gastrectomy (LADG) has been widely used to treat early gastric cancer (EGC).
The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring
system predicts the risk of fatal postoperative complications by quantifying
the patient’s reserve and degree of surgical stress, but there have been a few
reports of use of the E-PASS scoring system to assess the risk of mortality
following special types of surgical procedures such as LADG. In this study we
assessed the feasibility of LADG versus open distal gastrectomy (ODG) by the
E-PASS scoring system. The subjects of this study consisted of 69 stage IA
gastric cancer patients who underwent LADG (LADG group) and 69 stage IA gastric
cancer patients who underwent ODG (ODG group). The mean age of the patients in
the LADG group was 68.6 years, which was significantly higher than the mean age
of 63.4 years in the ODG group. There were no statistically significant
differences between the groups in operation time or preoperative risk score,
but there were statistically significant differences in blood loss, surgical
stress score, comprehensive risk score, and duration of postoperative hospital
stay. We conclude that using the E-PASS scoring system, LADG appreciates a more
beneficial procedure for the treatment of EGC than ODG.
The purpose of our study was to retrospectively evaluate the clinical efficacy and safety of laparoscopy assisted distal gastrectomy (LADG) performed by one operating and advising surgeon in patients with gastric cancer over a period of 10 years. We examined the choice of anastomosis techniques, and compared the duration of surgery, blood loss, number of dissected lymph nodes and intraoperative complications for LADG and open distal gastrectomy (ODG). We studied 254 patients who underwent laparoscopic gastrectomy and 36 patients who underwent ODG. 169 of 254 patients received LADG. Duration of surgery was significantly longer for LADG than that for ODG, blood loss was significantly smaller, and numbers of dissected lymph nodes were similar. With LADG, there was anastomotic leakage in 2 patients and postoperative obstruction in 2 patients. No recurrence of disease and no deaths have been reported to date. Though previous clinical trials have shown that LADG is less invasive, our study of LADG in the real world did not show superiority, but rather equivalence to ODG in terms of other outcomes. This study could be advantageous to evaluate the clinical efficacy and safety of LADG without having to take into account multiple surgeons’ technical levels and the background differences between the facilities.
Background: This study aimed to determine the safety and effectiveness of laparoscopy-assisted distal gastrectomy (LADG) after ESD. Methods: We reviewed patients with gastric cancer who underwent distal gastrectomy after non-curative ESD from May 2000 to July 2010, and classified them into LADG-ESD and open distal gastrectomy (ODG) after non-curative ESD (ODG-ESD). In addition, we analyzed the standard LADG (LADG-standard) during the same period. We retrospectively analyzed surgical outcomes and survival in these 3 groups. Pathological results after gastrectomy were compared between the LADG-ESD and ODG-ESD; Results: Sixty-one patients underwent distal gastrectomy after non-curative ESD. No differences in overall survival were found between the LADG-ESD and ODG-ESD. The average duration to surgery after ESD was 42.4 days. Although the average surgical duration and average length of hospital stay after surgery were longer in the LADG-ESD than in the ODG-ESD, number of LN dissections was statistically identical in these 2 groups. Operative complications in the LADG-ESD (16.0%) was higher than that in the LADG-standard (3.8% - 8.2%) but similar to that in the ODG-ESD (13.9%). Conclusion: The present study suggests that LADG contributes to the effectiveness of the treatment of choice for non-curative endoscopic resection.