A comparison between two methods for tumor localization during totally laparoscopic distal gastrectomy in patients with gastric cancer

Abstract

Purpose: The aim of this study was to compare two methods of tumor localization during totally laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer.

Methods: From March 2014 to November 2014, patients in whom TLDG had been engaged for middle third gastric cancer enrolled in this study. The patients were allocated to either the radiography or endoscopy group based on the type of tumor localization technique. Clinicopathologic outcomes were compared between the 2 groups.

Results: The accrual was suspended in November 2014 when 39 patients had been enrolled because a failed localization happened in the radiography group. The radiography and endoscopy groups included 17 (43.6 %) and 22 patients (56.4 %), respectively. Mean length of the proximal resection margin did not differ between the radiography and endoscopy groups (4.0 ± 2.6 and 2.8 ± 1.2 cm, respectively; P = 0.077). Mean localization time was longer in the radiography group than in the endoscopy group (22.7 ± 11.4 and 6.9 ± 1.8 minutes, respectively, P < 0.001). There were no statistically significant differences in the incidence of severe complications between the 2 groups (5.9% and 4.5%, respectively, P = 0.851).

Conclusion: As an intraoperative tumor localization for TLDG, radiologic method was unsafe even though other comparable parameters were not different from that of endoscopy group. Moreover, intraoperative endoscopic localization may be advantageous because it is highly accurate and contributes to reducing operation time.

Keywords: Endoscopy; Gastrectomy; Laparoscopy; Stomach neoplasms.

Fig. 1. Preoperative endoscopic clipping. Several metal clips were applied in the preoperative endoscopy.

Fig. 2. Radiographs showing the location of metallic clips. (A) Clips were located between the graspers (Red circle indicates the preoperative applied clips.). (B) Clips were located proximal to the graspers (Red circle indicates the preoperative applied clips.).

Fig. 3. Tumor localization by intraoperative endoscopy. Two surgeons determined the location of tumor in the laparoscopic view, as they compared the endoscopic and laparoscopic view.

Fig. 4. Necessity of preoperative endoscopic clipping. Without preoperative clipping, it is difficult to determine the range of an ambiguous and broad lesion (Yellow arrowhead indicates the preoperatively applied clips.).