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
Processing time: 81 Days and 23.7 Hours
ARTICLE HIGHLIGHTS
Research background

In Korea and Japan, the incidence of upper and middle body gastric cancer has increased as a result of improved nationwide surveillance. Furthermore, the indication of laparoscopic gastrectomy has also extended. Therefore, the demand for minimally invasive surgery for upper body gastric cancer has grown, and there is more need for new therapeutic methods and modalities.

Research motivation

Intracorporeal anastomosis and extracorporeal anastomosis in laparoscopic total gastrectomy has developed due to improvements in surgical devices and the accumulation of operative experience, but an optimal method for laparoscopic total gastrectomy has yet to be established due to the difficulties of esophagojejunostomy.

Research objectives

We aimed to evaluate the surgical safety and efficacy of intracorporeal anastomosis using linear stapler for treating gastric cancer of the upper third of the stomach by comparing its outcomes with those of extracorporeal anastomosis using circular stapler.

Research methods

From August 2008 to August 2014, 687 consecutive patients who underwent total gastrectomy (266 laparoscopic-assisted total gastrectomy (LATG) patients and 421 totally laparoscopic total gastrectomy (TLTG) patients) were reviewed retrospectively. Data obtained from medical records included patient age, sex, body mass index, American Society of Anesthesiologist score, history of abdominal surgery, operative time, pre- and postoperative hematocrit, time to first flatus, day of commencement of soft diet, pain score by visual analogue scale, number of analgesics administered, intra- and postoperative transfusion, intraoperative events, postoperative hospital stay, tumor size, number of retrieved lymph nodes, resection margins and cancer stage according to the American Joint Committee on Cancer - International Union for Cancer Control 7th edition.

Research results

The TLTG group had higher mean age at time of operation, and more histories of abdominal surgery. However, the TLTG group required a shorter operation time, lower postoperative hematocrit change, less intraoperative events, less intraoperative anastomosis events, and permitted faster postoperative recovery, such as median time to first flatus, median commencement of soft diet and length of postoperative hospital stay.

Research conclusions

TLTG may be considered a feasible procedure, as compared to LATG. Because TLTG provides a wider view than TLTG, reconstruction in TLTG carried out with a linear stapler is easy, rapid and requires no hand-sewn reinforcement procedure, and TLTG does not need additional mini-laparotomy. Furthermore, TLTG had superior surgical outcomes in terms of operation time, postoperative hematocrit change, intraoperative events and postoperative recovery.

Research perspectives

Based on our results, we can consider TLTG as a feasible and straightforward procedure. But this study has certain limitations. It is a retrospective study from a single institution, and although the pathologic results in the LATG and TLTG groups were similar, data on long-term outcomes are still needed to compare the oncological adequacy of these two methods.