NOSE laparoscopic gastrectomies for early gastric cancer may reduce morbidity and hospital stay: early results from a prospective nonrandomized study.

BACKGROUND: Natural orifice specimen extraction - NOSE laparoscopy is a promising technique that avoids mini-laparotomy, possibly reducing postoperative pain, wound infections and hospital stay. Recent systematic reviews have shown that postoperative morbidity associated with laparoscopically assisted gastrectomies is similar to that after open gastrectomies. More specifically, there is no difference in wound infection rate. The study objective was to evaluate whether postoperative morbidity and hospital stay may be reduced by transoral specimen extraction after laparoscopically assisted gastrectomy for early gastric cancer (EGC). MATERIAL AND METHODS: A prospective, nonrandomized study was carried out starting in August 2012. Data from all patients operated on during the first year, with minimum 18 months follow-up, were collected to assess feasibility, oncologic results, postoperative morbidity, hospital stay and functional results. Overall, 14 patients were included and followed-up. After gastric resection, a 3 cm opening was created on the gastric stump, and the specimen, divided into three segments stitched one to each other, was sutured to the gastric tube and retrieved through the mouth. RESULTS: Postoperative morbidity was 7.14% (1/14): one case of pneumonia. No wound infection occurred. The mean postoperative hospital stay was 4.7 ± 1.0 days. CONCLUSIONS: NOSE laparoscopic subtotal gastrectomy is feasible and safe, with similar oncologic results as LAG, but decreased morbidity and hospital stay.

Single-incision laparoscopic cholecystectomy: does it work? A systematic review.

BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) has been widely introduced into the clinical practice, but the real clinical benefits for patients still remain a matter of debate. We conducted a systematic review, according to the PRISMA guidelines comparing clinical and peri-operative outcomes of SILC and conventional laparoscopic cholecystectomy (CLC). METHOD: A literature search, including only randomised controlled trials (RCTs), was performed via PubMed, Google Scholar, Cochrane Library and Embase database. The reviewers extracted data from the manuscripts of selected articles including patient demographics, operative time, morbidity rate, post-operative length of stay, conversion rate, cost data, pain and satisfaction with cosmetic results. RESULT: Seventeen RCTs matching the inclusion criteria were finally selected for the analysis. A total of 1293 patients were involved in the review, including 663 (51.3 %) patients who have undergone SILC and 630 (48.7 %) patients who have undergone CLC. Post-operative pain was significantly worse in SILC patients in four studies, in CLC patients in four studies, while in the remnants seven studies, no differences in pain scores were found. Data on satisfaction for post-operative cosmetics were significantly better for SILC patients in all studies but two. Operating time was significantly longer in SILC group while there is no statistically significant difference in conversion rate. Morbidity rate was similar in both groups, as was the incidence of bile duct injuries. Costs were significantly higher in SILC group. SILC was considered a more challenging procedure in all studies. CONCLUSION: The role of SILC is still controversial. Until now, no real significant benefit has been proven: overall satisfaction is the only clear advantage of SILC, and this is mainly related to cosmetic results. Indications to SILC are mainly limited to patients with uncomplicated disease, with BMI ≤ 30 kg/m(2), whose surgery is unlikely to be converted to an open or multiport approach.

Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series.

BACKGROUND: Controversies exist about feasibility and oncologic effectiveness of laparoscopic gastrectomies with extended lymphadenectomy for advanced gastric cancer. The aim of our study was to determine if long-term results of these laparoscopic procedures may justify their use as an alternative to open surgery also in advanced gastric cancer. METHODS: We performed a retrospective review of 100 patients after laparoscopic surgery for gastric cancer. RESULTS: Tumor stage (S) was SIA in 21 patients, SIB in 20, SII in 17, SIIIA in 17, SIIIB in 5, and SIV in 20. Eleven total and 89 subtotal R0 gastrectomies were performed. The mean number of dissected lymph nodes was 35 +/- 18. The conversion rate was 3%. Surgical mortality and major morbidity were 6% and 13%, respectively. Overall and disease-free 5-year survival rates were 59% and 57%, respectively. CONCLUSIONS: Laparoscopic gastrectomy with extended lymphadenectomy for early and advanced gastric cancer is feasible, safe, and oncologically effective. Long-term survival rates are similar to those observed after open surgery.

Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial.

OBJECTIVE: The aim of this study was to compare technical feasibility and both early and 5-year clinical outcomes of laparoscopic-assisted and open radical subtotal gastrectomy for distal gastric cancer. SUMMARY BACKGROUND DATA: The role of laparoscopic surgery in the treatment of gastric cancer has not yet been defined, and many doubts remain about the ability to satisfy all the oncologic criteria met during conventional, open surgery. METHODS: This study was designed as a prospective, randomized clinical trial with a total of 59 patients. Twenty-nine (49.1%) patients were randomized to undergo open subtotal gastrectomy (OG), while 30 (50.9%) patients were randomized to the laparoscopic group (LG). Demographics, ASA status, pTNM stage, histologic type of the tumor, number of resected lymph nodes, postoperative complications, and 5-year overall and disease-free survival rates were studied to assess outcome differences between the groups. RESULTS: The demographics, preoperative data, and characteristics of the tumor were similar. The mean number of resected lymph nodes was 33.4 +/- 17.4 in the OG group and 30.0 +/- 14.9 in the LG (P = not significant). Operative mortality rates were 6.7% (2 patients) in the OG and 3.3% (1 patient) in the LG (P = not significant); morbidity rates were 27.6% and 26.7%, respectively (P = not significant). Five-year overall and disease-free survival rates were 55.7% and 54.8% and 58.9% and 57.3% in the OG and the LG, respectively (P = not significant). CONCLUSIONS: Laparoscopic radical subtotal gastrectomy for distal gastric cancer is a feasible and safe oncologic procedure with short- and long-term results similar to those obtained with an open approach. Additional benefits for the LG were reduced blood loss, shorter time to resumption of oral intake, and earlier discharge from hospital.