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Page 6 of 13 Ohmura et al. Mini-invasive Surg 2019;3:4 I http://dx.doi.org/10.20517/2574-1225.2018.69

Figure 3. Intraoperative endoscopic finding after completion of gastroduodenostomy by intracorporeal hemi-hand-sewn technique. The
suture line of the posterior wall by linear stapler (white arrow) and hand-sewn suture line of the anterior wall (black arrow)

requiring starvation for more than three days, excluding the cases where anastomotic stenosis or
mechanical bowel obstruction was confirmed by radiographic or endoscopic examination.

Evaluation of resected specimen
The resected stomach was incised and opened according to the rule of Japanese classification of gastric
[21]
carcinoma and then was placed on the flat board. After stretching the stomach wall sufficiently, we fixed
the edges of the stomach to the board with stainless steel pins. In addition to measuring the size of the
tumor, we also measured the length of the greater curvature, lesser curvature, duodenum, proximal margin
and distal margin. Where the staple line was removed, a length of 3 mm was added to each as a measured
value. Histological data were retrieved from the database based on the 14th version of the staging system of
[21]
Japanese Gastric Cancer Association .

Statistical analysis
Clinicopathological data and perioperative results were statistically compared between the EC-THS group
and the IC-HHS group. The length of each part of the resected specimen was also analyzed. Continuous
data was analyzed with the Student’s t-test. The Fisher’s exact test or Chi-square test were used for
comparison of categorical values. Pearson linear regression analyses were conducted to correlate BMI and
the length of the greater curvature of resected stomach. A two-sided P value < 0.05 was considered to be
statistically significant.

RESULTS
Patient characteristics
The number of cases of the EC-THS and IC-HHS groups were 85 and 110 cases, respectively. The 195
2
patients had an average age of 71.0 years (range, 38-93 years). The average BMI was 23.1 (range 17.0-34.0 kg/m ).
As for the location of the tumors, 142 cases were in the middle third of the stomach and 53 cases was in the
lower third of the stomach, 5 of them showed duodenal infiltration to the pyloric ring [Table 1].

Surgical outcome
Total laparoscopic or laparoscopy-assisted distal gastrectomies were successfully accomplished in all
patients (195 patients). D2 lymph node dissection was performed more frequently in the IC-HHS group
(12.7%) compared to the EC-THS group (1.2%) (P < 0.01). The proportion of concurrent cholecystectomy
was higher in the IC-HHS group, but there was no significant difference (P = 0.21). Operation time in the
IC-HHS group required an average of 275.0 min, which was significantly longer than the 234.8 min in
the EC-THS group (P < 0.01). The amount of intraoperative blood loss was less in IC-HHS group (25.4 mL
vs. 44.0 mL, P = 0.03). The subgroup analysis in D1+ cases revealed similar results; the average operation