SS  Vol.5 No.3 , March 2014
Open Distal Gastrectomy versus Laparoscopic Distal Gastrectomy: As Influenced by Facility Background Factors in the Real World
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.
Cite this paper: Murakami, N. , Kadoya, S. , Shimada, M. , Endo, N. , Ishiguro, K. , Sawada, K. , Tanabe, K. , Yasuda, H. , Inaki, N. , Yamada, T. , Kanehira, E. and Kashii, T. (2014) Open Distal Gastrectomy versus Laparoscopic Distal Gastrectomy: As Influenced by Facility Background Factors in the Real World. Surgical Science, 5, 97-104. doi: 10.4236/ss.2014.53019.

[1]   Kitano, S., Iso, Y., Moriyama, M. and Sugimachi, K. (1994) Laparoscopy-Assisted Billroth I Gastrectomy. Surgical Laparoscopy, Endoscopy, 4, 146-148.

[2]   Shiraishi, N., Adachi, Y., Kitano, S., Bandoh, T., Katsuta, T. and Morimoto, A. (1999) Indication for and Outcome of Laparoscopy-Assisted Billroth I Gastrectomy. British Journal of Surgery, 86, 541-544.

[3]   Kitano, S., Adachi, Y., Shiraishi, N., Suematsu, T. and Bando, T. (1999) Laparoscopic-Assisted Proximal Gastrectomy for Early Gastric Carcinomas. Surgery Today, 29, 389-391. BF02483072

[4]   Shiraishi, N., Yasuda, K. and Kitano, S. (2006) Laparoscopic Gastrectomy with Lymph Node Dissection for Gastric Cancer. Gastric Cancer, 9, 167-176.

[5]   Etoh, T., Shiraishi, N. and Kitano, S. (2009) Current Trends of Laparoscopic Gastrectomy for Gastric Cancer in Japan. Asian Journal of Endoscopic Surgery, 2, 18-23.

[6]   Yacoub, D., Athanasiou, T., Tekkis, P. and Hanna, G.B. (2009) Laparoscopic Assisted Distal Gastrectomy for Early Gastric Cancer: Is It an Alternative to the Open Approach? Surgical Oncology, 18, 322-333.

[7]   Katai, H., Sasako, M., Fukuda, H., Nakamura, K., Hiki, N., Saka, M., Yamaue, H., Yoshikawa, T., Kojima, K. and JCOG Gastric Cancer Surgical Study Group (2010) Safety and Feasibility of Laparoscopy-Assisted Distal Gastrectomy with Suprapancreatic Nodal Dissection for Clinical Stage I Gastric Cancer: A Multicenter Phase II Trial (JCOG 0703). Gastric Cancer, 13, 238-244. s10120-010-0565-0

[8]   Adachi, Y., Shiraishi, N., Shiromizu, A., Bandoh, T., Aramaki, M. and Kitano, S. (2000) Laparoscopy-Assisted Billroth I Gastrectomy Compared with Conventional Open Gastrectomy. Archives of Surgery, 135, 806-810.

[9]   Lee, S.E., Kim, Y.W., Lee, J.H., Ryu, K.W., Cho, S.J., Lee, J.Y., Kim, C.G., Choi, J.I., Kook, M.C., Nam, B.H., Park, S.R., Kim, M.J. and Lee, J.S. (2009) Developing and Institutional Protocol Guideline for Laparoscopy-Assisted Distal Gastrectomy. Annals of Surgical Oncology, 16, 2231-2236.

[10]   Japanese Gastric Cancer Association (1999) Japanese Classification of Gastric Carcinoma. 13th Edition.

[11]   Donohue, J.H. (2003) Distal Gastrectomy. Operative Techniques in General Surgery, 5, 3-13.

[12]   Kitano, S., Shiraishi, N., Kakisako, K., Yasuda, K., Inomata, M. and Adachi, Y. (2002) Laparoscopy-Assisted Billroth-I Gastrectomy (LADG) for Cancer: Our 10 Years’ Experience. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 12, 204-207. 17663.43677.6E

[13]   Ahn, C.W., Hur, H., Han, S.U. and Cho, Y.K. (2013) Comparison of Intracorporeal Reconstruction after Laparoscopic Distal Gastrectomy with Extracorporeal Reconstruction in the View of Learning Curve. Journal of Gastric Cancer, 13, 34-43.

