• Journal of Gastric Cancer
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• 제18권4호
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• pp.392-399
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• 2018

Purpose: To determine the incidence of incisional hernia (IH) in mini-laparotomy wounds and analyze the risk factors of IH following laparoscopic distal gastrectomy in patients with gastric cancer. Materials and Methods: A total of 565 patients who underwent laparoscopic distal gastrectomy for gastric cancer at Dong-A University Hospital, Busan, South Korea, between June 2010 and December 2015, were enrolled. IH was diagnosed through physical examination or computed tomography imaging. Incidence rate and risk factors of IH were evaluated through a long-term follow-up. Results: Of those enrolled, 16 patients (2.8%) developed IH. The median duration of follow-up was 58 months (range, 25-90 months). Of the 16 patients with IH, 15 (93.7%) were diagnosed within 12 months postoperatively. Multivariate analysis showed that female sex (odds ratio [OR], 3.869; 95% confidence interval [CI], 1.325-11.296), higher body mass index (BMI; OR, 1.229; 95% CI, 1.048-1.422), and presence of comorbidity (OR, 3.806; 95% CI, 1.212-11.948) were significant risk factors of IH. The vast majority of IH cases (15/16 patients, 93.7%) developed in the totally laparoscopic distal gastrectomy (TLDG) group. However, the type of surgery (i.e., TLDG or laparoscopy-assisted distal gastrectomy) did not significantly affect the development of IH (P=0.060). Conclusions: A median follow-up of 58 months showed that the overall incidence of IH in mini-laparotomy wounds was 2.8%. Multivariate analysis showed that female sex, higher BMI, and presence of comorbidity were significant risk factors of IH. Thus, surgeons should monitor the closure of mini-laparotomy wounds in patients with risk factors of IH undergoing laparoscopic distal gastrectomy.

• Journal of Gastric Cancer
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• 제18권2호
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• pp.152-160
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• 2018

Purpose: Totally laparoscopic gastrectomy (TLG) for advanced gastric cancer (AGC) is a technically and oncologically challenging procedure for surgeons. This study aimed to compare the oncologic feasibility and technical safety of TLG for AGC versus early gastric cancer (EGC). Materials and Methods: Between 2011 and 2016, 535 patients (EGC, 375; AGC, 160) underwent curative TLG for gastric cancer. Clinicopathologic characteristics and surgical outcomes of both patient groups were analyzed and compared. Results: Patients with AGC required a longer operation time and experienced more intraoperative blood loss than those with EGC did. However, patients from both the AGC and EGC groups demonstrated similar short-term surgical outcomes such as postoperative morbidity (14.4% vs. 13.3%, P=0.626), mortality (0% vs. 0.5%, P=0.879), time-to-first oral intake (2.7 days for both groups, P=0.830), and postoperative hospital stay (10.2 days vs. 10.1 days, P=0.886). D2 lymph node dissection could be achieved in the AGC group (95%), with an adequate number of lymph nodes being dissected ($36.0{\pm}14.9$). In the AGC group, the 3-year overall and disease-free survival rates were 80.5% and 73.7%, respectively. Conclusions: TLG is as safe and effective for AGC as it is for EGC.

• Journal of Gastric Cancer
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• 제23권4호
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• pp.523-534
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• 2023

Purpose: Intra-abdominal infection is a common postoperative complication of laparoscopic pylorus-preserving gastrectomies (PPGs). Many studies have reported that intra-abdominal infectious complications after gastrectomy adversely affect patient survival outcomes. To prevent gastric fluid leakage into the abdominal cavity, we developed a novel anastomosis method in which the stomach lumen is not opened (termed the non-opened clean end-to-end anastomosis method [NoCEAM]) and evaluated its feasibility. Materials and Methods: Subsequent to lymphadenectomy, the oral and anal resection lines were sutured using an intraoperative endoscope. After closing the stomach circumferentially with clips, the specimen was rolled outward like a "donut." We resected the specimen circumferentially using a linear stapler, and anastomosis was completed simultaneously. We examined the feasibility of this procedure ex vivo, using three porcine stomachs, and in vivo, using one pig. Subsequently, we applied the procedure to 13 consecutive patients with middle-third early gastric cancer utilizing laparotomic, laparoscopic, and robotic PPG. Results: NoCEAM was completed in all porcine models and human cases. In the human cases, the mean operation time (±standard deviation) was 279±51 minutes, and mean blood loss volume was 22±45 mL. The mean number of linear staples used was 5.06±0.76. None of the patients had complications, and all were discharged on the eighth postoperative. The serum total protein, serum albumin, and hemoglobin levels did not change significantly after surgery. Conclusions: NoCEAM is feasible and safe for performing totally laparoscopic or robotic PPG. It may reduce postoperative complications, such as intra-abdominal infections.

