Comparison of the Nutritional Status and the Acute Inflammatory Reaction between Laparoscopy-assisted Distal Gastrectomy and Conventional Open Distal Gastrectomy for Early Gastric Cancer

PURPOSE: Laparoscopy-assisted gastrectomy (LAG) is gaining wider acceptance as a minimally invasive treatment for early gastric cancer, but the safety, efficacy and clinical benefits of this type of surgery are still unclear. The purpose of this study is to compare laparoscopy-assisted gastrectomy (LADG) and conventional open distal gastrectomy (CODG) for early gastric cancer (EGC) according to the changes of the postoperative nutritional status and acute inflammatory reaction. MATERIALS AND METHODS: Eighty seven patients with EGC and who underwent a LADG between March 2006 and May 2009 at Daegu Catholic University Hospital, was enrolled. Over the same period, we enrolled 30 patients who underwent CODG and they were confirmed to have EGC from their pathology. The clinico-pathological features and serologic parameters were evaluated from the medical records and then retrospectively analyzed. RESULTS: There were no differences in the preoperative white blood cell (WBC), C-reactive protein (CRP) level, albumin level, the T4/T8 ratio and the other clinical data between the two groups. The total WBC counts gradually increased and they were significant lower at the 1st and 3rd postoperative days in the LADG group than that in the CODG group (P=0.001 and 0.008, respectively). The postoperative CRP levels were significantly lower at postoperative 5th day in the LADG group (P<0.001). The postoperative albumin and T4/T8 ratio gradually decreased, and the T4/T8 ratio was significantly higher at the 3rd postoperative day in the LADG group compared to that in the CODG group (P=0.003). CONCLUSION: This study demonstrates that the LADG has less of an influence on an acute inflammatory reaction than does CODG. Therefore, it is one of the safe and feasible procedures for the treatment of early gastric cancer.

The Effects of Obesity on Laparoscopy-Assisted Distal Gastrectomy and Conventional Open Gastrectomy in Patients with Early Gastric Cancer

PURPOSE: The aim of this study was to assess the short-term results of conventional open distal gastrectomy (ODG) and laparoscopy-assisted distal gastrectomy (LADG) in obese patients with early gastric cancer. METHODS: This study included 28 consecutive patients who underwent LADG and 33 patients who underwent ODG for early gastric cancer. The patients were divided into two groups: obese (body mass index, BMI> or =25) and non-obese (BMI<25). Patient characteristics, operative details, and postoperative outcomes were analyzed and compared between the two groups. RESULTS: The operation time was longer in LADG patients than in ODG patients. In the LADG group, the high BMI subset required significantly longer operative time than the low BMI subset. The number of retrieved lymph nodes, average perioperative hemoglobin concentration, serum albumin, first flatus, and postoperative WBC count were similar between the two groups. Regarding ODG patients, the mean perioperative decrease in hemoglobin concentration was significantly greater in the high BMI subset. The difference in operative time between the ODG/high BMI subset and the ODG/low BMI subset was not statistically significant. CONCLUSION: Obesity has differing effects on LADG and on ODG, and this should be considered when deciding what procedure to utilize in patients with early gastric cancer. Further research is needed to better elucidate the relationship between obesity and gastrectomy for early gastric cancer.