title: Laparoscopy-assisted distal gastrectomy with D1+beta compared with D1+alpha lymph node dissection.
abstract: BACKGROUND
  Laparoscopy-assisted distal gastrectomy (LADG) with D1+beta lymph node dissection has become the most popular treatment for early gastric cancer in Asian countries. However, the same clinical advantages with this procedure as with LADG with D1+alpha lymph node dissection has not been shown. The aim of this study was to compare the outcome of LADG with D1+beta to that of LADG with D1+alpha lymph node dissection.
  
  
  METHODS
  During the period June 2002 through June 2006, LADG with D1+alpha lymph node dissection was performed in 54 patients, and LADG with D1+beta lymph node dissection was performed in 42 patients. Surgical findings, clinicopathological data, postoperative course, complications, nutritional status, and blood analysis findings were compared between the two groups. Differences were analyzed with Mann-Whitney U test and chi-square test.
  
  
  RESULTS
  Patients in the two groups were comparable with respect to age, sex, body mass index, and stage and pathological characteristics of gastric cancer. A significantly greater number of N2 lymph nodes were harvested by D1+beta lymph node dissection than by D1+alpha dissection (5.9 vs. 2.7, P < 0.01). However, no significances in the total number of retrieved lymph nodes (24.7 vs. 22.2) or perigastric lymph nodes dissected (18.9 vs. 19.4) were identified between the D1+beta and D1+alpha groups. There was also no significant difference between the D1+alpha and D1+beta groups with respect to operation time, blood loss, complication rate, time to first walking, first flatus, first eating, and first defecation, frequency of analgesics given, volume of food intake on postoperative day 7, weight loss, and postoperative hospital stay. Blood analysis showed there were no significant differences in white blood cell count, granulocyte count, lymphocyte count, levels of C-reactive protein, and serum albumin.
  
  
  CONCLUSIONS
  The short-term outcome of LADG with D1+beta lymph node dissection is comparable to that of LADG with D1+alpha lymph node dissection. According to the oncological requirements, we can apply this operation as a minimally invasive surgery.
authors: Surgery 1, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, Beijing, Beijing, China. geka1@med.oita-u.ac.jp
authors: Jia-Ming
authors: JM
authors: Wei
authors: Norio
authors: N
authors: Shiraishi
authors: Shingo
authors: S
authors: Goto
authors: Kazuhiro
authors: K
authors: Yasuda
authors: Masafumi
authors: M
authors: Inomata
authors: Seigo
authors: S
authors: Kitano
mesh_terms: D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
references: J Am Coll Surg. 2005 Feb;200(2):191-7
references: 15664093
references: Gastric Cancer. 2005;8(2):75-7
references: 15864713
references: Cancer. 1999 May 15;85(10):2119-23
references: 10326688
references: J Am Coll Surg. 2003 Jan;196(1):75-81
references: 12517554
references: J Am Coll Surg. 2003 Sep;197(3):372-8
references: 12946791
references: Surg Laparosc Endosc Percutan Tech. 2002 Jun;12(3):204-7
references: 12080272
references: Surg Endosc. 2003 Jun;17(6):968-71
references: 12658427
references: Surgery. 2002 Jan;131(1 Suppl):S306-11
references: 11821829
references: Gastric Cancer. 2001;4(2):93-7
references: 11706767
references: Am J Surg. 2004 Dec;188(6):728-35
references: 15619491
references: World J Surg. 2002 Sep;26(9):1145-9
references: 12209244
references: Gastric Cancer. 1998 Dec;1(1):10-24
references: 11957040
references: Surg Laparosc Endosc. 1994 Apr;4(2):146-8
references: 8180768
references: Arch Surg. 2000 Jul;135(7):806-10
references: 10896374
references: Gastric Cancer. 2006;9(3):167-76
references: 16952034
references: Surgery. 2005 Mar;137(3):317-22
references: 15746786
references: Surg Endosc. 2005 Sep;19(9):1177-81
references: 16132317
references: Surg Endosc. 2005 Dec;19(12):1592-6
references: 16247578
references: Ann Surg. 2005 Feb;241(2):232-7
references: 15650632
references: Br J Surg. 2001 Jan;88(1):128-32
references: 11136325