Comparison of early outcomes of intracorporeal and extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer.

Background: Totally laparoscopic distal gastrectomy (TLDG) has several advantages over laparoscopic-assisted distal gastrectomy (LADG), including a shorter incision, less pain, and earlier recovery. We compared the feasibility and early surgical outcomes of TLDG and LADG in patients with gastric cancer. Methods: Between September 2008 and December 2009, 180 patients with gastric cancer underwent TLDG with intracorporeal gastroduodenostomy using linear staplers; and between January 2006 and December 2009, 268 patients with gastric cancer underwent LADG with extracorporeal gastroduodenostomy using circular staplers. Clinical features and early surgical outcomes were compared between the two groups. Results: There were no between-group differences in postoperative clinical course and complications. Postoperative pain and the amount of pain killer administered were significantly lower (P < .05 each), and postoperative scars were smaller in the TLDG group. Conclusions: TLDG with intracorporeal gastroduodenostomy is as safe and feasible as LADG for patients with gastric cancer. Moreover, TLDG is less invasive and more comfortable for patients than LADG.