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Comparing the short-term outcomes and cost between solo single-incision distal gastrectomy and conventional multiport totally laparoscopic distal gastrectomy for early gastric cancer: a propensity score-matched analysis

Annals of Surgical Treatment and Research 2021년 100권 2호 p.67 ~ 75
이보람, 윤상일, 이강행, 원용준, 민사홍, 이윤택, 박영석, 안상훈, 박도중, 김형호,
소속 상세정보
이보람 ( Lee Bo-Ram ) - Seoul National University Bundang Hospital Department of Surgery
윤상일 ( Youn Sang-Il ) - Seoul National University Bundang Hospital Department of Surgery
이강행 ( Lee Kang-Haeng ) - Seoul National University Bundang Hospital Department of Surgery
원용준 ( Won Yong-Joon ) - Seoul National University Bundang Hospital Department of Surgery
민사홍 ( Min Sa-Hong ) - Seoul National University Bundang Hospital Department of Surgery
이윤택 ( Lee Yoon-Taek ) - Ewha Womans University Hospital Department of Surgery
박영석 ( Park Young-Suk ) - Seoul National University Bundang Hospital Department of Surgery
안상훈 ( Ahn Sang-Hoon ) - Seoul National University Bundang Hospital Department of Surgery
박도중 ( Park Do-Joong ) - Seoul National University College of Medicine Department of Surgery
김형호 ( Kim Hyung-Ho ) - Seoul National University Bundang Hospital Department of Surgery

Abstract


Purpose: Single-incision laparoscopic distal gastrectomy (SIDG) requires experienced camera operators for a stable image. Since it is difficult for skilled camera operators to participate in all SIDG, we began performing solo surgery using mechanical camera holders. We aimed to compare the short-term outcomes and cost between solo SIDG and conventional multiport laparoscopic distal gastrectomy (MLDG) for early gastric cancer (EGC).

Methods: From January 2014 to December 2016, a total of 938 consecutive patients underwent laparoscopic gastrectomy for EGC. Solo SIDG (n = 99) and MLDG patients (n = 198) were selected and 1:2 propensity score matching was done to compare the quality of operation and cost-effectiveness. All solo SIDG was performed by a surgeon using a camera holder, without any assistant.

Results: Mean operation time (120 ± 35.3 vs. 178 ± 53.4 minutes, P = 0.001) and estimated blood loss (24.6 ± 47.4 vs. 46.7 ± 66.5 mL, P = 0.001) were significantly lower in the solo SIDG group. Hospital stay, use of analgesics, and postoperative inflammatory markers (WBC, CRP) were similar between the 2 groups. The early (<30 days) complication rate in solo SIDG and MLDG groups was 21.2% and 23.7%, respectively (P = 0.240); the late (≥30 days) complication rate was 7.1% and 11.1%, respectively (P = 0.672). The manpower cost of solo SIDG was significantly lower than that of MLDG (P = 0.001).

Conclusion: This study demonstrated that solo SIDG performed by experienced laparoscopic surgeons is safe and feasible for EGC. Solo SIDG is expected to be a promising potential treatment for EGC.

키워드

Cost analysis; Laparoscopy; Stomach neoplasms; Surgical wound

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