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2007 Program and Abstracts | 2007 Posters
Laparoscopy-Assited Distal Gastrectomy for Gastric Cancer
Teruo Kiyama*1, Takeshi Okuda1, Itsuro Fujita1, Toshiro Yoshiyuki1, Takashi Mizutani1, Hitoshi Kanno1, Aya Tani1, Shunji Kato1, Takashi Tajiri1, Adrian Barbul2
1Surgery, Nippon Medical School, Tokyo, Japan; 2Surgery, Johns Hopkins University, Baltimore, MD

The purpose of this study was to evaluate the safety and value of laparoscopy-assisted distal gastrectomy (LADG) for early stage gastric cancer (stage I and II). We studied retrospectively 101 cases of LADG and compared them to 49 contemporaneous cases treated by open distal gastrectomy (DG) at the Nippon Medical School Hospital between February 2001 and October 2006. Clinical variables such as tumor diameter (Tumor), mean operating time (OR time), mean blood loss (MBL), number of lymph nodes resected (LN) or length of stay (LOS) were investigated. Pathologically there more tumors in stage IA in the LADG group (84% vs. 38%), while tumors in stage IB (10% vs. 27%) and stage II (6% vs. 35%) were more frequent in the DG group. Tumor size was significantly smaller in the LADG group. Although operating times were similar, the mean blood loss was significantly higher in the DG group. Less lymph nodes were harvested in the LADG group. The hospital stay was longer in the DG group. The reconstruction methods were 44 cases in Billroth I, 20 cases in Billroth II, and 37 cases in Roux-en-Y anastomosis among the LADG group and 25 cases in Billroth I, 19 cases in Billroth II, and 5 cases in Roux-en-Y anastomosis among the DG group. There were 12 simultaneous operations of the LADG group, including 9 cholecystectomies, 2 inguinal hernias, and 1 colectomy and 8 simultaneous operations of the DG group, including 6 cholecystectomies and 2 colectomies. There was no mortality. Postoperative surgical complications occurred in 6 cases (6%) of the LADG group and consisted of anastomotic bleedings in 3 patients, wound infection in 1 patient, Roux-en-Y stasis in 1 patient, and anastomotic leakage in 1 patient. In the DG group surgical complications occurred in 4 cases (8%) and consisted of anastomotic stenosis in 1 patient, wound infection in 1 patient, cholangitis in 1 patient, and anastomotic leakage in 1 patient,.The authors conclude that laparoscopy-assisted distal gastrectomy is a safe and useful operation for early-stage gastric cancers. If patients are selected properly, laparoscopy-assisted distal gastrectomy can be a curative and minimally invasive treatment for gastric cancer.

Tumor φ(mm) OR time (mins) MBL (ml) #LN LOS (days)
LADG 22.0±13.9 278±57 139±181 27±14 13.3±8.5
DG 42.6±22.2 268±55 460±301 34±19 16.7±10.6
p <0.0001 NS <0.0001 0.011 0.034

2007 Program and Abstracts | 2007 Posters
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