title: Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer.
abstract: BACKGROUND
  Laparoscopic gastrectomy for gastric cancer has become common due to improvement of the surgical techniques and devices for laparoscopic surgery. Although laparoscopically assisted distal gastrectomy (LADG) has several advantages over open distal gastrectomy, little has been reported about the safety and feasibility of totally laparoscopic distal gastrectomy (TLDG).
  
  
  METHODS
  Between October 2005 and June 2007, 80 laparoscopic distal gastrectomies with regional lymphadenectomies were performed for patients with gastric cancer. After 24 patients underwent LADG and 56 patients underwent TLDG, the clinical data were compared between the two groups.
  
  
  RESULTS
  The groups were comparable in terms of age, gender, body mass index (BMI), tumor location, tumor size, macroscopic type, depth of invasion, histologic type, lymph node metastasis, and length of proximal margin. However, when only the patients with gastric cancer in the middle third of the stomach were compared between the two groups, the length of the proximal margin was significantly longer in the TLDG group (p < 0.05). The mean blood loss was significantly less in the TLDG group (p < 0.05). The patients in the TLDG group recovered earlier and thus had a significantly shorter postoperative hospital stay. Furthermore, the C-reactive protein level on postoperative day 7 was lower in the TLDG group than in the LADG group (p < 0.05). There was no significant difference in the postoperative complications between the two groups.
  
  
  CONCLUSIONS
  This study demonstrated that TLDG has several advantages over LADG including smaller wounds, less invasiveness, and better feasibility of a secure ablation. The TLDG procedure yields safe anastomosis independently of the patient's constitution or the location of the cancer. Therefore, TLDG is considered to be a useful technique for patients with gastric cancer.
authors.affiliation: Department of Gastroenterological Surgery, National Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan. ikecho@v101.vaio.ne.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Aoki
authors.forename: Norifumi
authors.initials: N
authors.lastname: Harimoto
authors.forename: Jyunya
authors.initials: J
authors.lastname: Taomoto
authors.forename: Takaaki
authors.initials: T
authors.lastname: Masuda
authors.forename: Takefumi
authors.initials: T
authors.lastname: Ohga
authors.forename: Eisuke
authors.initials: E
authors.lastname: Adachi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Toh
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okamura
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome