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Simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach  [cached]
Qian-Lin Zhu, Min-Hua Zheng, Bo Feng, Ai-Guo Lu, Min-Liang Wang, Jian-Wen Li, Wei-Guo Hu, Lu Zang, Zhi-Hai Mao, Feng Dong, Jun-Jun Ma, Ya-Ping Zong
World Journal of Gastroenterology , 2008,
Abstract: Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity, a shorter treatment time, and similar outcomes. However, simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature. Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort. He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected. The operation time was 270 min and the estimated blood loss was 120 mL. The patient required parenteral analgesia for less than 24 h. Flatus was passed on postoperative day 3, and a solid diet was resumed on postoperative day 7. He was discharged on postoperative day 13. With the advances in laparoscopic technology and experience, simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.
Port site herniation of the small bowel following laparoscopy-assisted distal gastrectomy: a case report
Tsuyoshi Itoh, Nobuaki Fuji, Hiroki Taniguchi, Taiji Watanabe, Toshiyuki Kosuga, Kingo Kashimoto, Kazuyo Naito
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-48
Abstract: We herein report the only case of a port site hernia among a series 52 consecutive cases of laparoscopy-assisted distal gastrectomy (LADG) carried out by our unit between July 2002 and March 2007. In this case the small bowel herniated and incarcerated through the port site on day 4 after LADG despite closure of the fascia. Initial manifestations experienced by the patient, possibly due to obstruction, and including mild abdominal pain and nausea, occurred on the third day postoperatively. The definitive diagnosis was made on day 4 based on symptoms related to leakage from the duodenal stump, which was considered to have developed after severe obstruction of the bowel. Re-operation for reduction of the incarcerated bowel and tube duodenostomy with peritoneal drainage were required to manage this complication.We present this case report and review of literature to discuss further regarding methods of fascial closure after laparoscopic surgery.Bowel herniation through the fascial defect created by the entry of trocars is now recognized as a rare but potentially serious complication of laparoscopic surgery [1]. Although port site herniation is an infrequent complication, there are still some reports of port site herniation after these procedures, even with closure of trocar sites[1,2]. The following report describes a case of a trocar site hernia that evolved into leakage from the duodenal stump after laparoscopy-assisted distal gastrectomy (LADG). Progression occurred because of complete obstruction of the incarcerated bowel after a Roux-en-Y reconstruction. We describe the significance of complete closure of the fascial defect at the trocar site including the peritoneum in the prevention of this condition, as well as the importance of early diagnosis to avoid serious subsequent events.An 80-year-old man was found to have early gastric cancer during his yearly check-up by gastrointestinal endoscopy. He was 158 cm in height and weighed 62 kg. Gastrointestinal endoscopy
The Requirements for Laparoscopy-Assisted Distal Gastrectomy to Become Standard Procedure for Gastric Cancer: Based on Qualitative Study of Surgeons’ Experiences  [PDF]
Nozomu Murakami, Kouichi Tanabe, Shinichi Kadoya, Masanari Shimada, Katsuo Shimada, Masahide Kaji, Mitsuaki Sakatoku, Koichiro Sawada, Hatsuna Yasuda, Tatsuhiko Kashii
Surgical Science (SS) , 2014, DOI: 10.4236/ss.2014.54031