• Journal of Gastric Cancer
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• 제17권3호
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• pp.267-276
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• 2017

Purpose: Different esophagojejunostomy (EJ) reconstruction methods are used after totally laparoscopic total gastrectomy (TLTG), and none is considered a standard technique. This report describes a 2-layer hand-sewn EJ technique during TLTG; we also evaluated postoperative morbidity associated with this technique. Materials and Methods: This retrospective cohort study included all consecutive patients who underwent TLTG for gastric cancer (GC) from 2012 to 2016 at 2 affiliated teaching hospitals. All participating surgeons performed standardized intracorporeal 2-layer hand-sewn EJ. Results: We included 51 patients who underwent TLTG for GC and standardized EJ anastomosis. Twenty-seven (53%) were male, and the median age was 60 (36-87) years. The average operative time was $337{\pm}71minutes$ and intraoperative bleeding was $160{\pm}107mL$. There were no open conversions related to EJ. Postoperative morbidity was observed in 9 (17.0%) patients. There was no postoperative mortality. EJ leakage was observed in 2 patients (3.8%) and 1 patient (1.9%) developed EJ stenosis. Patients with leakage were managed non-operatively and the patient with stenosis required endoscopic dilation. The median length of hospital stay was 8 (6-29) days. Conclusions: Two-layer hand-sewn EJ during TLTG for GC is a feasible and safe technique. This method avoids a laparotomy for reconstruction and the disadvantages associated with laparoscopic introduction of mechanical staplers for EJ, and provides an alternative for alimentary tract reconstruction after TLTG.

• Journal of Gastric Cancer
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• 제5권1호
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• pp.16-22
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• 2005

목적:최근 조기위암환자를 대상으로 복강경보조하 원위부 위적제술이 활발히 시행되고 있으나 전복강경하 원위부 위절제술은 복강 내 위장관 문합의 어려움 때문에 아직까지 활성화되어 있지 않다. 이에 저자들은 복강경용 선형 자동 문합기를 이용한 복강 내 위십이지장 문합술을 통한 전복강경하 원위부 위절제술의 초기 경험을 통하여 그 유용성을 알아보고자 하였다. 대상 및 방법: 2004년 6월부터 9월까지 가톨릭대학교 의과대학 성모자애병원 외과에서 조기위암으로 진단되어 전복강경하 원위부 위절제술을 시행받은 환자 8명을 대상으로 하였으며 복강 내 위십이지장 문합에는 복강경용 선형 자동 문합기를 이용한 델타형 문합 밥법을 이용하였다. 대상 환자에 대한 수술 관련 사항(수술 및 문합에 소요된 시간), 수술의 경과와 임상병리학적인 결과를 통한 근치도를 조사하였다. 결과: 수술 시간은 $369.4\pm62.5$분, 문합에 소요된 시간은 $45.1\pm14.4$분이었으며 증례의 증가에 따라 점차 단축되었다. 문합에 사용한 자동 문합기의 수은 $7.1\pm0.6$개였다. 절제 림프절은 $31.9\pm13.1$개였으며 개복 수술로 전환한 예는 없었다. 수술 후 첫 가스 배출은 $2.8\pm0.5$일, 첫 유동식 섭취는 $4.1\pm0.8$일, 재원 기간은 $10.3\pm4.1$일이었다. 수술과 관련된 합병증은 없었다. 결론: 델타형 위십이지장 문합을 이용한 전복강경하 원위부 위절제술은 기술적으로 용이하였고 조기위암환자에서 복강경 수술의 장점을 최대화할 수 있는 최소침습수술의 하나라고 생각된다.0\%$), 위 중부 20예($21\%$), 위 상부 18예($9\%$)였다. 위암 환자 중 흡연력이 있는 경우는 56명, 없는 경우는 40명이었고, 음주력이 있는 경우는 45명, 없는 경우는 51명이었다. 환자군에서 MTHFR의 유전자 다형성은 C/C 18($19\%$), C/T 59($61\%$), T/T 19($20\%$)였고, 대조군에서는 C/C 116($40\%$), C/T 103$40\%$), T/T 68($24\%$)이었다(P=0.045). 암의 위치에 따른 MTHFR유전자형의 분포는 위 하부에서 C/C 16($28\%$), C/T & T/T 42($77\%$)이었고, 위 중부 및 상부에서 C/C 2($5\%$), C/T & T/T 36($75\%$) 이었다(P=0.006). 환자군 내에서 흡연력 유무에 따른 MTHFR유전 자형의 분포는 흡연력이 있을 때 C/C 13($23\%$), C/T & T/T 43($77\%$)이었고, 흡연력이 없을 때 C/C 5($12\%$), C/T & T/T 35 ($88\%$)였다(P=0.189). 환자군 내에서 음주력 유무에 따른 MTHFR유전자형의 분포는 음주력이 있을 때 C/C 12($26\%$), C/T & T/T 33($74\%$)이었고, 음주력이 없을 때 C/C 6($12\%$),

