Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience

Table 1 Clinical characteristics of patients who underwent laparoscopic-assisted total gastrectomy and totally laparoscopic total gastrectomy

Variable	LATG, n = 266	TLTG, n = 421	P value
Age in years, mean ± SD	55.69 ± 11.96	57.78 ± 11.20	0.020
Sex			0.583
Male	167 (62.8)	273 (64.8)
Female	99 (37.2)	148 (35.2)
ASA score			0.064
I	181 (68.0)	249 (59.1)
II	68 (25.6)	145 (34.4)
III	17 (6.4)	27 (6.4)
BMI in kg/m2			0.883
< 23	119 (44.7)	198 (47.0)
≥ 23, < 25	70 (26.3)	103 (24.5)
≥ 25, < 30	69 (25.9)	110 (26.1)
≥ 30	8 (3.0)	10 (2.4)
History of abdominal surgery	33 (12.4)	85 (20.2)	0.008

Values are expressed as mean ± SD or n (%). ASA: American Society of Anesthesiologists physical status classification; BMI: Body mass index; LATG: Laparoscopic-assisted total gastrectomy; TLTG: Totally laparoscopic total gastrectomy.

Table 2 Pathologic results of the laparoscopic-assisted total gastrectomy and totally laparoscopic total gastrectomy groups

Variable	LATG, n = 266	TLTG, n = 421	P value
Tumor size in cm	3.72 ± 2.47	3.95 ± 2.90	0.302
Retrieved lymph nodes, n	34.91 ± 13.92	40.04 ± 15.59	< 0.001
metastatic lymph nodes, n	0.63 ± 2.59	0.82 ± 3.20	0.421
Proximal margin in cm	3.85 ± 3.11	2.68 ± 2.62	< 0.001
Distal margin in cm	12.72 ± 4.86	12.79 ± 4.67	0.870
TNM (AJCC/UICC) staging			0.395
IA	202 (75.9)	285 (67.7)
IB	26 (9.8)	52 (12.4)
IIA	19 (7.1)	40 (9.5)
IIB	8 (3.0)	22 (5.2)
IIIA	5 (1.9)	8 (1.9)
IIIB	4 (1.5)	11 (2.6)
IIIC	2 (0.8)	3 (0.7)

Values are expressed as mean ± SD or n (%). AJCC/UICC: 7^th edition of the American Joint Committee on Cancer staging - Union for International Cancer Control; LATG: Laparoscopic-assisted total gastrectomy; TLTG: Totally laparoscopic total gastrectomy.

Table 3 Early surgical outcomes in patients undergoing laparoscopic-assisted total gastrectomy and totally laparoscopic total gastrectomy

Variables	LATG, n = 266	TLTG, n = 421	P value
Operation time in min	170 (65-453)	149 (75-342)	< 0.001
Hematocrit change in (%)	4.04 (-3.8-15.2)	3.49 (-4.9-18.6)	0.002
Intra-operative transfusion	1 (0.4)	1 (0.2)	1.000
Post operative transfusion	28 (10.5)	55 (13.1)	0.32
Intra-operative event	27 (10.2)	13 (3.1)	< 0.001
Intra-operative anastomosis event	19 (7.1)	10 (2.4)	0.003
Combined operation	17 (6.4)	27 (6.4)	1.000
Time to first flatus in d (range)	3.60 (1-7)	3.30 (1-7)	< 0.001
Time to soft diet in d (range)	4.61 (2-68)	4.30 (3-36)	< 0.001
Pick of pain score, score (range)	7.11 (2-10)	6.96 (3-10)	0.912
8AM Pain socre of POD #1, score (range)	3.45 (0-10)	3.49 (0-10)	0.841
8AM Pain socre of POD #3, score (range)	2.44 (0-9)	2.54 (0-7)	0.529
8AM Pain socre of POD #5, score (range)	1.75 (0-10)	1.51 (0-8)	0.055
Number of administration of analgesics, n (range)	2.49 (0-69)	2.86 (0-67)	0.131
Post-operative hospital stay in d (range)	7.02 (5-1117)	6.75 (4-82)	0.005

Values are expressed as median (range) or n (%). Hematocrit change means the difference between preoperative hematocrit and postoperative hematocrit. LATG: Laparoscopic-assisted total gastrectomy; POD: Postoperative days; TLTG: Totally laparoscopic total gastrectomy.

Table 4 Early and late postoperative complications n (%)

	Early complications			Late complications
	LATG, n = 266	TLTG, n = 421	P value	LATG, n = 266	TLTG, n = 421	P value
CDC			0.447			0.681
0	213 (80.1)	334 (79.3)		245 (92.1)	384 (91.2)
1	24 (9.0)	26 (6.2)		10 (3.8)	15 (3.6)
2	13 (4.9)	26 (6.2)		0 (0)	4 (1.0)
3	12 (4.5)	33 (7.8)		11 (4.1)	18 (4.3)
4	4 (1.5)	2 (0.5)		0 (0)	0 (0)
Cx of EJ			0.211			0.439
None	252 (94.7)	407 (96.7)		262 (98.5)	418 (99.3)
Leakage	14 (5.3)	14 (3.3)		1 (0.4)	1 (0.2)
Stricture	0 (0.0)	0 (0.0)		3 (1.1)	2 (0.5)

Values are expressed as n (%). CDC: Clavien-Dindo classification; Cx: Complications; EJ: Esophagojejunostomy; LATG: Laparoscopic-assisted total gastrectomy; TLTG: Totally laparoscopic total gastrectomy.

Table 5 Postoperative complications in patients who underwent laparoscopic-assisted total gastrectomy and totally laparoscopic total gastrectomy n (%)

	LATG, n = 266	TLTG, n = 421
Bleeding	4 (1.50)	8 (1.90)
EJ leakage	15 (5.64)	15 (3.56)
EJ stricture	3 (1.13)	2 (0.48)
Intraabdominal fluid collection	8 (3.01)	26 (6.18)
Internal hernia	5 (1.88)	12 (2.85)
Mechanical ileus	10 (3.76)	28 (6.65)
Paralytic ileus	3 (1.13)	7 (1.66)
Wound infection	18 (6.77)	9 (2.14)
Other surgical complications	4 (1.50)	8 (1.90)
Medical complications	4 (1.50)	2 (0.48)

EJ: Esophagojejunostomy; LATG: Laparoscopic-assisted total gastrectomy; TLTG: Totally laparoscopic total gastrectomy.