Abstract: Laparoscopy-assisted distal gastrectomy (LADG) has become one of the standard surgical procedures for gastric cancer in Japan and Korea. However, LADG is currently listed as being in the clinical research phase under the Gastric Cancer Treatment Guidelines. The aim of this study is to report surgeons’ opinions of what is needed if LADG is to become a standard procedure. We conducted questionnaire survey with open questions in hospitals that either applied or did not apply LADG and compared the answers. We labeled and categorized the collected data using content analysis. The number of hospitals which applied LADG more than doubled from 5 to 12 hospitals over 3 years. Overall, hospitals reported that the necessary elements for LADG to become a standard procedure are: clinical trials of LADG (n = 5, 22.7%), surgeons’ practical experience in performing LADG (n = 4, 18.2%), stability of radical treatment (n = 4, 18.2%), and a shorter operative duration (n = 3, 13.6%) for the procedure. Surgeons’ practical experience was chosen as the most important requirement in the hospitals which applied LADG while clinical trials (n = 2, 40.0%) and stability of radical treatment (n = 2, 40.0%) were the most common answers in the hospitals which did not apply LADG. Hospitals and surgeons’ practical experience, stabilizing radical cure, and the large scale of clinical trials are for LADG to become a standard procedure and to gain equivalent importance as open distal gastrectomy in treating gastric cancer.
Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report  [PDF]
Kazuhito Yajima,Tatsuo Kanda,Ryo Tanaka,Yu Sato,Takashi Ishikawa,Shin-ichi Kosugi,Tadayuki Honda,Katsuyoshi Hatakeyama
Case Reports in Surgery , 2012, DOI: 10.1155/2012/863163
Abstract: We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum. 1. Introduction Due to advances in instruments and surgical techniques, laparoscopic surgery has been widely used in recent years for the treatment of early gastric cancer [1]. The many advantages of laparoscopic gastrectomy, including reduced surgical invasiveness, less postoperative pain, better cosmetic outcomes, and faster recovery after surgery, are well documented [2, 3]. Although surgical stress and tissue damage are minimized by laparoscopic techniques, laparoscopic surgery is associated with the risk of serious adverse events that are laparoscopic specific. These complications are mainly a result of prolonged pneumoperitoneum with concomitant high intraabdominal pressure. Reexpansion pulmonary edema (RPE) is a potentially life-threatening complication. Morbidity is caused by the rapid reexpansion of collapsed lungs, a process associated with the treatment of pleural effusion, pneumothorax, and single-lung ventilation. We herein report a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG) associated with unintended single-lung ventilation. 2. Case Report A 57-year-old Japanese woman (body height: 146?cm; body weight: 54.3?kg; body mass index: 25.3?kg/m2) was diagnosed with early adenocarcinoma of the middle third of the stomach. She had no history of smoking, lung disease, or heart disease. Preoperative laboratory data were normal. Respiratory function tests showed that her vital capacity was 2160?mL, and forced
Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report
Kazuhito Yajima,Tatsuo Kanda,Ryo Tanaka,Yu Sato,Takashi Ishikawa,Shin-ichi Kosugi,Tadayuki Honda,Katsuyoshi Hatakeyama
Case Reports in Surgery , 2012, DOI: 10.1155/2012/863163
Abstract: We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.
Estimation of Physiologic Ability and Surgical Stress Scoring System Appraises Laparoscopy-Assisted and Open Distal Gastrectomy in Treatment of Early Gastric Cancer  [PDF]
Hideki Bou, Hideyuki Suzuki, Kentaro Maejima, Hidetsugu Hanawa, Masanori Watanabe, Eiji Uchida
Journal of Cancer Therapy (JCT) , 2013, DOI: 10.4236/jct.2013.49A1001
Abstract:

