A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report.
BACKGROUND
The application of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer remains controversial among gastric surgeons. The purpose of this study was to compare LADG with open distal gastrectomy (ODG) regarding clinical outcome and postoperative parameters, including postoperative pain and pulmonary function.


METHODS
From October 1998 to March 2001, 28 patients with early gastric cancer were randomly assigned to an LADG (n = 14) or ODG group (n = 14) with Billroth I reconstruction. Postoperative pain during resting, coughing, and walking were evaluated by a visual analog scale (VAS). Pulmonary functions such as forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) measured on the third postoperative day were compared with preoperative functions.


RESULTS
Patients in the 2 groups were comparable for age, gender, height, weight, staging, and location of gastric cancer. The mean blood loss was significantly less in the LADG than in the ODG group (P <.05). Histologic examinations of resected specimens revealed that these 2 operations were identical from the standpoint of curability. Patients in the LADG group recovered both bowel movement and walking ability earlier than did patients in the ODG group (P <.05). The postoperative VAS pain score during rest was lower for 3 days after LADG than ODG (P <.05) and for 1 day during coughing or walking (P <.05). The pulmonary functions such as FVC and FEV1 values were reduced on the third day after LADG and ODG. However, the FVC value on the third day after LADG was lower than after ODG (P <.05).


CONCLUSIONS
This study demonstrates that LADG has several advantages including an earlier recovery, less pain, and less impaired pulmonary function after gastric surgery when compared with ODG; furthermore, no reduction in curability was observed.
Kitano
Seigo
S
Department of Surgery I, Oita Medical University, Oita, Japan.
Shiraishi
Norio
N
Fujii
Kyuzo
K
Yasuda
Kazuhiro
K
Inomata
Masafumi
M
Adachi
Yosuke
Y
D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D005541:Forced Expiratory Volume; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D014797:Vital Capacity