title: Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study.
abstract: BACKGROUND
  Laparoscopic surgery has been adopted for the treatment of gastric cancer, and many reports have confirmed its favorable outcomes. Most surgeons prefer to laparoscopy-assisted gastrectomy using minilaparotomy rather than totally laparoscopic procedures because of technical difficulties of intracorporeal anastomosis. We conducted this study to compare laparoscopy-assisted distal gastrectomy with totally laparoscopic distal gastrectomy. In addition, laparoscopic procedures were compared with open distal gastrectomy.
  
  
  METHODS
  This prospective, nonrandomized, multicenter study enrolled 60 patients with early gastric cancer at three branch hospitals of our institutes. Twenty-five- to 30-cm-long mid-line incision, 5-cm midline or transverse incision, and 3-cm U-shaped incision were used in open distal gastrectomy, laparoscopy-assisted distal gastrectomy, and totally laparoscopic distal gastrectomy, respectively. Postoperative outcomes, immunologic changes, and operation-related costs were compared between the three groups.
  
  
  RESULTS
  There was no difference in gender, mean age, body mass index, and tumor characteristics between the three groups. No operation-related death occurred. Estimated blood loss, number of additional analgesics use, first flatus, and soft meal diet time were significantly different between the three groups (P < 0.05). In totally laparoscopic distal gastrectomy, the time to first flatus was significantly shorter than laparoscopy-assisted distal gastrectomy (3.7 vs. 2.8 days, in laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy, respectively, P < 0.05). White blood cell count and C-reactive protein level at postoperative day 1 were significantly higher in open distal gastrectomy than the other groups; however, there was no difference between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy. The operation-related costs were significantly greater in totally laparoscopic distal gastrectomy (P < 0.05).
  
  
  CONCLUSIONS
  Although totally laparoscopic distal gastrectomy needs more cost, totally laparoscopic distal gastrectomy provides shorter bowel recovery time than laparoscopy-assisted distal gastrectomy.
authors.affiliation: Department of Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Kyo Young
authors.initials: KY
authors.lastname: Song
authors.forename: Cho Hyun
authors.initials: CH
authors.lastname: Park
authors.forename: Han Chol
authors.initials: HC
authors.lastname: Kang
authors.forename: Jin-Jo
authors.initials: JJ
authors.lastname: Kim
authors.forename: Seung Man
authors.initials: SM
authors.lastname: Park
authors.forename: Kyong Hwa
authors.initials: KH
authors.lastname: Jun
authors.forename: Hyung Min
authors.initials: HM
authors.lastname: Chin
authors.forename: Hoon
authors.initials: H
authors.lastname: Hur
mesh_terms: D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000191:economics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome