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Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer

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Abstract

Background

Although a few studies have reported the use of reduced-port laparoscopic gastrectomy (RPG) in gastric cancer patients, the feasibility of routinely using this technique remains unclear. It is therefore important to evaluate the surgical advantages of this technique in this patient group.

Methods

Between August 2010 and July 2015, 165 patients underwent RPGs at our hospital, performed by a single surgeon. Of these patients, 88 underwent reduced-port laparoscopic distal gastrectomy (RPLDG) and 77 underwent reduced-port laparoscopic total gastrectomy (RPLTG). In addition to short-term surgical outcomes after RPG, survival times and the surgical learning curve were also evaluated.

Results

Blood losses during lymph node dissection in the RPLDG and RPLTG groups were not significantly different (p = 0.160). Conversion to open surgery was necessary in only two patients. Postoperative morbidities were observed in 14.8 % of the RPLDG group and 14.3 % of the RPLTG group, but there were no deaths. Most patients expressed high cosmetic satisfaction in both groups. In the RPLDG group, operation time during reconstruction decreased over the first 50 cases and then plateaued, as the surgeon’s experience of the technique increased. In contrast, in the RPLTG group, operation times dropped with surgical experience for both lymph node dissection, plateauing after 40 cases, and for reconstruction, plateauing after 30 cases. Only three patients died of gastric cancer in the follow-up period and three patients died of other diseases. Five-year overall survival and 5-year disease-specific survival were 95.6 and 98.0 %, respectively.

Conclusions

We have shown that reduced-port gastrectomy (RPG) could be an acceptable and satisfactory procedure for treating gastric cancer for an experienced laparoscopic gastric surgeon who has sufficient previous experience of conventional laparoscopic gastrectomies.

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References

  1. Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC (2006) Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg 202:874–880

    Article  PubMed  Google Scholar 

  2. Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 255:446–456

    Article  PubMed  Google Scholar 

  3. Takiguchi S, Fujiwara Y, Yamasaki M, Miyata H, Nakajima K, Sekimoto M, Mori M, Doki Y (2013) Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study. World J Surg 37:2379–2386

    Article  PubMed  Google Scholar 

  4. Kunisaki C, Makino H, Kosaka T, Oshima T, Fujii S, Takagawa R, Kimura J, Ono HA, Akiyama H, Taguri M, Morita S, Endo I (2012) Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case–control study. Surg Endosc 26:804–810

    Article  PubMed  Google Scholar 

  5. Fukunaga T, Hiki N, Kubota T, Nunobe S, Tokunaga M, Nohara K, Sano T, Yamaguchi T (2013) Oncologic outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer. Ann Surg Oncol 20:2676–2682

    Article  PubMed  Google Scholar 

  6. Kim KH, Kim YM, Kim MC, Jung GJ (2013) Is laparoscopy-assisted total gastrectomy feasible for the treatment of gastric cancer? A case-matched study. Dig Surg 30:348–354

    Article  PubMed  Google Scholar 

  7. Kunisaki C, Makino H, Oshima T, Fujii S, Kimura J, Takagawa R, Kosaka T, Akiyama H, Morita S, Endo I (2011) Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc 25:1300–1305

    Article  PubMed  Google Scholar 

  8. LaFemina J, Viñuela EF, Schattner MA, Gerdes H, Strong VE (2013) Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol 20:2975–2983

    Article  CAS  PubMed  Google Scholar 

  9. Kawamura H, Tanioka T, Shibuya K, Tahara M, Takahashi M (2013) Comparison of the invasiveness between reduced-port laparoscopy-assisted distal gastrectomy and conventional laparoscopy-assisted distal gastrectomy. Int Surg 98:247–253

    Article  PubMed  PubMed Central  Google Scholar 

  10. Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T (2011) Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc 25:2400–2404

    Article  PubMed  Google Scholar 

  11. Kawamura H, Tanioka T, Kuji M, Tahara M, Takahashi M (2013) The initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy. Gastric Cancer 16:602–608

