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Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience

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World Journal of Gastroenterology 2017年第48期23卷 8553-8561页

作者： Chung Sik Gong Byung Sik Kim Hee Sung Kim department of gastric surgery asan medical centeruniversity of ulsan college of medicine

AIM To evaluate the safety and efficacy of totally laparoscopic total gastrectomy(TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy(LATG) using a circular stapler in gastric cancer *** We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and *** The TLTG group had higher mean ages at the time of operation(57.78 ± 11.20 years and 55.69 ± 11.96 years,P = 0.020) and more histories of abdominal surgery(20.2% and 12.4%,P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions,combined operations,pain scores and administration of analgesics,and complications were similar between the two groups. However,compared with the LATG group,the TLTG group required a shorter operation time(149 min vs 170 min,P < 0.001),had lower postoperative hematocrit change(3.49% vs 4.04%,P = 0.002),less intraoperative events(3.1% vs 10.2%,P < 0.001),less intraoperative anastomosis events(2.4% vs 7.1%,P = 0.003),faster postoperative recovery such as median time to first flatus(3.30 d vs 3.60 d,P < 0.001),faster median commencement of soft diet(4.30 d vs 4.60 d,P < 0.001) and shorter length of postoperative hospital stay(6.75 d vs 7.02 d,P = 0.005). CONCLUSION The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore,TLTG can be recommended as an appropriate procedure for gastric cancer.

关键词： Totally laparoscopic total gastrectomy laparoscopic-assisted total gastrectomy Gastric cancer

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Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis

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World Journal of Clinical Cases 2020年第5期8卷 900-911页

作者： Song Wang Mei-Lan Su Yang Liu Zhi-Ping Huang Ning Guo Tian-Jin Chen Zhong-Hui Zou Department of Stomach/Thyroid/Vascular Surgery Chongqing Three Gorges Central HospitalChongqing 404000China Department of Psychosomatic Medicine Chongqing Three Gorges Central HospitalChongqing 404000China

BACKGROUND laparoscopic radical gastrectomy is currently the most common surgical approach for gastric *** main difference between totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)is the route of digestive tract ***,TLTG is currently not widespread as the safety and feasibility of intracorporeal esophagojejunostomy is *** To compare the short-term efficacy of TLTG and LATG for radical gastrectomy of gastric cancer,and to determine the safety and feasibility of intracorporeal *** PubMed,EMBASE,and Web of Science databases were searched for all relevant articles regarding TLTG vs LATG for gastric cancer published up to October 1,*** and exclusion criteria were *** the basic conditions of patients and important clinical data related to surgery were extracted,and a meta-analysis was performed with RevMan 5.3 *** Eight studies involving a total of 1883 cases(869 cases in the TLTG group and 1014 cases in the LATG group)were *** with the LATG group,reduced intraoperative blood loss(weighted mean difference=-35.37,95%CI:-61.69--9.06,P=0.008)and a larger number of retrieved lymph nodes(weighted mean difference=3.11,95%CI:-2.60-12.00,P=0.01)were found in the TLTG *** were no significant differences in operating time,anastomotic time,tumor size,proximal resection margin length,postoperative pain score,time to first flatus,time to first oral intake,postoperative hospital stay,postoperative anastomosis-related complication rate and overall complication rate between the two groups(P>0.05).CONCLUSION Intracorporeal esophagojejunostomy is safe and *** has the advantages of being minimally invasive,reduced intraoperative blood loss and easier access to lymph nodes compared with *** laparoscopic gastrectomy is likely to be the surgical trend for gastric cancer in the future.

关键词： Gastric cancer Total gastrectomy Esophagojejunostomy Totally laparoscopic laparoscopic-assisted Meta-analysis

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laparoscopic-assisted radical gastrectomy for distal gastric cancer

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Chinese Journal of Cancer Research 2013年第4期25卷 460-462页

作者： Yian Du Xiangdong Cheng Zhiyuan Xu Litao Yang Ling Huang Bing Wang Pengfei Yu Ruizeng Dong Department of Abdominal Surgery Zhejiang Cancer Hospital

A 48-year-old female patient was diagnosed with a superficial depressed type early gastric cancer （type IIc） of 1.0 cm at the gastric angle as indicated by gastroscopy. laparoscopic-assisted greater omentumpreserving D2 radical gastrectomy was performed in combination with Billroth I reconstruction under general anesthesia for the distal gastric cancer on April 5, 2013. The postoperative recovery was satisfying without complications. The patient was discharged seven days after surgery.

关键词： Early gastric cancer gastrectomy laparoscopic-assisted D2 lymph node dissection

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Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for laparoscopic-assisted Distal Gastrectomy

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International Journal of Clinical Medicine 2013年第6期4卷 28-34页

作者： Masashi Takemura Katsuyuki Mayumi Takashi Ikebe Sinya Tanimura Department of Gastrointestinal Surgery Osaka City General Hospital Osaka Japan Department of Surgery Gohshi Hospital Hyogo Japan

Aim: Laparoscopy-assisted distal gastrectomy (LADG) with regional lymph node dissection is a treatment option for patient with early gastric cancer. However, LADG is a technically complex and advanced procedure, which is challenging for inexperienced surgeons. In this report, we retrospectively evaluated the learning curve for LADG of a single surgeon with no previous experience in LADG and the usefulness of direct instruction by a surgeon experienced in LADG in shortening the learning curve. Patients and Methods: This study was analyzed 80 consecutive patients, who underwent LADG by a single surgeon (first assistant in 10 cases and operator in 70 cases) between January 2008 and December 2012. Patients were divided into 3 sequential groups of 10 (training period), 30 (learning period), and 40 (operating period) cases in each group. Median operation time and estimated blood loss for these 3 groups were determined. Other learning indicators, including transfusion requirement, postoperative complications, number of lymph node harvested, and rate of conversion open gastrectomy, were also evaluated. Results: During the training period, median operation time and estimated blood loss were 219.5 min and 83.0 ml, respectively. During the learning period, the operation time was significantly longer than that of training period. In the operating period, the operation time was significantly lesser than that during the learning period. However, the operation time was not different from that during the training period and reached a plateau. The estimated blood loss during the operating period was significantly lesser than that during the learning period. The difference in the number of lymph nodes retrieved between each group was not significant. Conclusions: Direct instructions by an experienced surgeon can decrease the number of cases required for learning. Because LADG is technically more complex than other laparoscopic procedures, standardization of LADG and an effective trai

关键词： laparoscopic-assisted Distal Gastrectomy Learning Training System

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