title: Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer.
abstract: Although a few studies have reported the use of reduced-port laparoscopic gastrectomy (RPG) in gastric cancer patients, the feasibility of routinely using this technique remains unclear. It is therefore important to evaluate the surgical advantages of this technique in this patient group.
  
  
  
  Between August 2010 and July 2015, 165 patients underwent RPGs at our hospital, performed by a single surgeon. Of these patients, 88 underwent reduced-port laparoscopic distal gastrectomy (RPLDG) and 77 underwent reduced-port laparoscopic total gastrectomy (RPLTG). In addition to short-term surgical outcomes after RPG, survival times and the surgical learning curve were also evaluated.
  
  
  
  Blood losses during lymph node dissection in the RPLDG and RPLTG groups were not significantly different (p = 0.160). Conversion to open surgery was necessary in only two patients. Postoperative morbidities were observed in 14.8 % of the RPLDG group and 14.3 % of the RPLTG group, but there were no deaths. Most patients expressed high cosmetic satisfaction in both groups. In the RPLDG group, operation time during reconstruction decreased over the first 50 cases and then plateaued, as the surgeon's experience of the technique increased. In contrast, in the RPLTG group, operation times dropped with surgical experience for both lymph node dissection, plateauing after 40 cases, and for reconstruction, plateauing after 30 cases. Only three patients died of gastric cancer in the follow-up period and three patients died of other diseases. Five-year overall survival and 5-year disease-specific survival were 95.6 and 98.0 %, respectively.
  
  
  
  We have shown that reduced-port gastrectomy (RPG) could be an acceptable and satisfactory procedure for treating gastric cancer for an experienced laparoscopic gastric surgeon who has sufficient previous experience of conventional laparoscopic gastrectomies.
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. s0714@med.yokohama-cu.ac.jp.
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Hirochika
authors.initials: H
authors.lastname: Makino
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Yamaguchi
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Izumisawa
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyamato
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sugano
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Ota
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuburaya
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kimura
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Takagawa
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosaka
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Hidetaka Andrew
authors.initials: HA
authors.lastname: Ono
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Akiyama
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Cosmetic benefit; Distal gastrectomy; Gastric cancer; Reduced-port laparoscopic gastrectomy; Total gastrectomy