Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3604–3612 | Cite as

Surgical Outcomes of Reduced-Port Laparoscopic Gastrectomy Versus Conventional Laparoscopic Gastrectomy for Gastric Cancer: A Propensity-Matched Retrospective Cohort Study

  • Chikara KunisakiEmail author
  • Hiroshi Miyamoto
  • Sho Sato
  • Yusaku Tanaka
  • Kei Sato
  • Yusuke Izumisawa
  • Norio Yukawa
  • Takashi Kosaka
  • Hirotoshi Akiyama
  • Yusuke Saigusa
  • Kentaro Sakamaki
  • Takeharu Yamanaka
  • Itaru Endo
Gastrointestinal Oncology



The technical feasibility and oncologic efficacy of reduced-port laparoscopic gastrectomy (RPG) for gastric cancer remain unclear.


A series of 767 patients with gastric cancer who underwent R0 laparoscopic gastrectomy were retrospectively matched for age, gender, American Society of Anesthesiology score, body mass index, surgeon, lymph node dissection, and pathologic stages by propensity scoring. Finally, data from 274 patients (74 conventional laparoscopic distal gastrectomy [CLDG] cases, 74 reduced-port distal gastrectomy [RPDG] cases, 63 conventional laparoscopic total gastrectomy [CLTG] cases, and 63, reduced-port total gastrectomy [RPTG] cases) were selected for analysis.


Compared with the conventional group, the reduced-port group had significantly longer operation times (RPDG 265 min vs CLDG 239 min; p = 0.001 and RPTG 305 min vs CLTG 285 min; p = 0.012) and reduced blood loss (RPDG 48 ml vs CLDG 68 ml; p = 0.001 and RPTG 75 ml vs CLTG 110 ml; p = 0.026). The number of dissected lymph nodes was significantly higher in the CLDG group than in the RPDG group (38 vs 31; p = 0.002). Cosmetic satisfaction showed significant superiority in the reduced-port group compared with the conventional group. No significant difference was observed in overall survival (OS) (5-year OS: RPDG 100% vs CLDG 96.7%; p = 0.207 and RPTG 91.6% vs CLTG 91.8%; p = 0.615) or relapse-free survival (RFS) (5-year RFS: RPTG 92.3% vs CLTG 92.1%; p = 0.587).


The study results suggest that RPG for gastric cancer by an experienced surgeon is a feasible and safe technique. The RPG procedure can be presented to patients as one of the effective treatment options.


