Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2021; 27(18): 2193-2204
Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2193
Totally laparoscopic total gastrectomy using the modified overlap method and conventional open total gastrectomy: A comparative study
Chang Seok Ko, Nam Ryong Choi, Byung Sik Kim, Jeong Hwan Yook, Min-Ju Kim, Beom Su Kim
Chang Seok Ko, Nam Ryong Choi, Byung Sik Kim, Jeong Hwan Yook, Beom Su Kim, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Min-Ju Kim, Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Ko CS, Choi NR, Kim BS, Yook JH and Kim BS performed the literature search, conception and design, drafting of the article; Kim MJ performed the analysis and interpretation; all authors were involved in the critical revision and final approval of the article.
Institutional review board statement: This study was approved by the Institutional Review Board of the Asan Medical Center (approval No. 2019-0702).
Informed consent statement: Patients were not required to give informed consent for the study because the clinical data were obtained retrospectively after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Beom Su Kim, MD, PhD, Professor, Surgeon, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. bskim0251@naver.com
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: March 7, 2021
Revised: March 21, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: May 14, 2021
Abstract
BACKGROUND

Although several methods of totally laparoscopic total gastrectomy (TLTG) have been reported. The best anastomosis technique for LTG has not been established.

AIM

To investigate the effectiveness and surgical outcomes of TLTG using the modified overlap method compared with open total gastrectomy (OTG) using the circular stapled method.

METHODS

We performed 151 and 131 surgeries using TLTG with the modified overlap method and OTG for gastric cancer between March 2012 and December 2018. Surgical and oncological outcomes were compared between groups using propensity score matching. In addition, we analyzed the risk factors associated with postoperative complications.

RESULTS

Patients who underwent TLTG were discharged earlier than those who underwent OTG [TLTG (9.62 ± 5.32) vs OTG (13.51 ± 10.67), P < 0.05]. Time to first flatus and soft diet were significantly shorter in TLTG group. The pain scores at all postoperative periods and administration of opioids were significantly lower in the TLTG group than in the OTG group. No significant difference in early, late and esophagojejunostomy (EJ)-related complications or 5-year recurrence free and overall survival between groups. Multivariate analysis demonstrated that body mass index [odds ratio (OR), 1.824; 95% confidence interval (CI): 1.029-3.234, P = 0.040] and American Society of Anaesthesiologists (ASA) score (OR, 3.154; 95%CI: 1.084-9.174, P = 0.035) were independent risk factors of early complications. Additionally, age was associated with ≥ 3 Clavien-Dindo classification and EJ-related complications.

CONCLUSION

Although TLTG with the modified overlap method showed similar complication rate and oncological outcome with OTG, it yields lower pain score, earlier bowel recovery, and discharge. Surgeons should perform total gastrectomy cautiously and delicately in patients with obesity, high ASA scores, and older ages.

Keywords: Laparoscopic surgery, Gastrectomy, Anastomosis, Stomach neoplasms, Totally laparoscopic total gastrectomy

Core Tip: The aim of the present study was to investigate the effectiveness and surgical outcomes of totally laparoscopic total gastrectomy (TLTG) using the modified overlap method compared with open total gastrectomy (OTG) using the circular stapled method. Although TLTG with the modified overlap method demonstrated similar complication rate and oncological outcome with OTG, it resulted in lower pain scores, and earlier bowel recovery and hospital discharge.