Gasless laparoscopy-assisted distal gastrectomy for early gastric cancer: Analysis of initial results

Background: Laproscopic surgery is widely used in treating gastrointestinal disease. This study investigated the clinical result, short-term outcomes, and cost analysis of the newly developed gasless laparoscopy-assisted distal gastrectomy (GLADG) and compared it with conventional open distal gastrectomy (ODG). Methods: Seventy-five patients underwent distal gastrectomy with radical lymph node dissection for early gastric cancer from December 2005 to January 2008. Thirty-one patients underwent GLADG and 44 underwent ODG. Postoperative pain, morphine use, disease-free and overall survival, and surgical and hospital costs were measured postoperatively and compared between the two groups. Results: Patients in the two groups were comparable by age, sex, body mass index, tumor size, tumor location, cancer staging, and operative time. The GLADG group had early start of oral intake and shorter postoperative hospital stay (P<05). There was less morphine use from postoperative day 1 to 4 in the GLADG group than in the ODG group (P<.05), and body temperature from postoperative day 1 to 2 was lower in the GLADG than in the ODG group (P<.05). Cost analysis showed that operation cost (100,242±5385 versus 36,455±1419) and equipment cost (65,909±5385 versus 2122±1419) was higher in the GLADG group, but its total hospital cost (193,552±12,715 versus 206,676±41,920) was lower than in the ODG group (P<.05). The 2-year disease-free and overall survival rates were not different between the two groups. Conclusions: GLADG is feasible for early gastric cancer. It is advantageous because of less pain, less postoperative inflammatory response, less blood loss, and shorter total hospital stay while achieving the same oncologic results as ODG.