Developing an institutional protocol guideline for laparoscopy-assisted distal gastrectomy.
BACKGROUND
The technical difficulty of lymph node dissection in laparoscopy-assisted distal gastrectomy (LADG) remains a barrier for extending the indication for this modality and limits its widespread clinical practice. The aim of this study was to evaluate our institutional guidelines for LADG, limiting the indications for this modality to only clinical stage T1N0 or T1N1 gastric cancer.


METHODS
From January 2002 to October 2006, a total of 294 cases of LADG and 664 cases of open distal gastrectomy (ODG) for clinical T1N0 or T1N1 gastric cancer were performed at the National Cancer Center, Korea. The two groups' clinicopathologic characteristics, surgical outcome, morbidity, and survival were compared.


RESULTS
The mean operating time for the LADG group was significantly longer than that for the ODG group (265.8 +/- 56.3 vs. 171.4 +/- 43.1 minutes, P < .001). The mean number of retrieved lymph nodes in the LADG group was higher than that of the ODG group (39.5 +/- 14.7 vs. 37.2 +/- 12.9, P = .017). The postoperative hospital stay was shorter in the LADG group (8.0 +/- 3.3 vs. 10.5 +/- 4.1 days, P < .001). The complications rate was lower for the LADG group than that for the ODG group (6.8% vs. 11.3%, P = .032). The overall survival rate was not significantly different between the two groups (P = .880).


CONCLUSIONS
Before considering expanding the indications for LADG, developing a carefully thought-out guideline and conducting an audit are mandatory.
Lee
Sang Eok
SE
Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Kim
Young-Woo
YW
Lee
Jun Ho
JH
Ryu
Keun Won
KW
Cho
Soo Jeong
SJ
Lee
Jong Yeul
JY
Kim
Chan Gyoo
CG
Choi
Il Ju
IJ
Kook
Myeong-Cherl
MC
Nam
Byung-Ho
BH
Park
Sook Ryun
SR
Kim
Min Ju
MJ
Lee
Jong Seok
JS
D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009017:Morbidity; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome