Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2017; 23(48): 8553-8561
Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8553
Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience
Chung Sik Gong, Byung Sik Kim, Hee Sung Kim
Chung Sik Gong, Byung Sik Kim, Hee Sung Kim, Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Gong CS, Kim BS and Kim HS conceived and designed the study and performed the literature search; Kim HS reviewed the data; Gong CS drafted the article; All the authors were involved in the critical revision and final approval of the article.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Asan Medical Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used clinical data that were obtained retrospectively after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relation-ships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hee Sung Kim, PhD, Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. vangogh420@amc.seoul.kr
Telephone: +82-2-30101509 Fax: +82-2-4749027
Received: October 6, 2017
Peer-review started: October 7, 2017
First decision: October 25, 2017
Revised: November 14, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: December 28, 2017
Abstract
AIM

To evaluate the safety and efficacy of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy (LATG) using a circular stapler in gastric cancer patients.

METHODS

We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed.

RESULTS

The TLTG group had higher mean ages at the time of operation (57.78 ± 11.20 years and 55.69 ± 11.96 years, P = 0.020) and more histories of abdominal surgery (20.2% and 12.4%, P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions, combined operations, pain scores and administration of analgesics, and complications were similar between the two groups. However, compared with the LATG group, the TLTG group required a shorter operation time (149 min vs 170 min, P < 0.001), had lower postoperative hematocrit change (3.49% vs 4.04%, P = 0.002), less intraoperative events (3.1% vs 10.2%, P < 0.001), less intraoperative anastomosis events (2.4% vs 7.1%, P = 0.003), faster postoperative recovery such as median time to first flatus (3.30 d vs 3.60 d, P < 0.001), faster median commencement of soft diet (4.30 d vs 4.60 d, P < 0.001) and shorter length of postoperative hospital stay (6.75 d vs 7.02 d, P = 0.005).

CONCLUSION

The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore, TLTG can be recommended as an appropriate procedure for gastric cancer.

Keywords: Totally laparoscopic total gastrectomy, Laparoscopic-assisted total gastrectomy, Gastric cancer

Core tip: There are many studies that compared totally laparoscopic total gastrectomy (TLTG) with laparoscopic-assisted total gastrectomy (LATG). Moreover, various modified methods of intracorporeal esophagojejunostomy have been presented, but standardized methods have not been established. Our results show that TLTG by esophagojejunostomy intracorporeal anastomosis using linear stapler is an easier and more straightforward procedure compared with LATG by extracorporeal anastomosis using circular stapler.