Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a phase II study following the learning curve.
OBJECTIVE
A preliminary study on the use of laparoscopy-assisted approach to treat gastric carcinoma resulted in higher morbidity.


METHODS
A prospective phase II study of laparoscopy-assisted distal gastrectomy (LADG) was performed for patients with preoperative diagnosis of T1 N0 stage cancer located in the lower or middle-third stomach. Bleeding amount, operating time, mortality, morbidity, and the number of lymph node retrieval were recorded and compared with the preliminary series reported previously by the same authors.


RESULTS
Between 2000 and 2002, 47 patients were accrued. The mean blood loss and postoperative hospital stay were significantly decreased compared with the previous series, whereas the operating time was not. There were no in-hospital deaths, with the incidence of anastomotic leakage significantly decreased. All patients remain disease-free to date.


CONCLUSIONS
LADG can be performed safely and morbidity, no longer, is a drawback by experienced hands that have reached plateau of the learning curve, although it remains a time-consuming procedure. Its application to gastric cancer surgery is feasible for early stage cancer, and its applicability to the treatment of T2 stage cancer will be the next issue to be explored.
Department of Surgery II, Nagoya University School of Medicine, Nagoya/Aichi, Japan.
Michitaka
M
Fujiwara
Yasuhiro
Y
Kodera
Shinichi
S
Miura
Yasuaki
Y
Kanyama
Hiroyuki
H
Yokoyama
Norifumi
N
Ohashi
Kenji
K
Hibi
Katsuki
K
Ito
Seiji
S
Akiyama
Akimasa
A
Nakao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D013270:Stomach / Q000098:blood supply / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*