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01.12.2012 | Research | Ausgabe 1/2012 Open Access

World Journal of Surgical Oncology 1/2012

Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy

Zeitschrift:
World Journal of Surgical Oncology > Ausgabe 1/2012
Autoren:
Sang-Woong Lee, Nobuhiko Tanigawa, Eiji Nomura, Takaya Tokuhara, Masaru Kawai, Kazutake Yokoyama, Masako Hiramatsu, Junji Okuda, Kazuhisa Uchiyama
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1477-7819-10-267) contains supplementary material, which is available to authorized users.

Competing interests

None of the authors have any conflicts of interest or financial ties to disclose.

Authors’ contributions

SL designed and conducted the study, analyzed the data, and helped to write the manuscript. NT helped to design the study, conducted surgical operations, and helped to write the manuscript. EN conducted surgical operations and helped to write the manuscript. TT, MK, KY, MH, and JO helped to design the study and helped to write the manuscript. KU is the principal investigator, and designed the study, assisted in writing, revising and editing the manuscript. All authors approved the final manuscript.

Abstract

Background

Laparoscopic gastrectomy has recently been gaining popularity as a treatment for cancer; however, little is known about the benefits of intracorporeal (IC) gastrointestinal anastomosis with pure laparoscopic distal gastrectomy (LDG) compared with extracorporeal (EC) anastomosis with laparoscopy-assisted distal gastrectomy (LADG).

Methods

Between June 2000 and December 2011, we assessed 449 consecutive patients with early-stage gastric cancer who underwent LDG. The patients were classified into three groups according to the method of reconstruction LADG followed by EC hand-sewn anastomosis (LADG + EC) (n = 73), using any of three anastomosis methods (Billroth-I (B-I), Billroth-II (B-II) or Roux-en-Y (R-Y); LDG followed by IC B-I anastomosis (LDG + B-I) (n = 248); or LDG followed by IC R-Y anastomosis (LDG + R-Y) (n = 128)). The analyzed parameters included patient and tumor characteristics, operation details, and post-operative outcomes.

Results

The tumor location was significantly more proximal in the LDG + R-Y group than in the LDG + B-I group (P < 0.01). Mean operation time, intra-operative blood loss, and the length of post-operative hospital stay were all shortest in the LDG + B-I group (P < 0.05). Regarding post-operative morbidities, anastomosis-related complications occurred significantly less frequently in with the LDG + B-I group than in the LADG + EC group (P < 0.01), whereas there were no differences in the other parameters of patients’ characteristics.

Conclusions

Intracorporeal mechanical anastomosis by either the B-I or R-Y method following LDG has several advantages over at the LADG + EC, including small wound size, reduced invasiveness, and safe anastomosis. Although additional randomized control studies are warranted to confirm these findings, we consider that pure LDG is a useful technique for patients with early gastric cancer.
Zusatzmaterial
Authors’ original file for figure 1
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Authors’ original file for figure 2
12957_2012_1193_MOESM2_ESM.pdf
Authors’ original file for figure 3
12957_2012_1193_MOESM3_ESM.ppt
Authors’ original file for figure 4
12957_2012_1193_MOESM4_ESM.ppt
Literatur
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