title: Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison.
abstract: This study aimed to compare the short-term surgical outcomes and cost-benefits following totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for the treatment of gastric cancer.
  
  
  
  Between April 2007 and December 2013, a total of 100 patients with gastric cancer underwent laparoscopic distal gastrectomy. The patients were classified into two groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed. The comparison between the groups was based on clinicopathological characteristics and surgical and economic outcomes.
  
  
  
  There were 57 and 43 patients who underwent TLDG and LADG, respectively. The patients' demographics and tumor characteristics did not show any statistically significant differences with the exception for tumor location. In the LADG group, tumors were localized to relatively higher positions (p = 0.024) and received Roux-en-Y reconstruction more frequently (p < 0.001). There were no differences in the incidence of morbidity. Anastomotic leakage was not recorded in either group, although anastomotic stenosis occurred in one patient (1.8 %) after TLDG and in two patients (4.7 %) after LADG. Compared with the LADG group, the TLDG group was associated with significantly less operative blood loss (p < 0.001), a shorter time to oral intake (p = 0.012), and hospital stay (p = 0.018). The median operation costs were greater in the TLDG group than in the LADG group (¥982,000 in TLDG vs. ¥879,830 in LADG; p < 0.001), whereas the median total hospital costs were similar between the two groups (¥1302,665 in LADG vs. ¥1383,322 in TLDG: p = 0.119).
  
  
  
  This study suggests that TLDG is as technically feasible, safe, and effective as LADG for treating patients with gastric cancer. Furthermore, TLDG is associated with equivalent total hospital costs compared with LADG. The increased operation cost is offset by the decreased costs associated with longer periods of hospitalization.
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan. shinohara@jikei.ac.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shinohara
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kawano
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Muneharu
authors.initials: M
authors.lastname: Fujisaki
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Medical Affairs, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Machida Municipal Hospital, 2-15-41 Asahicho, Machida, Tokyo, 194-0023, Japan.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Hanyu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D005743:Gastrectomy / Q000191:economics* / Q000379:methods*; D017721:Hospital Costs; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Cost analysis; Gastric cancer; Laparoscopic gastrectomy