Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2

Article information

Kosin Med J. 2013;28(1):27-33
Publication date (electronic) : 2013 January 19
doi :
1Department of Surgery, College of Medicine, Kosin University, Busan, Korea
2Postgraduate school, College of Medicine, Kosin University, Busan, Korea
Corresponding author: Ki Young YOON, Department of Surgery, College of Medicine, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan, 602-703, Republic of Korea TEL: +82-51-990-6462 FAX: +82-51-246-6093 E-mail:
Received 2012 August 14; 2012 December 22; Accepted 2013 January 28.



Laparoscopy-assisted distal gastrectomy (LADG) is a common surgical procedure that has recently been accepted as safe and feasible for the treatment of early gastric cancer. There have been many efforts to expand the indications of LADG to include the treatment of advanced gastric cancer. The aim of this study was to determine the usefulness of noncompliance rate as an indicator for D2 lymph node dissection (LND) validation in LADG.


The subjects were 48 patients who underwent distal gastrectomy with D2 LND at Kosin University Gospel Hospital from October to December 2010. Of them, 28 underwent LADG and 20 underwent open distal gastrectomy (ODG). We compared several factors including noncompliance rate to validate D2 LND.


There were no significant differences in clinicopathologic factors except for BMI and tumor depth between the two groups. The average number of retrieved lymph nodes was significantly greater in the ODG group (45.9 ± 2.9) than in the LADG group (35.5 ± 2.0). The noncompliance rate was 43% in the LADG group and 40% in the ODG group with no significant difference.


In terms of no difference of noncompliance rate, LADG with D2 lymph node dissection is a safe, feasible and oncologicallycamparable with open gastrectomy. A large scaled prospective randomized trial should be needed to confirm the benefit of LADG.

Patient clinicopathologic characteristics

Patient surgical outcomes


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Table 1.

Patient clinicopathologic characteristics

Variables LADG (n = 28) ODG (n = 20) P
Sex M 21 15 1.000
F 7 5
BMI 23.7 ± 0.49 22.0 ± 0.45 0.019
T stage T1 26 8 0.001
T2 1 2
T3 1 5
T4 0 5
N stage N0 27 12 0.015
N1 1 4
N2 0 2
N3 0 2
Anastomosis Billroth I 23 16 0.856
Billroth II 5 4

Mean ± SEM.

Table 2.

Patient surgical outcomes

Variables LADG (n = 28) ODG (n = 20) P
Estimated blood loss 117.8 ± 18.2 230.0 ± 27.2 0.002
Op. time (min.) 199.6 ± 11.4 190.7 ± 7.7 0.521
Retrieved LN 35.5 ± 2.0 45.9 ± 2.9 0.006
Noncompliance rate 0.43 0.4 0.847
Hospital stay (days) 7.2 8.4 0.678
First flatus (days) 2.7 3.3 0.785
Starting semi-liquid diet 3 3 1