Laparoscopy-assisted distal 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.

Open Distal Gastrectomy versus Laparoscopic Distal Gastrectomy: As Influenced by Facility Background Factors in the Real World  [PDF]
Nozomu Murakami, Shinichi Kadoya, Masanari Shimada, Naoki Endo, Kaname Ishiguro, Koichiro Sawada, Kouichi Tanabe, Hatsuna Yasuda, Noriyuki Inaki, Tetsuji Yamada, Eiji Kanehira, Tatsuhiko Kashii
Surgical Science (SS) , 2014, DOI: 10.4236/ss.2014.53019
Abstract:

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.

高龄患者腹腔镜下远端胃癌根治术的安全性分析
Analysis of safety of laparoscopy-assisted distal gastrectomy on elderly patients
 [PDF]

钱昌林,刘骅,张捷,
QIAN Chang-lin
, LIU Hua, ZHANG Jie, et al

- , 2015, DOI: 10.3969/j.issn.1674-8115.2015.12.029
Abstract: 目的 评价高龄患者(≥70岁)腹腔镜远端胃癌根治术的安全性。方法 采用前瞻性队列研究方法,选取100例择期高龄胃恶性肿瘤手术患者,随机分为腹腔镜组(n=50)和开腹组(n=50)。比较两组患者手术时间、术中出血量、术后首次排气时间、住院天数、并发症(吻合口漏、术后心肺相关并发症)、外周血白细胞计数及C反应蛋白的差异。 结果 腹腔镜组与开腹组手术时间无明显差异(P=0.086),两组术中出血量(P=0.016)、术后首次排气时间(P=0.000)、住院天数(P=0.000)的差异有统计学意义。吻合口漏腹腔镜组为2例,开腹组3例;术后心肺相关并发症腹腔镜组为6例,开腹组5例。术后1、3、7 d腹腔镜组的C反应蛋白、白细胞计数与开腹组均有明显差异(P=0.000)。结论 与开腹远端胃癌根治术相比,为高龄患者实施腹腔镜远端胃癌根治术安全可行,在术中出血、术后首次排气时间、住院时间、术后炎症因子指标方面较传统术式更有优势。
: Objective To evaluate the safety of laparoscopy-assisted distal gastrectomy on elderly patients (≥70 years old). Methods The prospective cohort study was adopted. A total of 100 elderly patients with malignant gastric cancer were selected and randomly divided into laparoscopy group (n=50) and open surgery group (n=50). The operation time, intra-operative blood loss, post-operative flatus time, hospital stay, complications (anastomotic leakage and post-operative cardiopulmonary complications), peripheral blood leukocyte count, and C reactive protein of two groups were compared. Results The difference of operation time of two groups was not significant (P=0.086), while the differences of intra-operative blood loss (P=0.016), post-operative flatus time (P=0.000), and hospital stay (P=0.000) of two groups were statistically significant. For laparoscopy group, there were 2 cases of anastomotic leakage and 6 cases of cardiopulmonary complications. For open surgery group, there were 3 cases of anastomotic leakage and 5 cases of cardiopulmonary complications. The differences of C reactive protein and leukocyte of two groups 1, 3, and 7 d after surgery were significant (P=0.000). Conclusion Laparoscopy-assisted distal gastrectomy is more safe and feasible than open surgery for the treatment of elderly patients with distal gastric cancer in terms of intra-operative blood loss, postoperative flatus time, post-operative hospital stay, and post-operative inflammatory factors
Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer without serosal invasion: a case control study  [cached]
Chen Qi-Yue,Huang Chang-Ming,Lin Jian-Xian,Zheng Chao-Hui
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-248
Abstract: Background The application of laparoscopic surgery for advanced gastric cancer (AGC) remains questionable on account of technical difficulty of D2 lymphadenectomy, and there has been few large-scale follow-up results regarding the oncological adequacy of laparoscopic surgery compared with that of open surgeries for AGC. The aim of this study is to evaluate technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer without serosal invasion. Methods From January 2008 to December 2012, 1114 patients with gastric cancer underwent D2 gastrectomy, including 336 T2 and T3 patients in term of depth of invasion. Of all 336 patients, 224 underwent LAG, while open gastrectomy (OG) performed on the other 112 patients. The comparison was based on the clinicopathologic characteristics, surgical outcome, and follow-up results. Results There are not significant differences in clinicopathological characteristics between the two groups (P > 0.05). The operation time and first ambulation time was similar in the two groups. However, estimated blood loss, bowel function recovery time and duration of hospital stay were significantly less in the LAG group. No significant difference in morbidity and mortality was found between the LAG group and OG group (11.1% vs. 15.3%, P = 0.266; 0.9% vs. 1.8%, P = 0.859). The mean number of resected lymph nodes (LNS) between the LAG group and OG group was similar (30.6 ± 10.1 vs. 30.3 ± 8.6, P = 0.786). Furthermore, the mean number of removed LNS in each station was not significantly different in the distal gastrectomy and total gastrectomy (P > 0.05). No statistical difference was seen in 1 year survival rate (91.5% vs. 89.8% P > 0.05) and the survival curve after surgery between the LAG group and OG group. Conclusion Laparoscopy-assisted D2 radical gastrectomy is feasible, effective and has comparative oncological efficacy compared with open gastrectomy for advanced gastric cancer without serosal invasion.
Safety and Efficacy of Laparoscopy-Assisted Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Retrospective Report  [PDF]
Takahisa Suzuki, Kazuaki Tanabe, Dang Thuc Anh Vu, Toshihiro Misumi, Nobuaki Fujikuni, Noriaki Tokumoto, Hideki Ohdan
Journal of Cancer Therapy (JCT) , 2013, DOI: 10.4236/jct.2013.41A008
Abstract:

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.

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