Comparative study of clinical outcomes between conventional laparoscopic distal gastrectomy and pure single-incision distal gastrectomy for early gastric cancer.

Sang-Hoon Ahn, MD, Do Joong Park, MD, PhD, Hyung-Ho Kim, MD, PhD. Department of Surgery, Seoul National University Bundang Hospital.

Purpose: Single-port surgery was introduced to reduce the invasiveness of laparoscopic surgery. The aim of this study was to show the feasibility and safety of pure single-incision laparoscopic distal gastrectomy (SIDG) by comparing its short-term outcomes with those of conventional laparoscopic distal gastrectomy (LDG).

Methods: Prospectively collected data of 90 gastric cancer patients who underwent pure SIDG from October 2010 through May 2013 were compared with the matched data of 45 patients who underwent LDG by single surgeon.

Results: All 90 patients underwent distal gastrectomy with gastroduodenostomy or uncut Roux-en-Y gastrojejunostomy without open or laparoscopic conversion. The mean operation time was similar in the both groups (149.1 vs 142.3 min, P = 0.367). The estimated blood loss (EBL) was lesser in the SIDG group (52.3 ± 32.8 vs. 91.4 ± 79.1 ml, P = 0.003), as was postoperative pain in terms of immediate postoperative visual analogue scale scores (6.2 ± 1.5 vs 7.0 ± 1.4, P = 0.015) and usage of parenteral analgesics (0.77 ± 1.00 vs 1.4 ± 1.0, P = 0.020). Postoperative morbidity occurred in 4 and 5 patients in the SIDG and LDG group, respectively. Cosmetic result, which was assessed by numerical rating scale, was more satisfactory in the SIDG group (9.00 vs 6.09, P < 0.001)

Conclusion: pure SIDG seems safe and feasible for early gastric cancer, and has similar or better short-term outcomes than does LDG in terms of postoperative pain, EBL, and cosmetic result. However, further studies are required to confirm its safety and feasibility.

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