Developing an Institutional Protocol Guideline for Laparoscopy-Assisted Distal Gastrectomy

Sang Eok Lee MD, Young-Woo Kim MD, Jun Ho Lee MD, Keun Won Ryu MD, Soo Jeong Cho MD, Jong Yeul Lee MD, Chan Gyoo Kim MD, Il Ju Choi MD, Myeong-Cherl Kook MD, Byung-Ho Nam PhD, Sook Ryun Park MD, Min Ju Kim MD, Jong Seok Lee MD
Gastrointestinal tumors
Volume 16, Issue 8 / August , 2009

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Abstract

Background

The technical difficulty of lymph node dissection in laparoscopy-assisted distal gastrectomy (LADG) remains a barrier for extending the indication for this modality and limits its widespread clinical practice. The aim of this study was to evaluate our institutional guidelines for LADG, limiting the indications for this modality to only clinical stage T1N0 or T1N1 gastric cancer.

Methods

From January 2002 to October 2006, a total of 294 cases of LADG and 664 cases of open distal gastrectomy (ODG) for clinical T1N0 or T1N1 gastric cancer were performed at the National Cancer Center, Korea. The two groups’ clinicopathologic characteristics, surgical outcome, morbidity, and survival were compared.

Results

The mean operating time for the LADG group was significantly longer than that for the ODG group (265.8 ± 56.3 vs. 171.4 ± 43.1 minutes, P < .001). The mean number of retrieved lymph nodes in the LADG group was higher than that of the ODG group (39.5 ± 14.7 vs. 37.2 ± 12.9, P = .017). The postoperative hospital stay was shorter in the LADG group (8.0 ± 3.3 vs. 10.5 ± 4.1 days, P < .001). The complications rate was lower for the LADG group than that for the ODG group (6.8% vs. 11.3%, P = .032). The overall survival rate was not significantly different between the two groups (P = .880).

Conclusions

Before considering expanding the indications for LADG, developing a carefully thought-out guideline and conducting an audit are mandatory.

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