Laparoscopy Assisted Distal Gastrectomy Versus Open Distal Gastrectomy for Patients with Gastric Cancer in A Middle Resources Country
2019
Background: Laparoscopic surgery with a small laparotomy has several advantages over conventional open
surgery, including less invasiveness, less pain, earlier recovery, and better cosmoses. The aim of this study
was to compare technical feasibility and early clinical outcomes of laparoscopy-assisted distal gastrectomy
in comparison with open distal gastrectomy for gastric cancer in a developing country.
Patients and methods: In this retrospective study, patients with distal gastric cancer were divided into two
groups (a) patients underwent laparoscopy assisted distal gastrectomy (LADG) (21 patients) and (b) open
distal gastrectomy (ODG) (21 patients). For the postoperative pathologic results, the tumor-nodal-metastasis
(TNM) stage, grade of tumor differentiation, distal and proximal margins, the number of harvested lymph
nodes were evaluated. Staging was done according to the 7th edition of the UICC tumor, node, and
metastasis (TNM) classification. D1/D2 lymphadenectomy with curative R0 intention was attempted in all
cases. Perioperative mortality and morbidity were assessed.
Results: The time to initiate oral intake, and postoperative hospital stay were significantly shorter in the
LADG group than in the ODG group (P < 0.001). The operative time in the LADG group was significantly
less than that of the ODG group (P = 0.05). Blood loss and blood transfusion frequency were significantly
lower (P < 0.0001) in the LADG group in comparison to ODG group.
Conclusion: Laparoscopic-assisted distal gastrectomy for distal gastric cancer could be safe and feasible
technique alternative to open gastrectomy in a middle income country, with at least similar short term
surgical and oncological results. However, laparoscopic gastric surgery is in need to adequate training and
technical support especially in D2 lymphadenectomy
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