Z Gastroenterol 2018; 56(08): e196
DOI: 10.1055/s-0038-1668646
Kurzvorträge
Ösophagus und Magen
Ösophagus und Magen: Chirurgische Techniken – Freitag, 14. September 2018, 16:30 – 17:34, 22a
Georg Thieme Verlag KG Stuttgart · New York

Comparing single incision gastrectomy with corresponding multiport surgery in early gastric cancer

F Berlth
1   Uniklinik Köln, Allgemein-, Viszeral- und Tumorchirurgie, Köln, Deutschland
2   Seoul National University Hospital, Department of Surgery, Division of Gastrointestinal Surgery, Seoul, Korea, Republik
,
YS Suh
2   Seoul National University Hospital, Department of Surgery, Division of Gastrointestinal Surgery, Seoul, Korea, Republik
,
SY Oh
2   Seoul National University Hospital, Department of Surgery, Division of Gastrointestinal Surgery, Seoul, Korea, Republik
,
CC Zhu
2   Seoul National University Hospital, Department of Surgery, Division of Gastrointestinal Surgery, Seoul, Korea, Republik
,
SH Park
2   Seoul National University Hospital, Department of Surgery, Division of Gastrointestinal Surgery, Seoul, Korea, Republik
,
SH Kong
2   Seoul National University Hospital, Department of Surgery, Division of Gastrointestinal Surgery, Seoul, Korea, Republik
,
HJ Lee
2   Seoul National University Hospital, Department of Surgery, Division of Gastrointestinal Surgery, Seoul, Korea, Republik
,
Y Han-Kwang
2   Seoul National University Hospital, Department of Surgery, Division of Gastrointestinal Surgery, Seoul, Korea, Republik
› Author Affiliations
Further Information

Publication History

Publication Date:
13 August 2018 (online)

Also available at
 

Background:

Single port/incision gastrectomy is technically challenging and reliable data regarding oncological outcome and safety is mandatory.

Purpose:

To evaluate safety and efficacy of pure single incision gastrectomy (SI).

Method:

SI was performed using 2.5 – 3.0 cm trans-umbilical incision without assistant port. All single institution SI cases including the first case between 03/2014 – 11/2017 were included, analyzed and propensity score matched for BMI, age, sex and the resection types distal/pylorus-preserving (DG/PPG) and total/proximal (TG/PG) with multiport totally laparoscopic (L) surgery in the same period. Postoperative complication data according to Clavien-Dindo (CD) were taken from a prospectively collected database.

Results:

764 cases were analyzed, including 90 SI, in which no conversion to multiport or open surgery was needed. Before and after 1: 1 matching, no difference was seen in SIDG/SIPPG in regards of overall complication rate (SIDG/SIPPG n = 78, 17.9% vs. LDG/LPPG n = 520, 15,8%, p = 0.652 before matching and 17.9% vs. 11.5%, p = 0.259 after matching). No differences were seen as well for total and proximal gastrectomy (SITG/SIPG n = 12, LTG/LPG n = 154). No statistical difference was seen for overall lymph node count in both groups before and after matching. Operation time was significantly longer by a mean of 15.4minutes after matching SIDG/SIPPG and LDG/LPPG (p = 0.22), whereas no difference was seen for total/proximal gastrectomy (257 m vs. 256 m, p = 0.805). Analysis of learning curve showed no tendency towards faster operation time in all SIDG (n = 74) over time, but CUSUM analysis using comprehensive complication index suggested a stabilization after 30 cases and a drop after 45 cases showing favorable outcomes after time.

Conclusion:

This retrospective propensity score matched study shows non-inferiority of pure single incision gastrectomy compared to corresponding multiport surgery in early gastric cancer, when carried out by a specialized surgeon in a high volume center.