[14]   Hosoya, Y., Lefor, A., Hyodo, M., Zuiki, T., Haruta, H., Kurashina, K., Saito, S. and Yasuda, Y. (2009) Gasless Laparoscopic Distal Gastrectomy with Roux-en-Y reconstruction. Hepato-Gastroenterology, 56, 1571-1575.

[15]   Schweizer, W., Blunschi, T., Gertsch, P. and Blumgart, L.H. (1990) Postoperative Course Following Stomach Resection: A Comparison of Billroth I, Billroth II and Roux-en-Y resection-reconstruction. Swhweiz Med Wochenschr, 120, 521-528.

[16]   Nunobe, S., Okaro, A., Sasako, M., Saka, M., Fukagawa, T., Katai, H. and Sano, T. (2007) Billroth I versus Roux-en Y Reconstructions: A Quality of Life Survey at 5 Years. International Journal of Clinical Oncology, 12, 433-439.

[17]   Ishikawa, M., Kitayama, J., Kaizaki, S., Nakayama, H., Ishigami, H., Fujii, S., Suzuki, H., Inoue, T., Sako, A., Asakage, M., Yamashita, H., Hatono, K. and Nagawa, H. (2005) Prospective Randomized Trial Comparing Billroth I and Roux-en-Y Procedures after Distal Gastrectomy for Gastric Carcinoma. World Journal of Surgery, 29, 1415-1420.

[18]   Kojima, K., Yamada, H., Inokuchi, M., Kawano, T. and Sugihara, K. (2008) A Comparison of Roux-en Y and Billroth-I Reconstruction after Laparoscopy-Assisted Distal Gastrectomy. Annals of Surgery, 247, 962-967.

[19]   Fukunaga, T., Kidokoro, A., Fukunaga, M., Iba, T., Fuse, S., Nagakari, K., Suda, M. and Yoshikawa, S. (2003) Clipless D2 Laparoscopy-Assisted Distal Gastrectomy: Experience with LigaSure AtlasTM. Asian Journal of Endoscopic Surgery, 8, 267-271.

[20]   Fukunaga, T., Kidokoro, A., Fukunaga, M., Nagakari, K., Suda, M., Yoshikawa, S. and Ogasawara, T. (2003) Application LigaSureTM in Laparoscopy-Assisted Gastrectomy with Lymph Node Dissection. Asian Journal of Endoscopic Surgery, 8, 391-396.

[21]   Kim, M.C., Kim, K.H., Kim, H.H. and Jung, G.J. (2005) Comparison of Laparoscopy-Assisted by Conventional Open Distal Gastrectomy and Extraperigastric Lymph Node Dissection in Early Gastric Cancer. Journal of Surgical Oncology, 91, 90-94.

[22]   Ministry of Health, Labour and Welfare, Medical Support Division Department of Insurance (2012) Outline of Revision for Remuneration for Medical Care. hoken15/dl/gaiyou.pdf

[23]   Yasunaga, H., Ide, H., Imamura, T. and Ohe, K. (2005) Impact of the Japanese Diagnosis Procedure Combination-Based Payment System on Cardiovascular Medicine-Relate Costs. International Heart Journal, 46, 855-866.

[24]   Zhao, Y., Yu, P., Hao, Y., Qian, F., Tang, B., Shi, Y., Luo, H. and Zhang, Y. (2011) Comparison of Outcomes for Laparoscopically Assisted and Open Radical Gastrectomy with Lymphadenectomy for Advanced Gastric Cancer. Surgical Endoscopy, 25, 2960-2966.

[25]   Martinez-Ramos, D., Miralles-Tena, J.M., Cuesta, M.A., Escrig-Sos, J., Van der Peet, D., Hoashi, J.S. and Salvador-Sanchís, J.L. (2011) Laparoscopy versus Open Surgery for Advanced and Resectable Gastric Cancer: A Meta-Analysis. Revista Espanola de Enfermedades Digestivas, 103, 133-141.