title: A totally laparoscopic distal gastrectomy can be an effective way of performing laparoscopic gastrectomy in obese patients (body mass index≥30).
abstract: BACKGROUND
  In the surgical treatment of gastric cancer, obesity is known to be a predictive factor for poor early surgical outcomes. To evaluate the more effective modality of laparoscopic gastrectomy in obese patients, we compared the early surgical outcomes of laparoscopy-assisted and totally laparoscopic gastrectomy.
  
  
  METHODS
  We retrospectively analyzed early surgical outcomes in 1,480 consecutive patients who underwent distal gastrectomy for gastric cancer between April 2004 and July 2010. To compare surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) with those of totally laparoscopic distal gastrectomy (TLDG) in 76 obese patients (LADG, n = 39; TLDG, n=37), the patients were classified as either obese or nonobese. The obesity was defined using the WHO classification BMI cutoff of 30 kg/m2.
  
  
  RESULTS
  In the analysis of surgical outcomes of the LADG group, there were significant differences between the obese and nonobese groups with respect to operative time (P=0.004, obese, 171.8 min; nonobese, 141.0 min), time to first flatus (P=0.027, obese, 3.3 days; nonobese, 3.1 days), commencement of soft diet (P=0.040, obese, 4.6 days; nonobese, 4.0 days), postoperative complication rate (P=0.045, obese, 15.4%; nonobese, 6.5%), and postoperative hospital stay (P=0.014, obese, 8.9 days; nonobese, 7.2 days). In TLDG group, on the other hand, there were no significant differences in surgical outcomes between the groups.
  
  
  CONCLUSIONS
  Based on these findings, early surgical outcomes of LADG were strongly influenced by the obesity. TLDG without minilaparotomy, however, was unaffected by the obesity. These findings strongly suggest that TLDG could be a safe procedure to avoid the impact of obesity.
authors.affiliation: Division of Gastric Surgery, Department of Surgery, Asan Medical Center, Ulsan University, Pungnap 2-dong, Songpa-gu, Seoul, Republic of Korea.
authors.forename: Min Gyu
authors.initials: MG
authors.lastname: Kim
authors.forename: Kap Choong
authors.initials: KC
authors.lastname: Kim
authors.forename: Beom Su
authors.initials: BS
authors.lastname: Kim
authors.forename: Tae Hwan
authors.initials: TH
authors.lastname: Kim
authors.forename: Hee Sung
authors.initials: HS
authors.lastname: Kim
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Yook
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Kim
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012016:Reference Values; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome