Laparoscopy-Assisted Distal Gastrectomy（LADG） for Early Gastric Cancer : A review of forty cases

概要

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　Forty patients with an average age of 64.6 years （range: 45-83） with early gastric cancer of cT1 （M,SM） underwent a curative-intended laparoscopy-assisted distal gastrectomy （LADG） where laparoscopic D1+αnodal clearance and extra-abdominal Billroth-I stapled anastomosis were performed. There was no conversionto open gastrectomy. The operation time for the 40 cases ranged 150 - 482 min （median: 285）, while that for thelatest 10 cases reduced to 154-278 min （median: 216）. The length of hospital stay of the patients varied 10-85 days（median: 17）. Postoperative complications encountered were anastomosis-related: 2 anastomotic bleeding and 2anastomotic passage disturbance（ 1 stricture and 1 temporary stenosis） occurred but no dehiscence. Four inaccuratepreoperative diagnoses of tumor invasion depth were revealed by postoperative pathology of the resected specimens.Thereafter the accuracy in the preoperative diagnosis was highly enhanced with implementation of endoscopicultrasound. Recurrence occurred in one patient with pT2（ SS） pN2, who died of pleural carcinomatosis 4 years and 3months after surgery.　 As the reduced operation time in LADG came closer to that in open distal gastrectomy, we will continuethis procedure for early gastric cancer. For this, the importance of an accurate preoperative diagnosis can’t beoveremphasized.