Application Of Right-to-lateral Approach In Laparoscopic-assisted Radical Distal Gastrectomy

Objective To explore the safety,effect of radical cure and short-term clinical efficacy of right-to-lateral approach in laparoscopic-assisted radical distal gastrectomy. Methods Clinical data of 192 patients with gastric cancer who received laparoscopic-assisted radical distal gastrectomy with right-to-lateral approach(LG group) and 198 cases underwent open radical gastrectomy(OG group)from October 2010 to September 2013 were retrospectively analyzed. The operation time,intraoperative blood loss, the average number of dissected lymph nodes,recovery time of peristalsis,the retain time of gastric tuber, time for dieting, time for getting down from bed,time of pulling urinary drainage tube, painkillers used time, postoperative complieations, postoperative hospital stay and medical expenses were studied. Results There were not statistically significant between LG group and OG group in genders and TNM-staging(p>0.05). All the patients had no serious complications such as death in 192 cases.The conversion to open radical gastrectomy was 7 cases. 185 cases of laparoscopic-assisted radical distal gastrectomy with right-to-lateral approach were successfully completed,including 91 cases with distal gastrectomy Billroth II gastrojejunostomy anastomosis,94 cases with distal gastrectomy gastroduodenal anastomosis(Billroth I 78 cases and delta-shaped anastomosis 16 cases).Compare with OG group, LG group had less intraoperative blood loss(148.81±56.43) ml vs(212.37±53.42) ml,recovery time of peristalsis(3.75±0.89)d vs(5.03±0.89)d, the average time to ground activities(2.83±0.67)d vs(3.98±0.93)d, the retain time of gastric tuber(4.24±0.56)d vs(6.03±0.89)d, time for dieting(5.05±0.89)d vs(6.01±0.84)d,painkillers used time(2.85±0.67)d vs(4.93±0.81)d and postoperative hospital stay(10.78±1.63)d vs(13.22±1.69)d. In the mean operation time,OG groupwere less(178.18±25.68) vs(219.78±19.81)min.The differences had statistic significance(P<0.05).There were no significance(P>0.05)of number of dissected lymph nodes per patient, medical expenses and time of pulling urinary drainage tube between LG and OG group.The postoperative complications in LG group was 5.9%, OG group was 7.1%.No mortality and recurrence were observed during a follow-up period of 3-24 months.Conclusion Right-to-lateral approach in laparoscopic-assisted radical distal gastrectomy is a safe and feasible procedure, and could be feasible for the requirements of tumor cure with less trauma, less bleeding, quick recovery, shorter hospital stay and so on.