Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy

Background: Although several studies compare surgical results of laparoscop ic and open colonic resections, there is no study of laparoscopic gastrecto my compared with open gastrectomy. Hypothesis: When compared with conventional open gastrectomy, laparoscopy-a ssisted Billroth I gastrecromy is less invasive in patients with early-stag e gastric cancer. Design: Retrospective review of operative data, blood analyses, and postope rative clinical course after Billroth I gastrectomy. Setting: University hospital in Japan. Patients: The study included 102 patients who were treated with Billroth I gastrectomy for early-stage gastric cancer from January 1993 to July 1999: 49 with laparoscopy-assisted gastrectomy and 53 with conventional open gast rectomy. Main Outcome Measures: Demographic features examined were operation time, b lood loss; blood cell counts of leukocytes, granulocytes, and lymphocytes; serum levels of C-reactive protein, interleukin 6, total protein, and album in; body temperature; weight loss; analgesic requirements; time to first fl atus; time to liquid diet; length of postoperative hospital stay, complicat ions; proximal margin of the resected stomach; and number of harvested lymp h nodes. Results: Significant differences (P<.05) were present between laparoscopy-a ssisted and conventional open gastrectomy when the following features were compared: blood loss (158 vs 302 mt), leukocyte count on day 1 (9.42 vs 11. 14 X 10 degrees/L) and day 3 (6.99 vs 8.22 X 10 degrees/L), granulocyte cou nt on day 1 (7.28 vs 8.90X10 degrees/L), C-reactive protein level on day 7 (2.91 vs 5.19 mg/dL), interleukin 6 level on day 3 (4.2 vs 26.0 U/mL), seru m albumin level on day 7 (35.6 vs 33.9 g/L), number of times analgesics giv en (3.3 vs 6.2), time to first flatus (3.9 vs 4.5 days), time to liquid die t (5.0 vs 5.7 days), postoperative hospital stay (17.6 vs 22.5 days), and w eight loss on day 14 (5.5% vs 7.1%). There was no significant difference be tween laparoscopy-assisted and conventional open gastrectomy with regard to operation time (246 vs 228 minutes), proximal margin (6.2 vs 6.0 cm), numb er of harvested lymph nodes (18.4 vs 22.1), and complication rate (8% vs 21 %). Conclusions: Laparoscopy-assisted Billroth I gastrectomy, when compared wit h conventional open gastrectomy, has several advantages, including less sur gical trauma, less impaired nutrition, less pain, rapid return of gastroint estinal function, and shorter hospital stay, with no decrease in operative curability. Wizen performed by a skilled surgeon, laparoscopy-assisted Bill roth I gastrectomy is a safe and useful technique for patients with early-s tage gastric cancer.