Short-term outcome of laparoscopic assited distal gastrectomy for early gastric cancer in obese and nonobese patients

Katsunobu Sakurai, PhD, Kazuya Muguruma, PhD, Hiroaki Tanaka, PhD, Tomohiro Lee, PhD, Hisashi Nagahara, Kenjiro Kimura, PhD, Takahiro Toyokawa, PhD, Eiji Noda, PhD, Ryosuke Amano, PhD, Naoshi Kubo, PhD, Masakazu Yashiro, PhD, Kiyoshi Maeda, Masaichi Ohira, PhD, Kosei Hirakawa, PhD

Department of Surgical Oncology, Osaka City University Graduated School of Medicine

Background: LADG for early gastric cancer has widely accepted in Japan. However technical difficulty depends on the obesity of patients strongly because it is difficult to keep laparoscopic working space in obese patients. We assessed the short-term results of this procedure in a group of obese patients.

Method: Between January 2009 and December 2011, 107 patients with early gastric cancer underwent LADG with perigastric lymph node dissection at the department of surgical oncology of Osaka City University Graduate School of Medicine in Japan. The indication for LADG was tumor restricted to the mucosa or submucosa. The patients were divided into two groups, consisting of obese and nonobese patients, according to the obesity criteria recommended by the Japan Society for the Study of Obesity. Body mass index (BMI) in the nonobese group was <25.0 kg/m2 (n=81); in the obese group, (BMI) was >25.0 kg/m2 (n=26).

Result: Mean BMI in the obese group was 28.3; in the nonobese group, BMI was 21.7. Operative time was significantly longer in obese patients than in nonobese patients (275 vs 250 min, p<0.05). Mean estimated blood loss was greater for obese than for nonobese patients (137 vs 78 ml, p<0.05). The length of postoperative hospital stay was significantly longer in obese than in nonobese patients (18.7 vs 14.1 days, p<0.01). There was no difference between the two groups in the numbers of lymph node dissection (35.0 vs 33.9). As the intra-operative complication in nonobese patients, one case of a perforation of jejunum and one of injury of splenic artery were recognized. There was no intra-operative complication in obese patients. Postoperative complication occurred 30.8% (wound infection in two cases, pancreatic fistula in two cases, pneumonia in one case, intra-peritoneal abcess in one case, remnant gastritis in one case, urinary infection in one case) in obese patients, and 16.0% (anastomotic bleeding in three cases, wound infection in two cases, intra-peritoneal abcess in two cases, pancteatic fistula in two cases, anastomotic stenosis in two cases, colitis in one case, intractable vomiting in one case). There were no conversional open surgery and no operative deaths in both groups.

Conclusion: LADG in obese patients required a longer operating time, greater blood loss and a longer length of postoperative hospital days. Postoperative complication trended more in obese patients than in nonobese patients, but there was no major complication in even obese patients. Therefore we believe that LADG is likely to be a safe and feasible treatment for even obese patients with early gastric cancer.

Session: Poster Presentation

Program Number: P610

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