Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer: a case-control and case-matched study

Mi Lin, Chao-Hui Zheng, Chang-Ming Huang, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Long-Long Cao, Ru-Hong Tu, Mi Lin, Chao-Hui Zheng, Chang-Ming Huang, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Long-Long Cao, Ru-Hong Tu

Abstract

Objective: To evaluate the safety, feasibility and clinical results of the modified delta-shaped gastroduodenostomy (MDSG) in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer (GC).

Methods: We performed a case-control and case-matched study enrolling 642 patients with GC undergoing laparoscopic distal gastrectomy with Billroth-I anastomosis from January 2011 to December 2014. TLDG with MDSG was performed in 158 patients (Group TL), and laparoscopy-assisted distal gastrectomy with circular anastomosis was performed in 484 patients (Group LA). One-to-one propensity score matching (PSM) was performed to compare the clinicopathological characteristics between the two groups.

Results: Patients with smaller tumors or stage I cancer were more likely to receive TLDG (P < 0.05). In the propensity-matched analysis of 143 pairs, there were no differences in demographic and pathologic characteristics between groups (all P < 0.05). All patients successfully underwent laparoscopic radical distal gastrectomy. Before PSM, Group TL had more dissected lymph nodes (LNs), a longer time to first fluid diet and a longer postoperative length of stay than Group LA (all P < 0.05). After PSM, except for the fact that more dissected LNs were obtained in Group LA (P < 0.05), no difference was found in the intraoperative and postoperative outcomes between the groups (all P > 0.05). The postoperative complications were similar in both groups (all P > 0.05). Stratification analysis performed after PSM showed that in early GC, no difference was observed in intraoperative and postoperative outcomes between the groups (all P > 0.05). However, in locally advanced GC, Group TL had more dissected LNs and a higher rate of postoperative complications (both P < 0.05). Univariate analysis carried out in locally advanced cases after PSM showed that the body mass index (BMI), the method of digestive tract reconstruction and Charlson's score were significant factors that affected postoperative morbidity (all P < 0.05). Multivariate analysis indicated that BMI was an independent risk factor for postoperative morbidity (P < 0.05).

Conclusions: The MDSG in TLDG is safe and feasible for early GC; however, it should be chosen with caution in advanced GC, particularly in patients with a high BMI.

Keywords: Locally advanced; Modified delta-shaped gastroduodenostomy; Stomach neoplasms; Totally laparoscopic surgery.

Figures

Fig. 1
Fig. 1
Enrollment of patients in the study
Fig. 2
Fig. 2
Procedures of laparoscopy-assisted circular anastomosis and modified delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy. A A 28-mm circular stapler was inserted through the greater curvature to perform gastroduodenostomy. B A linear stapler was used to close the greater curvature of the stomach. C The stapler was positioned to join the posterior walls of the gastric remnant and duodenum together. D The completed involution of the common stab incision using the instruments of the surgeon and assistant with the blind angle of the duodenum being pulled up into the stapler. E The completed inverted T-shaped appearance of anastomosis
Fig. 3
Fig. 3
Distribution of propensity scores in the unmatched and matched units

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Source: PubMed

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