Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy

• Published in: World journal of surgical oncology Vol. 10; no. 1; p. 267
• Main Authors: Lee, Sang-Woong, Tanigawa, Nobuhiko, Nomura, Eiji, Tokuhara, Takaya, Kawai, Masaru, Yokoyama, Kazutake, Hiramatsu, Masako, Okuda, Junji, Uchiyama, Kazuhisa
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.12.2012; BioMed Central; BMC
• Subjects: Aged; Analysis; Anastomosis, Roux-en-Y; Billroth I; Cancer; Care and treatment; Design; Extracorporeal anastomosis; Female; Follow-Up Studies; Gastrectomy; Gastric cancer; Gastrointestinal Tract - surgery; Humans; Intracorporeal anastomosis; Laparoscopic distal gastrectomy; Laparoscopic surgery; Laparoscopy; Length of Stay; Male; Medical research; Medicine, Experimental; Methods; Middle Aged; Neoplasm Staging; Patients; Postoperative Complications; Reconstructive Surgical Procedures; Roux-en-Y; Stomach cancer; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Treatment Outcome; Japan
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/1477-7819-10-267

Laparoscopic gastrectomy has recently been gaining popularity as a treatment for cancer; however, little is known about the benefits of intracorporeal (IC) gastrointestinal anastomosis with pure laparoscopic distal gastrectomy (LDG) compared with extracorporeal (EC) anastomosis with laparoscopy-assisted distal gastrectomy (LADG). Between June 2000 and December 2011, we assessed 449 consecutive patients with early-stage gastric cancer who underwent LDG. The patients were classified into three groups according to the method of reconstruction LADG followed by EC hand-sewn anastomosis (LADG + EC) (n = 73), using any of three anastomosis methods (Billroth-I (B-I), Billroth-II (B-II) or Roux-en-Y (R-Y); LDG followed by IC B-I anastomosis (LDG + B-I) (n = 248); or LDG followed by IC R-Y anastomosis (LDG + R-Y) (n = 128)). The analyzed parameters included patient and tumor characteristics, operation details, and post-operative outcomes. The tumor location was significantly more proximal in the LDG + R-Y group than in the LDG + B-I group (P < 0.01). Mean operation time, intra-operative blood loss, and the length of post-operative hospital stay were all shortest in the LDG + B-I group (P < 0.05). Regarding post-operative morbidities, anastomosis-related complications occurred significantly less frequently in with the LDG + B-I group than in the LADG + EC group (P < 0.01), whereas there were no differences in the other parameters of patients' characteristics. Intracorporeal mechanical anastomosis by either the B-I or R-Y method following LDG has several advantages over at the LADG + EC, including small wound size, reduced invasiveness, and safe anastomosis. Although additional randomized control studies are warranted to confirm these findings, we consider that pure LDG is a useful technique for patients with early gastric cancer.