A Comparison Between Two Methods for Tumor Localization During Totally Laparoscopic Distal Gastrectomy in the Patients With Gastric Cancer

Chang Min Lee, Jun-Min Cho, You-Jin Jang, Sung-Soo Park, Seong-Heum Park, Seung-Joo Kim, Young-Jae Mok, Chong-Suk Kim, Jong-Han Kim. Korea University Medical Center

Introduction : TLDG (totally laparoscopic distal gastrectomy) has several advantages over LADG (laparoscopy assisted distal gastrectomy). However, one of critical issues about TLDG is intraoperative tumor localization. The aim of this study is to compare two methods for tumor localization during TLDG in the patients with gastric cancer.

Methods and Procedures: We retrospectively reviewed the medical records from a prospectively collected database of 36 patients who underwent TLDG from July, 2013 to September, 2014 in a single center. The patients were classified into two groups: Radiography group including the patients underwent intraoperative tumor localization by the radiographic imaging, and Endoscopy group including the patients in whom intraoperative endoscopy was performed for localizing the tumor sites. The clinical outcomes were compared between two groups.

Results : Radiography and Endoscopy groups included 15 (41.7 %) and 21 (58.3 %) patients, respectively. Mean operation time was longer in Radiography group than in Endoscopy (328.7 ± 52.5 and 262.0 ± 47.4 minutes, respectively, p < 0.001). Moreover, mean localization time was also longer in Radiography group than in Endoscopy (21.7 ± 12.8 and 7.6 ± 2.9 minutes, respectively, p = 0.001). In addition, mean hospital stay was longer in Radiography group than in Endoscopy (8.1 ± 0.9 and 9.4 ± 2.7 days, respectively, p = 0.040). However, there were no statistically significant differences between two groups in the incidence of complication (26.7 and 23.8 %, respectively, p = 0.845).

Conclusions : If intraoperative endoscopy is performed by a sufficiently trained surgeon, there is no evidence that intraoperative endoscopic localization is inferior than radiographic in terms of the safety. Moreover, the recovery can be facilitated by reducing the operation time, as the surgeon performs intraoperative endoscopy.

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