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Comparing short-term outcomes after totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy with Billroth I anastomosis: early experience of a single institution

Journal of Minimally Invasive Surgery 2021년 24권 1호 p.26 ~ 34
이인혁, 김광희, 서상혁, 안민성, 백형주, 박요한, 강상현, 오상훈,
소속 상세정보
이인혁 ( Lee In-Hyuck ) - Inje University Busan Paik Hospital Department of Surgery
김광희 ( Kim Kwang-Hee ) - Inje University Busan Paik Hospital Department of Surgery
서상혁 ( Seo Sang-Hyuk ) - Inje University Busan Paik Hospital Department of Surgery
안민성 ( An Min-Sung ) - Inje University Busan Paik Hospital Department of Surgery
백형주 ( Baik Hyung-Joo ) - Inje University Busan Paik Hospital Department of Surgery
박요한 ( Park Yo-Han ) - Inje University Busan Paik Hospital Department of Surgery
강상현 ( Kang Sang-Hyun ) - Inje University Busan Paik Hospital Department of Surgery
오상훈 ( Oh Sang-Hoon ) - Inje University Busan Paik Hospital Department of Surgery

Abstract


Purpose: To determine the safety and feasibility of totally laparoscopic distal gastrectomy (TLDG) with modified delta-shaped anastomosis, we compared the short-term outcomes of TLDG to those of laparoscopy-assisted distal gastrectomy (LADG) with Billroth I anastomosis.

Methods: We analyzed the characteristics of 85 patients with gastric cancer who underwent laparoscopic distal gastrectomy with Billroth I anastomosis between January 2013 and December 2018. After propensity score matching, each group had 35 patients.

Results: Of these 85 patients, 44 underwent TLDG and 41 underwent LADG. Propensity score matching was performed with three covariates (age, underlying disease, and hypertension), and 35 patients from each group were matched 1:1. After matching, the TLDG group was older than the LADG group (64.5 ± 10.6 years vs. 56.3 ± 11.2 years, p = 0.003) and had more patients with hypertension (57.1% vs. 22.9%, p = 0.003). Tumors were larger in the TLDG group than in the LADG group (23.4 ± 16.2 mm vs. 16.0 ± 7.9 mm, p = 0.018). A greater proportion of patients had fever in the TLDG group than the LADG group (42.9% vs. 20.0%, p = 0.039), and C-reactive protein from postoperative days 3 to 6 was greater in the TLDG group (11.4 ± 5.7 mg/dL vs. 7.0 ± 5.0 mg/dL, p = 0.001).

Conclusion: Although our data represent only our early experience performing TLDG with modified deltashaped anastomosis, this procedure is relatively safe and feasible. Nevertheless, compared to LADG, which is the conventional method, the operative time for TLDG was longer. Surgeons must also watch out for anastomotic complications.

키워드

Gastroenterostomy; Laparoscopy; Stomach neoplasms

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