  1. 1.
    Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC. Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg. 2006;202:874–80.CrossRefGoogle Scholar
  2. 2.
    Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255:446–56.CrossRefGoogle Scholar
  3. 3.
    Takiguchi S, Fujiwara Y, Yamasaki M, et al. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy: a prospective randomized single-blind study. World J Surg. 2013;37:2379–86.CrossRefGoogle Scholar
  4. 4.
    Kunisaki C, Makino H, Kosaka T, et al. Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case-control study. Surg Endosc. 2012;26:804–10.CrossRefGoogle Scholar
  5. 5.
    Fukunaga T, Hiki N, Kubota T, et al. Oncologic outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20:2676–82.CrossRefGoogle Scholar
  6. 6.
    Inaki N, Etoh T, Ohyama T, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg. 2015;39:2734–41.CrossRefGoogle Scholar
  7. 7.
    Park DJ, Han SU, Hyung WJ, et al. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. Surg Endosc. 2012;26:1548–53.CrossRefGoogle Scholar
  8. 8.
    Yu J, Hu J, Huang C, et al. The impact of age and comorbidity on postoperative complications in patients with advanced gastric cancer after laparoscopic D2 gastrectomy: results from the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group. Eur J Surg Oncol. 2013;39:1144–9.CrossRefGoogle Scholar
  9. 9.
    Kim KH, Kim YM, Kim MC, Jung GJ. Is laparoscopy-assisted total gastrectomy feasible for the treatment of gastric cancer? A case-matched study. Dig Surg. 2013;30:348–54.PubMedGoogle Scholar
  10. 10.
    Kunisaki C, Makino H, Oshima T, et al. Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc. 2011;25:1300–5.CrossRefGoogle Scholar
  11. 11.
    LaFemina J, Viñuela EF, Schattner MA, Gerdes H, Strong VE. Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol. 2013;20:2975–83.CrossRefGoogle Scholar
  12. 12.
    Kawamura H, Tanioka T, Shibuya K, Tahara M, Takahashi M. Comparison of the invasiveness between reduced-port laparoscopy-assisted distal gastrectomy and conventional laparoscopy-assisted distal gastrectomy. Int Surg. 2013;98:247–53.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T. Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc. 2011;25:2400–4.CrossRefGoogle Scholar
  14. 14.
    Kawamura H, Tanioka T, Kuji M, Tahara M, Takahashi M. the initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy. Gastric Cancer. 2013;16:602–8.CrossRefGoogle Scholar
  15. 15.
    Kunisaki C, Ono HA, Oshima T, Makino H, Akiyama H, Endo I. Relevance of reduced-port laparoscopic distal gastrectomy for gastric cancer: a pilot study. Dig Surg. 2012;29:261–8.CrossRefGoogle Scholar
  16. 16.
    Kunisaki C, Makino H, Kimura J, et al. Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen. Gastric Cancer. 2015;18:868–75.CrossRefGoogle Scholar
  17. 17.
    Sobin LH, Gospodarowicz MK, Wittekind C. International Union Against Cancer (UICC) TNM classification of malignant tumors. 8th ed. New York: Wiley; 2016.Google Scholar
  18. 18.
    Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2018, Version 5, in Japanese. Tokyo: Kanehara; 2018.Google Scholar
  19. 19.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: third english edition. Gastric Cancer. 2011;14:101–12.CrossRefGoogle Scholar
  20. 20.
    Lee TG, Lee IS, Yook JH, Kim BS. Totally laparoscopic total gastrectomy using the overlap method: early outcomes of 50 consecutive cases. Surg Endosc. 2017;31:3186–90.CrossRefGoogle Scholar
  21. 21.
    Li X, Hong L, Ding D, et al. Comparison of OrVil and RPD in laparoscopic total gastrectomy for gastric cancer. Surg Endosc. 2017;31:4773–9.CrossRefGoogle Scholar
  22. 22.
    Shi Y, Xu X, Zhao Y, et al. Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc. 2018;32:2427–33.CrossRefGoogle Scholar
  23. 23.
    Nakauchi M, Suda K, Nakamura K, et al. Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional, and oncological outcomes. Surg Endosc. 2017;31:4631–40.CrossRefGoogle Scholar
  24. 24.
    Kim SM, Ha MH, Seo JE, et al. Comparison of reduced-port totally laparoscopic distal gastrectomy (Duet TLDG) and conventional laparoscopic-assisted distal gastrectomy Ann Surg Oncol. 2015;22:2567–72.CrossRefGoogle Scholar
  25. 25.
    Jeong O, Park YK, Ryu SY. Early experience of due to laparoscopic distal gastrectomy (duet-LDG) using three abdominal ports for gastric carcinoma: surgical technique and comparison with conventional laparoscopic distal gastrectomy. Surg Endosc. 2016;30:3559–66.CrossRefGoogle Scholar
  26. 26.
    Oh SD, Oh SJ. Three-port versus five-port laparoscopic distal gastrectomy for early gastric cancer patients: a propensity score-matched case-control study. J Invest Surg. 2017;22:1–9.CrossRefGoogle Scholar
  27. 27.
    Seo HS,. Song KY, Jung YJ, Kim JH, Park CH, Lee HH. Right-side approach-duet totally laparoscopic distal gastrectomy (R-Duet TLDG) using a three-port to treat gastric cancer. J Gastrointest Surg. 2018;22:578–86.CrossRefGoogle Scholar
  28. 28.
    Kashiwagi H, Kumagai K, Monma E, Nozue M. Dual-port distal gastrectomy for the early gastric cancer. Surg Endosc. 2015;29:1321–6.CrossRefGoogle Scholar
  29. 29.
    Kim HB, Kim SM, Ha MH, et al. Comparison of reduced port totally laparoscopic-assisted total gastrectomy (Duet TLTG) and conventional laparoscopic-assisted total gastrectomy. Surg Laparosc Endosc Percutan Tech. 2016;26:e132–6.CrossRefGoogle Scholar
  30. 30.
    Seo HS, Lee HH. Is the 5-ports approach necessary in laparoscopic gastrectomy? Feasibility of reduced-port totally laparoscopic gastrectomy for the treatment of gastric cancer: a prospective cohort study. Int J Surg. 2016;29:118–22.CrossRefGoogle Scholar
  31. 31.
    Kim SM, Ha MH, Seo JE, et al. Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer. Surg Endosc. 2016;30:3950–7.CrossRefGoogle Scholar
  32. 32.
    Seo HS, Lee HH. Short-term outcomes of three-port totally laparoscopic distal gastrectomy in the treatment of gastric cancer: comparison with a four-port approach using a propensity score-matching analysis. J Laparoendosc Adv Surg Tech A. 2016;26:531–5.CrossRefGoogle Scholar
  33. 33.
    33 Lee S, Kim JK, Kim YN, et al. Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial. Surg Endosc. 2017;31:4002–9.CrossRefGoogle Scholar
  34. 34.
    Kodera Y. Reduced-port surgery for gastric cancer: another giant leap for mankind? Gastric Cancer. 2013;16:457–9.CrossRefGoogle Scholar
  35. 35.
    Kunisaki C, Makino H, Yamaguchi N, et al. Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer. Surg Endosc. 2016;30:5520–8.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Chikara Kunisaki
    • 1
    Email author
  • Hiroshi Miyamoto
    • 1
  • Sho Sato
    • 1
  • Yusaku Tanaka
    • 1
  • Kei Sato
    • 1
  • Yusuke Izumisawa
    • 2
  • Norio Yukawa
    • 1
  • Takashi Kosaka
    • 2
  • Hirotoshi Akiyama
    • 2
  • Yusuke Saigusa
    • 3
  • Kentaro Sakamaki
    • 3
    • 4
  • Takeharu Yamanaka
    • 3
  • Itaru Endo
    • 2
  1. 1.Department of Surgery, Gastroenterological CenterYokohama City UniversityYokohamaJapan
  2. 2.Department of Gastroenterological Surgery, Graduate School of MedicineYokohama City UniversityYokohamaJapan
  3. 3.Department of Biostatistics, School of MedicineYokohama City UniversityYokohamaJapan
  4. 4.Department of Biostatistics and Bioinformatics, Graduate School of MedicineThe University of TokyoTokyoJapan

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