title: Laparoscopy-assisted distal gastrectomy for gastric cancer patients with comorbid diseases: is it contraindicated for patients with systemic comorbidity?
abstract: BACKGROUND
  This study was carried out to evaluate the safety and feasibility of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer patients with systemic comorbidity.
  
  
  METHODS
  Two hundred and seventy-six patients who had undergone LADG by a single surgeon were given a physical status classification as defined by the American Society of Anesthesiologists (ASA class) and then divided into 2 criteria groups: criteria I group (ASA 1 vs ASA 2,3,4) and criteria II group (ASA 1,2 vs ASA 3,4). The clinicopathologic data of each patient were reviewed retrospectively and grouped by criteria.
  
  
  RESULTS
  The percentage of patients with a comorbid disease was 8.1% (11 cases) in ASA class 1, 71.7% (86 cases) in class 2, 95.0% (19 cases) in class 3, and 100% (1 case) in class 4. No statistical difference was found between criteria I and II in terms of operative and postoperative results, operative time, estimated blood loss, transfusion rate, tumor size, total and positive number of dissected lymph nodes, proximal resection margin from lesion, the rate of open conversion, the duration of hospital stay, the time required before resuming a liquid diet, and the rate of complications, except the distal resection margin in criteria II (all P >0.05). There were no cases of mortality in any criteria group.
  
  
  CONCLUSIONS
  LADG would be a safe and feasible operation for patients with gastric cancer with systemic comorbidity, without reducing radicality, losing the advantages of minimally invasive surgery, or increasing operative risk.
authors.affiliation: Department of Surgery, Chung-Ang University, Korea.
authors.forename: Yoo Shin
authors.initials: YS
authors.lastname: Choi
authors.forename: Do Joong
authors.initials: DJ
authors.lastname: Park
authors.forename: Hyuk-Joon
authors.initials: HJ
authors.lastname: Lee
authors.forename: Hyung-Ho
authors.initials: HH
authors.lastname: Kim
authors.forename: Han-Kwang
authors.initials: HK
authors.lastname: Yang
authors.forename: Kuhn Uk
authors.initials: KU
authors.lastname: Lee
mesh_terms: D016009:Chi-Square Distribution; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome