Laparoscopy-assisted D2 Subtotal Gastrectomy in Early Gastric Cancer

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Abstract
The purpose of this study is to prove the safety and efficacy of laparoscopy-assisted subtotal gastrectomy and D2 lymph node dissection using 4 ports and an EEA stapler with a Billroth I anastomosis. From 1999 to 2001, 20 patients with EGC located in the distal stomach underwent laparoscopy-assisted Billroth I gastrectomy (LABIG). A 4-port-technique was performed for omentectomy, vascular ligation, and D2 lymph node dissection. A mini-incision was created between the two ports in the epigastric area and a gastroduodenal anastomosis with an EEA stapler and a distal resection was performed. The mean operating time was 261.8 (170–410) minutes. There was one postoperative complication without any intraoperative transfusions or perioperative mortality. The number of harvested nodes was 31.9 ± 11.4. Mean distance from the lesion to the margin of resection was 5.3 ± 2.2 cm proximally and 4.0 ± 2.0 cm distally. On average, oral liquids were started at the 4.7th (3rd -8th) postoperative day. LABIG is a safe and effective way of performing D2 gastrectomy in terms of morbidity and oncological principles. A randomized controlled clinical study to compare long-term survival and quality of life is warranted.