Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 859-870
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.859
Influence of liver function after laparoscopy-assisted vs totally laparoscopic gastrectomy
Fan Xiao, Xing-Feng Qiu, Cai-Wen You, Fu-Ping Xie, Yao-Yuan Cai
Fan Xiao, Xing-Feng Qiu, Cai-Wen You, Fu-Ping Xie, Yao-Yuan Cai, The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
Fan Xiao, Xing-Feng Qiu, Cai-Wen You, Fu-Ping Xie, Yao-Yuan Cai, Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
Author contributions: Xiao F contributed significantly to analysis and manuscript preparation; Qiu XF contributed to the conception of the study; You CW, Xie FP, and Cai YY helped perform the analysis with constructive discussions.
Institutional review board statement: The study was reviewed and approved by the Institutional review board of Zhongshan Hospital Xiamen University (approval No. 2022-257).
Informed consent statement: The informed consent was waived from the patients.
Conflict-of-interest statement: We declare that we have no conflict of interest.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xing-Feng Qiu, MD, Professor, Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, No. 201-209 Hubin South Road, Xiamen 361000, Fujian Province, China. qiuxingfeng1@163.com
Received: December 13, 2022
Peer-review started: December 13, 2022
First decision: March 1, 2023
Revised: March 11, 2023
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: May 27, 2023
Processing time: 164 Days and 2.9 Hours
ARTICLE HIGHLIGHTS
Research background

Previously, some studies have proposed that totally laparoscopic gastrectomy (TLG) is superior to laparoscopy-assisted gastrectomy (LAG) in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications. However, there are still few studies on the changes in postoperative liver function in patients undergoing LG. The present study compared the postoperative liver function of patients with TLG and LAG, aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.

Research motivation

To compare the postoperative liver function of patients with TLG and LAG.

Research objectives

To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.

Research methods

The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center (including the Department of Gastrointestinal Surgery and the Department of General Surgery) of Zhongshan Hospital affiliated with Xiamen University, including 40 patients who underwent TLG and 40 patients who underwent LAG. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGLT), total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL), and other liver function-related test indices were compared between the 2 groups before surgery and on the 1st, 3rd, and 5th d after surgery.

Research results

The levels of ALT and AST in the 2 groups were significantly increased on the 1st to 2nd postoperative days compared with those before the operation. The levels of ALT and AST in the TLG group were within the normal range, while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group (P < 0.05). The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range (P < 0.05). The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2, the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4, and the TBIL, DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7 (P < 0.05). No significant difference was observed at other time points (P > 0.05).

Research conclusions

Both TLG and LAG can affect liver function, but the effect of LAG is more serious. The influence of both surgical approaches on liver function is transient and reversible. Although TLG is more difficult to perform, it may be a better choice for patients with gastric cancer combined with liver insufficiency.

Research perspectives

In conclusion, both TLG and LAG can affect liver function, and this effect is transient and reversible. The effect of LAG on liver function is more serious. TLG is not only superior to LAG in terms of short-term efficacy and long-term quality of life but also in terms of liver function protection. Although TLG is more difficult to perform, it may be a better choice in radical gastrectomy.