Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term
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and Other Interventional Techniques
Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial Shinichi Sakuramoto • Keishi Yamashita • Shiro Kikuchi • Nobue Futawatari • Natsuya Katada • Masahiko Watanabe Toshiyuki Okutomi • Guoqin Wang • Leon Bax
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Received: 21 September 2011 / Accepted: 3 October 2012 / Published online: 18 December 2012 Ó Springer Science+Business Media New York 2012
Abstract Background Short-term outcomes of laparoscopy-assisted distal gastrectomy (LADG) and open DG (ODG) have been investigated in previous clinical trials, but operative techniques and concomitant treatments have evolved, and up-to-date evidence produced by expert surgeons is required to provide an accurate image of the relative efficacies of the treatments. The purpose of this study was to compare laparoscopic versus ODG with respect to specific primary and secondary short-term outcomes. Methods From October 2005 to February 2008, a total of 64 patients with early gastric cancer were randomly assigned to the LADG or the ODG group. One patient was excluded due to concurrent illness unrelated to the intervention, so the data from 63 patients were analyzed. The primary short-term outcome was the 4-day postoperative
Electronic supplementary material The online version of this article (doi:10.1007/s00464-012-2658-9) contains supplementary material, which is available to authorized users. S. Sakuramoto (&) K. Yamashita S. Kikuchi N. Futawatari N. Katada M. Watanabe Department of Surgery, Kitasato University School of Medicine, 2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan e-mail: [email protected] K. Yamashita e-mail: [email protected] T. Okutomi Department of Anesthesiology, Kitasato University School of Medicine, 2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan G. Wang L. Bax Kitasato Clinical Research Center, Kitasato University School of Medicine, 2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan
use of analgesics. Secondary short-term outcomes were postoperative residual pain, complications, days hospitalized, blood data, days with fever, and days to first flatus. Results There was a significant difference in favor of LADG for postoperative use of analgesics (P = 0.022). Unexpectedly, there was no significant difference in degree of pain in the immediate postoperative period, putatively due to the optimal use of analgesics. Of the secondary outcomes, residual pain at postoperative day 7 (P = 0.003) and days to first flatus (P = 0.001) were significantly better with LADG. Postoperative complications, number of days hospitalized, and number of days with fever were also better with LADG, but the differences were not significant. Blood data representing inflammation (WBC and CRP) showed marked differences, especially on postoperative day 7 (P = 0.0016 and P = 0.0061, respectively). Conclusions LADG performed by expert surgeons results in less postoperative pain accom
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