Influence of liver function after laparoscopy-assisted vs totally laparoscopic gastrectomy

Abstract

Background: Previously, some studies have proposed that total laparoscopic gastrectomy (TLG) is superior to laparoscopic-assisted gastrectomy (LAG) in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications. However, there are still few studies on the changes in postoperative liver function in patients undergoing LG. The present study compared the postoperative liver function of patients with TLG and LAG, aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.

Aim: To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.

Methods: The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center (including the Department of Gastrointestinal Surgery and the Department of General Surgery) of Zhongshan Hospital affiliated with Xiamen University, including 40 patients who underwent TLG and 40 patients who underwent LAG. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGLT), total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL), and other liver function-related test indices were compared between the 2 groups before surgery and on the 1^st, 3^rd, and 5^th d after surgery.

Results: The levels of ALT and AST in the 2 groups were significantly increased on the 1^st to 2^nd postoperative days compared with those before the operation. The levels of ALT and AST in the TLG group were within the normal range, while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group (P < 0.05). The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range (P < 0.05). The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2, the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4, and the TBIL, DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7 (P < 0.05). No significant difference was observed at other time points (P > 0.05).

Conclusion: Both TLG and LAG can affect liver function, but the effect of LAG is more serious. The influence of both surgical approaches on liver function is transient and reversible. Although TLG is more difficult to perform, it may be a better choice for patients with gastric cancer combined with liver insufficiency.

Keywords: Alanine aminotransferase; Aspartate aminotransferase; Laparoscopy-assisted gastrectomy; Liver function; Totally laparoscopic gastrectomy.

Figure 1

Liver traction. A: Liver traction by a fine line; B: Abdominal incision in the totally laparoscopic gastrectomy group; C: Liver traction by an S-type retractor and Abdominal incision in another 7 cm longitudinal incision group.

Figure 2

Comparison of transaminase levels in each group. A: Changes in alanine aminotransferase in each group; B: Changes in aspartate aminotransferase in each group. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BO: Before the operation; AO: After the operation.

Figure 3

Hierarchical comparison of transaminases in each group. A: Changes in alanine aminotransferase (ALT) in total laparoscopic total gastrectomy (TLTG) group and laparoscopic-assisted total gastrectomy (LATG) group; B: Changes in aspartate aminotransferase (AST) in TLTG group and LATG group; C: Changes in ALT in total laparoscopic distal gastrectomy (TLGG) group and laparoscopic-assisted distal gastrectomy (LAGG) group; D: Changes in AST in TLGG group and ALGG group. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TLTG: Total laparoscopic total gastrectomy; LATG: Laparoscopic-assisted total gastrectomy; TLGG: Total laparoscopic distal gastrectomy; LAGG: Laparoscopic-assisted distal gastrectomy; BO: Before the operation; AO: After the operation.

Figure 4

Comparison of bilirubin in each group. A: Changes in total bilirubin in each group; B: Changes in direct bilirubin in each group; C: Changes in indirect bilirubin in each group. TBIL: Total bilirubin; DBIL: Direct bilirubin; IBIL: Indirect bilirubin; BO: Before the operation; AO: After the operation.

Figure 5

Comparison of other liver function indicators in each group. A: Changes in alkaline phosphatase in each group; B: Changes in γ-glutamyltransferase in each group. ALP: Alkaline phosphatase; GGLT: γ-glutamyltransferase; BO: Before the operation; AO: After the operation.