    Article  PubMed  Google Scholar 

  12. Kunisaki C, Ono HA, Oshima T, Makino H, Akiyama H, Endo I (2012) Relevance of reduced-port laparoscopic distal gastrectomy for gastric cancer: a pilot study. Dig Surg 29:261–268

    Article  PubMed  Google Scholar 

  13. Kunisaki C, Makino H, Kimura J, Takagawa R, Ota M, Kosaka T, Akiyama H, Endo I (2015) Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen. Gastric Cancer 18:868–875

    Article  CAS  PubMed  Google Scholar 

  14. Japanese Gastric Cancer Association (2014) Japanese gastric cancer treatment guidelines 2014 (ver. 4) in Japanese. Kanehara, Tokyo

    Google Scholar 

  15. Sobin LH, Gospodarowicz MK, Wittekind C (2010) International Union Against Cancer (UICC) TNM classification of malignant tumors, 7th edn. Wiley, New York

    Google Scholar 

  16. Association Japanese Gastric Cancer (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  17. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S (2015) A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg World J Surg 39:2734–2741

    Article  PubMed  Google Scholar 

  18. Park do J, Han SU, Hyung WJ, Kim MC, Kim W, Ryu SY, Ryu SW, Song KY, Lee HJ, Cho GS, Kim HH; Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group (2012) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc 26:1548–1553

    Article  Google Scholar 

  19. Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, Bae JM (2008) Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 15:1625–1631

    Article  PubMed  Google Scholar 

  20. Kunisaki C, Makino H, Takagawa R, Sato K, Kawamata M, Kanazawa A, Yamamoto N, Nagano Y, Fujii S, Ono HA, Akiyama H, Shimada H (2009) Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2085–2093

    Article  PubMed  Google Scholar 

  21. Jeong O, Ryu SY, Zhao XF, Jung MR, Kim KY, Park YK (2012) Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center. Surg Endosc 26:3418–3425

    Article  PubMed  Google Scholar 

  22. Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R (2013) Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc 27:1509–1520

    Article  PubMed  Google Scholar 

  23. Kodera Y (2013) Reduced port surgery for gastric cancer: another giant leap for mankind? Gastric Cancer 16:457–459

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Chikara Kunisaki, Naotaka Yamaguchi, Yusuke Izumisawa, Hiroshi Miyamato, Kei Sato, Tsutomu Hayashi, Nobuhiro Sugano, Yoshihiro Suzuki, Mitsuyoshi Ota & Akira Tsuburaya

  2. Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan

    Hirochika Makino, Jun Kimura, Ryo Takagawa, Takashi Kosaka, Hidetaka Andrew Ono, Hirotoshi Akiyama & Itaru Endo

Authors
  1. Chikara Kunisaki
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  2. Hirochika Makino
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  3. Naotaka Yamaguchi
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  4. Yusuke Izumisawa
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  5. Hiroshi Miyamato
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  6. Kei Sato
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  8. Nobuhiro Sugano
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  9. Yoshihiro Suzuki
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  11. Akira Tsuburaya
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  12. Jun Kimura
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  13. Ryo Takagawa
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  14. Takashi Kosaka
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  15. Hidetaka Andrew Ono
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  16. Hirotoshi Akiyama
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  17. Itaru Endo
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Corresponding author

Correspondence to Chikara Kunisaki.

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Disclosures

Drs. Chikara Kunisaki, Hirochika Makino, Naotaka Yamaguchi, Yusuke Izumisawa, Hiroshi Miyamato, Kei Sato, Tsutomu Hayashi, Nobuhiro Sugano, Yoshihiro Suzuki, Mitsuyoshi Ota, Akira Tsuburaya, Jun Kimura, Ryo Takagawa, Takashi Kosaka, Hidetaka Andrew Ono, Hirotoshi Akiyama, and Itaru Endo have no conflicts of interest or financial ties to disclose.

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Kunisaki, C., Makino, H., Yamaguchi, N. et al. Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer. Surg Endosc 30, 5520–5528 (2016). https://doi.org/10.1007/s00464-016-4916-8

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  • DOI: https://doi.org/10.1007/s00464-016-4916-8

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