Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer: a report of short-term outcomes.

Background: The safety and efficacy of laparoscopic gastrectomy in the treatment of early gastric cancer have been demonstrated in many clinical studies. Most surgeons prefer laparoscopy-assisted gastrectomy with extracorporeal anastomosis rather than total laparoscopic procedures because of the technical difficulties of intracorporeal anastomosis. This study assessed the efficacy of total laparoscopic Billroth-I (B-I) gastrectomy.

Methods: We conducted a retrospective analysis of a single surgeon's experience. We reviewed patients with gastric cancer who underwent laparoscopic B-I gastrectomy (n=83) and classified them into laparoscopy-assisted distal gastrectomy (LADG; n=41) and total laparoscopic distal gastrectomy (TLDG; n=42) groups. Short-term surgical variables and outcomes were compared between the groups.

Results: There was no difference in gender, mean age, body mass index, or tumor characteristics between the groups. Estimated blood loss was significantly less in TLDG (21.2±36.8 g) than in LADG (62.5±81.6 g). Anastomotic leakage was not recorded in either group, and there was no difference in the incidence of other postoperative complications. Postoperative hospital stay was shorter for TLDG (10.6±2.6 days) than for LADG (12.0±3.5 days). Serum C-reactive protein level on day 7 after surgery was significantly lower in TLDG (2.58±2.57 mg/ml) than LADG (4.85±6.17 mg/ml); however, the level on day 1 or 4 was not significantly different. There was no difference in nutritional status or clinical symptoms during the 3 months after surgery.

Conclusions: TLDG can be performed safely after appropriate experience with LADG. Our results imply that TLDG may lead to faster recovery, better cosmesis, and improved quality of life in the short-term compared with LADG. Because of the limitations of a retrospective analysis on the study and a patient selection bias, a prospective randomized study should be conducted to reach definitive conclusions.