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Background: Although laparoscopic gastrectomy has been in use for many years, there was great debate for its technical feasibility and oncological safety. However, with recent advancements of laparoscopic surgical instruments and the accumulation of operative experience, laparoscopic gastrectomy becomes more feasible, and laparoscopic D2 lymphadenectomy has been achieved. Methods: This study was prospectively conducted from April 2016 to September 2018 on 40 patients presenting with distal gastric cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study performed radical distal gastrectomy with D2 lymphadenectomy aiming for cure. The patients were divided into 2 groups: group A (20 patients operated upon with open gastrectomy (OG) technique) and group B (20 patients operated upon with the laparoscopic gastrectomy (LG) technique). Both groups were compared in this study regarding operative details, short term post-operative complications and pathological results.Results: The mean operative time in OG was shorter than LG (p value: 0.04), while there was significant difference between both groups regarding blood loss, mean blood loss in OG was 420.8±87.6 ml and in LG was 283.4±45.9ml, parenteral analgesic requirement was significantly less in LG than OG (p value: 0.04) while no significant difference regarding Intra-operative complications and pathological results.Conclusions: Assisted Laparoscopic distal gastrectomy with D2 lymphadenectomy is feasible and safe with less post-operative pain and short hospital stay.
RESUMO
PURPOSE: There has been increased the number of early gastric cancer and laparoscopy-assisted gastrectomy (LAG), due to early detection through mass screening program. We started the LAG in April 2004 and performed 119 cases of gastric cancer in 2005, so we report a surgical outcome compared with that of open gastrectomy (OG). MATERIALS AND METHODS: 119 patients underwent LAG in 2005, and for open group, 126 patiens of early gastric cancer were selected sequentially from January 2005 to March 2005. We compared clinicopathologic characteristics, postoperative courses and complications between two groups. RESULTS: There was no significant difference between age, a length of hospital stay, distal resection margin and a number of retrived lymph nodes. The operation time was longer in LAG group (239.2 vs 123.3 mins, P < 0.001) and a diet progression was faster in LAG group (first flatus: 3.05 vs 3.70 days, SOW: 2.86 vs 3.22 days, liquid diet: 3.87 vs 4.19 days ,soft diet: 4.84 vs 5.26 days, P < 0.001). But there was no difference statistically in postoperative discharge date (7.73 vs 8.25 days, P=0.229). The additional requirement of analgesic injection was less frequent in LAG group (2.97 vs 4.92 times, P < 0.001). The harvested lymph nodes were similar in both groups (23.9 vs 23.1, P=0.563). A complication rate was lower in LAG group (4.9% vs 9.5%), but there was no statistical significance (P=0.179). There was no mortality in both groups and no conversion to open gastrectomy in the LAG group. CONCLUSION: LAG can be performed safely and accepted in view of curative procedure in treatment of early gastric cancer. But we need the follow up of long-term period to evaluate the survival rate and recurrence, and a prospective randomized controlled study should be done to establish that LAG will be a standard operation for early gastric cancer.