• Journal of Minimally Invasive Surgery
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• 제21권4호
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• pp.180-182
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• 2018

The frequency of anastomotic leakage after gastrectomy is reported to be 0.9~8%. To reduce deleterious outcomes of anastomotic leakage, we devised the "Omental Free-shaped Flap Reinforcement On Anastomosis and Dissected area" procedure not only to prevent fatal complications following anastomotic leakage but also to promote vascularity of anastomoses and other expected oncological benefits. This video illustrates the surgical procedure following a totally laparoscopic distal gastrectomy. After completion of the anastomosis, the remaining omentum was mobilized upward and divided into two sections. We placed the left section of the omental flap under the anastomosis between the stomach and pancreas. Finally, we grasped and curved the tip of the section to cover the anastomosis from behind, and we placed the right section of the omental flap above the anastomosis. These two sections were approximated with clips to the anterior wall of the stomach. The patient was discharged without complications.

• Journal of Gastric Cancer
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• 제7권3호
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• pp.132-138
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• 2007

목적: 최근 우리나라에서는 복강경보조하 위절제술이 활발히 시행되고 있으나 전복강경하 위절제술은 복강 내 위장관 문합의 어려움 때문에 별로 시행되고 있지 않다. 이에 저자들은 복강경용 선형 문합기를 이용한 다양한 복강내 문합술을 통한 전복강경하 위절제술의 경험을 통하여 그 유용성을 알아보고자 하였다. 대상 및 방법: 2004년 6월부터 2007년 5월까지 000대학교 0000병원 외과에서 위암 또는 위양성종양으로 전복강경하 위절제술을 시행 받은 환자 81명을 대상으로 하였으며 위절제술 후 복강 내 문합에는 복강경용 선형 문합기 만을 사용하였다. 대상 환자에 대한 수술의 결과와 임상병리학적인 결과를 후향적으로 조사하였다. 결과: 수술 시간은 평균 287분이었고, 문합에 소요된 시간은 평균 40분이었으며 사용한 선형 문합기의 카트리지 수는 평균 7.5개였다. 수술 후 첫 가스 배출은 2.9일, 첫 유동식 섭취는 3.6일, 재원 기간은 10.3일이었다. 수술과 관련된 합병증은 11예(13.6%)에서 발생하였으나 수술로 인한 사망예나 개복수술로의 전환 예는 없었다. 75명의 위암 환자에서 절제된 림프절은 평균 38.1개였으며 병기는 I기가 72명, II기가 2명 그리고 IV기가 1명이었다. 위암 환자들의 평균 추적기간 16개월 동안에 5명의 환자가 사망하였으나 위암의 재발에 의한 사망은 없었다. 결론: 전복강경하 위절제술은 안전하고 기술적으로 용이 하였으며 위절제술이 필요한 환자들에 대한 좋은 최소침습수술 중의 하나라고 생각한다.

