Laparoscopy-assisted distal gastrectomy with D1+beta compared with D1+alpha lymph node dissection.

BACKGROUND

Laparoscopy-assisted distal gastrectomy (LADG) with D1+beta lymph node dissection has become the most popular treatment for early gastric cancer in Asian countries. However, the same clinical advantages with this procedure as with LADG with D1+alpha lymph node dissection has not been shown. The aim of this study was to compare the outcome of LADG with D1+beta to that of LADG with D1+alpha lymph node dissection.

METHODS

During the period June 2002 through June 2006, LADG with D1+alpha lymph node dissection was performed in 54 patients, and LADG with D1+beta lymph node dissection was performed in 42 patients. Surgical findings, clinicopathological data, postoperative course, complications, nutritional status, and blood analysis findings were compared between the two groups. Differences were analyzed with Mann-Whitney U test and chi-square test.

RESULTS

Patients in the two groups were comparable with respect to age, sex, body mass index, and stage and pathological characteristics of gastric cancer. A significantly greater number of N2 lymph nodes were harvested by D1+beta lymph node dissection than by D1+alpha dissection (5.9 vs. 2.7, P < 0.01). However, no significances in the total number of retrieved lymph nodes (24.7 vs. 22.2) or perigastric lymph nodes dissected (18.9 vs. 19.4) were identified between the D1+beta and D1+alpha groups. There was also no significant difference between the D1+alpha and D1+beta groups with respect to operation time, blood loss, complication rate, time to first walking, first flatus, first eating, and first defecation, frequency of analgesics given, volume of food intake on postoperative day 7, weight loss, and postoperative hospital stay. Blood analysis showed there were no significant differences in white blood cell count, granulocyte count, lymphocyte count, levels of C-reactive protein, and serum albumin.

CONCLUSIONS

The short-term outcome of LADG with D1+beta lymph node dissection is comparable to that of LADG with D1+alpha lymph node dissection. According to the oncological requirements, we can apply this operation as a minimally invasive surgery.