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

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. 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. 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 +/- A 36.8 g) than in LADG (62.5 +/- A 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 +/- A 2.6 days) than for LADG (12.0 +/- A 3.5 days). Serum C-reactive protein level on day 7 after surgery was significantly lower in TLDG (2.58 +/- A 2.57 mg/ml) than LADG (4.85 +/- A 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. 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.