Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes.
BACKGROUND
The feasibility, safety, and improved quality of postoperative life following laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with a hand-sewn anastomosis via a mini-laparotomy for early gastric cancer (EGC) have been previously established. Here we describe the surgical procedure of totally laparoscopic pylorus-preserving gastrectomy (TLPPG) using an intracorporeal delta-shaped anastomosis technique, and the short-term surgical outcomes of 60 patients with EGC in the middle stomach are reported.


METHODS
After lymphadenectomy and mobilization of the stomach, intraoperative gastroscopy was performed in order to verify the location of the tumor, and then the distal and proximal transecting lines were established, 5 cm from the pyloric ring and just proximal to Demel's line, respectively. Following transection of the stomach, a delta-shaped intracorporeal gastrogastrostomy was made with linear staplers.


RESULTS
There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 259 min and 28 mL, respectively. Twelve patients (20.0%) experienced postoperative complications classified as grade II using the Clavien-Dindo classification, with the most frequent complication being gastric stasis (6 cases, 10.0 %). The incidence of severe complications classified as grade III or above was 1.7%; only one patient required reoperation and intensive care due to postoperative intraabdominal bleeding and subsequent multiple organ failure.


CONCLUSIONS
TLPPG with an intracorporeal delta-shaped anastomosis was found to be a safe procedure, although it tended to require a longer operating time than the well-established LAPPG with a hand-sewn gastrogastrostomy.
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Koshi
K
Kumagai
Naoki
N
Hiki
Souya
S
Nunobe
Sayuri
S
Sekikawa
Takehiro
T
Chiba
Takashi
T
Kiyokawa
Xiaohua
X
Jiang
Shinya
S
Tanimura
Takeshi
T
Sano
Toshiharu
T
Yamaguchi
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D016063:Blood Loss, Surgical; D055088:Early Detection of Cancer; D005260:Female; D005743:Gastrectomy / Q000379:methods; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011708:Pylorus / Q000601:surgery*; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome