young-Woo Kim MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, S.E., Kim, YW., Lee, J.H. et al. Developing an Institutional Protocol Guideline for Laparoscopy-Assisted Distal Gastrectomy. Ann Surg Oncol 16, 2231–2236 (2009). https://doi.org/10.1245/s10434-009-0490-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-009-0490-9

Keywords

Search

Navigation