Randomized comparison of surgical stress and the nutritional status between laparoscopy-assisted and open distal gastrectomy for gastric cancer.
BACKGROUND
Laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer may prevent the development of an impaired nutritional status due to reduced surgical stress compared with open distal gastrectomy (ODG).


METHODS
This study was performed as an exploratory analysis of a phase III trial comparing LADG and ODG for stage I gastric cancer during the period between May and December of 2011. All patients received the same perioperative care via fast-track surgery. The level of surgical stress was evaluated based on the white blood cell count and the interleukin-6 (IL-6) level. The nutritional status was measured according to the total body weight, amount of lean body mass, lymphocyte count, and prealbumin level.


RESULTS
Twenty-six patients were randomized to receive ODG (13 patients) or LADG (13 patients). The baseline characteristics and surgical outcomes were similar between the two groups. The median IL-6 level increased from 0.8 to 36.3 pg/dl in the ODG group and from 1.5 to 53.3 pg/dl in the LADG group. The median amount of lean body mass decreased from 48.3 to 46.8 kg in the ODG group and from 46.6 to 46.0 kg in the LADG group. There are no significant differences between two groups.


CONCLUSIONS
The level of surgical stress and the nutritional status were found to be similar between the ODG and LADG groups in a randomized comparison using the same perioperative care of fast-track surgery.
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Toru
T
Aoyama
Takaki
T
Yoshikawa
Tsutomu
T
Hayashi
Shinichi
S
Hasegawa
Kazuhito
K
Tsuchida
Takanobu
T
Yamada
Haruhiko
H
Cho
Takashi
T
Ogata
Hirohito
H
Fujikawa
Norio
N
Yukawa
Takashi
T
Oshima
Yasushi
Y
Rino
Munetaka
M
Masuda
D000328:Adult; D000368:Aged; D001823:Body Composition; D001835:Body Weight; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology*; D011228:Prealbumin / Q000378:metabolism; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013312:Stress, Physiological / Q000276:immunology*
D015850:Interleukin-6; D011228:Prealbumin; D002097:C-Reactive Protein