A prospective feasibility and safety study of laparoscopy-assisted distal gastrectomy for clinical stage I gastric cancer initiated by surgeons with much experience of open gastrectomy and laparoscopic surgery

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• 作者：Takaki Yoshikawa (1)
  Haruhiko Cho (1)
  Yasushi Rino (2)
  Yuji Yamamoto (3)
  Masayuki Kimura (4)
  Tetsu Fukunaga (4)
  Shinichi Hasegawa (1)
  Takanobu Yamada (1)
  Toru Aoyama (1)
  Akira Tsuburaya (1)
  
• 关键词：Laparoscopy ; Gastrectomy ; Prospective study ; Gastric cancer
• 刊名：Gastric Cancer
• 出版年：2013
• 出版时间：April 2013
• 年：2013
• 卷：16
• 期：2
• 页码：126-132
• 全文大小：172 KB
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  2. Fujiwara M, Kodera Y, Kasai Y, Kanyama Y, Hibi K, Ito K, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: a review of 43 cases. J Am Coll Surg. 2003;196:75-1. CrossRef
  3. Sakuramoto S, Kikuchi S, Kuroyama S, Futawatari N, Katada N, Kobayashi N, et al. Laparoscopy-assisted distal gastrectomy for early gastric cancer: experience with 111 consecutive patients. Surg Endosc. 2006;20:55-0. CrossRef
  4. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:S306-1. CrossRef
  5. Kim MC, Kim KH, Kim HH, Jung GJ. Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol. 2005;91:90-. CrossRef
  6. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, 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-. CrossRef
  7. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245:68-2. CrossRef
  8. Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. 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. 2010;13:238-4. CrossRef
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  13. Naka T, Ishikura T, Shibata S, Yamaguchi Y, Ishiguro M, Yurugi E, et al. Laparoscopy-assisted and open distal gastrectomies for early gastric cancer at a general hospital in Japan. Hepatogastroenterology. 2005;52:293-.
  14. Sasako M, Katai H, Sano T, Maruyama K. Management of complications after gastrectomy with extended lymphadenectomy. Surg Oncol 2000;9(1):31-.
  15. Dulucq JL, Wintringer P, Stabilini C, Solinas L, Perissat J, Mahajna A. Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study. Surg Endosc. 2005;19:933-. CrossRef
  16. Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol. 2005;11:7508-1.
  17. Kunisaki C, Makino H, Yamamoto N, Sato T, Oshima T, Nagano Y, et al. Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer. Surg Laparosc Endosc Percutan Tech. 2008;18:236-1. CrossRef
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• 作者单位：Takaki Yoshikawa (1)
  Haruhiko Cho (1)
  Yasushi Rino (2)
  Yuji Yamamoto (3)
  Masayuki Kimura (4)
  Tetsu Fukunaga (4)
  Shinichi Hasegawa (1)
  Takanobu Yamada (1)
  Toru Aoyama (1)
  Akira Tsuburaya (1)
  
  1. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-ku, Yokohama, 241-0815, Japan
  2. Department of Surgery, Yokohama City University, Yokohama, Japan
  3. Department of Surgery, Kanagawa Ashigawa Kami Hospital, Kanagawa, Japan
  4. Department of Gastrointestinal Surgery, St Marianna University, Kawasaki, Japan
  
• ISSN：1436-3305

文摘

Background The aim of this prospective study was to evaluate the feasibility and safety of laparoscopy-assisted distal gastrectomy (LADG) initiated by surgeons with much experience of open gastrectomy and laparoscopic surgery. Methods Three surgeons who each had experience with more than 300 cases of open gastrectomy, more than 100 cases of laparoscopic cholecystectomy, more than 5 cases of laparoscopic colectomy, and more than 5 cases of laparoscopic partial gastrectomy were nominated as LADG operators. All three operators received training for LADG with study materials including videotapes, a box simulator, and an animal laboratory, with lectures and assistance from LADG instructors who each had experience of more than 50 LADG operations. Then the nominated LADG operators performed LADG with the instructors, in which their skills were evaluated and certified. Thereafter, they performed LADG without assistance from the instructors. The target of this study was clinical stage I gastric cancer that was resectable by distal gastrectomy. D1?+?alpha, D1?+?beta, or D2 dissection was performed laparoscopically. Basically reconstruction was done extracorporeally with a Billroth-I gastroduodenostomy. An extramural review board checked the surgical quality of the operations performed by the three surgeons. The primary endpoint was morbidity and mortality. Results A total of 193 patients were enrolled in this study between August 2004 and July 2009. The median blood loss was 35?ml and the median operation time was 250?min. Conversion to open surgery was seen in 6 patients; 4 due to bleeding and 2 due to advanced disease. Overall morbidity was 1.6?%, including grade 2 anastomotic leakage in 0.5?% and grade 2 pancreatic fistula in 0.5?%. No mortality was observed. The number of cases required until the LADG operators acted as LADG surgeons without an instructor was 3 for each of the three surgeons. When comparing the data between that in the training period (n?=?9) and the operators-data (n?=?174), the median operation time was significantly longer in the training period (355?min) than in the latter period (247.5?min) (p?=?0.015). Median blood loss was also greater in the training period (150?ml) than the latter period (32.5?ml), but the difference did not reach statistical significance (p?=?0.084). During the training period, no patient developed any complications of ≥grade 2. Conclusion These results suggested that LADG could be initiated and performed feasibly and safely if surgeons with much experience of open gastrectomy and laparoscopic surgery received adequate training for LADG.