• Journal of Gastric Cancer
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• 제13권4호
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• pp.266-272
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• 2013

We report our experience with two cases of situs inversus totalis, both involving patients diagnosed with gastric cancer. These were a 52-year-old male with a preoperative staging of cT1bN0M0 and a 68-year-old male with a staging of cT2N0M0, both of whom underwent surgery. The former was found to have vascular anomalies in the preoperative computed tomography, so we performed a computed tomography angiography with three-dimensional reconstruction. Laparoscopy-assisted distal gastrectomy with Billroth I anastomosis was performed with D1+ lymph node dissection, and a small laparotomy was made for extracorporeal anastomosis. In contrast, the latter case showed no vascular anomalies in the preoperative computed tomography, and totally laparoscopic distal gastrectomy with delta anastomosis was performed with D1+ lymph node dissection. There were no intraoperative problems in either patient and they were discharged without postoperative complications. Histopathological examination revealed a poorly differentiated adenocarcinoma (pT2N0M0) and a well-differentiated adenocarcinoma (pT1aN0M0), respectively.

• Journal of Gastric Cancer
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• 제19권4호
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• pp.438-450
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• 2019

Purpose: Although linear-shaped gastroduodenostomy (LSGD) was reported to be a feasible and reliable method of Billroth I anastomosis in patients undergoing totally laparoscopic distal gastrectomy (TLDG), the feasibility of LSGD for patients undergoing totally robotic distal gastrectomy (TRDG) has not been determined. This study compared the feasibility of LSGD in patients undergoing TRDG and TLDG. Materials and Methods: All c: onsecutive patients who underwent LSGD after distal gastrectomy for gastric cancer between January 2009 and December 2017 were analyzed retrospectively. Propensity score matching (PSM) analysis was performed to reduce the selection bias between TRDG and TLDG. Short-term outcomes, functional outcomes, learning curve, and risk factors for postoperative complications were analyzed. Results: This analysis included 414 patients, of whom 275 underwent laparoscopy and 139 underwent robotic surgery. PSM analysis showed that operation time was significantly longer (163.5 vs. 132.1 minutes, P<0.001) and postoperative hospital stay significantly shorter (6.2 vs. 7.5 days, P<0.003) in patients who underwent TRDG than in patients who underwent TLDG. Operation time was the independent risk factor for LSGD after intracorporeal gastroduodenostomy. Cumulative sum analysis showed no definitive turning point in the TRDG learning curve. Long-term endoscopic findings revealed similar results in the two groups, but bile reflux at 5 years showed significantly better improvement in the TLDG group than in the TRDG group (P=0.016). Conclusions: LSGD is feasible in TRDG, with short-term and long-term outcomes comparable to that in TLDG. LSGD may be a good option for intracorporeal Billroth I anastomosis in patients undergoing TRDG.

• Journal of Gastric Cancer
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• 제11권4호
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• pp.239-242
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• 2011

A debate is currently ongoing about whether a large gastrointestinal stromal tumor (GIST) should be treated by the laparoscopic approach because of the increased risk of tumor rupture during manipulation of the tumor with laparoscopic instruments and the resultant peritoneal tumor dissemination. Herein, we report a case of a large GIST of the stomach which was successfully treated by the laparoscopic approach. A 57 year old female patient visited our institution complaining of postprandial epigastric discomfort. An esophagogastroduodenoscopy and an abdominal computed tomography scan revealed a $10{\times}8$ cm sized submucosal tumor at the greater curvature side of the gastric antrum. The patient underwent laparoscopic distal gastrectomy with intracorporeal Billroth-II reconstruction without any breakage of the tumor. Her postoperative course was uneventful and she was discharged on the 7th postoperative day. Even a large GIST of the stomach can safely be treated by the laparoscopic approach when it is performed with proper techniques by an experienced surgeon.