Title : Mobile dual-suspension technique-assisted single-incision versus conventional multi-port laparoscopic D2 radical distal gastrectomy: A comparative study of short-term outcomes and quality of life
Abstract:
Background: Laparoscopic D2 radical distal gastrectomy is a standard treatment for distal gastric cancer. Single-Incision Laparoscopic Surgery (SILS) offers potential advantages in cosmetic outcomes and recovery, but its technical complexity limits widespread adoption. We independently developed a mobile dual-suspension technique applicable to both laparoscopic and robotic surgery to facilitate SILS. This study aims to compare the short-term efficacy and Quality of Life (QoL) between SILS assisted by this novel technique and conventional Multi-Port Laparoscopic Surgery (MPLS) for D2 radical distal gastrectomy.
Methods: A retrospective analysis of 305 patients was performed. After 1:1 Propensity Score Matching (PSM), 86 patients were included in each group (SILS vs. MPLS). Perioperative parameters, pathological outcomes, complications, health economics, and nutritional/inflammatory markers were compared. QoL was assessed at 1 year post-surgery using the EORTC QLQ-C30 and QLQ-STO22 questionnaires.
Results: The SILS group showed significantly fewer drainage tubes (1.12±0.32 vs. 1.64±0.48), lower nasogastric tube retention rate (55.81% vs. 76.74%), faster recovery (time to first flatus: 2.42±0.68 vs. 2.76±0.51 days), less early postoperative pain (VAS day 1: 3.13±0.68 vs. 3.35±0.75), and shorter postoperative hospital stay (7.77±1.41 vs. 9.17±2.46 days) (all P<0.05). Direct surgical costs were similar, but total hospitalization costs were significantly lower in the SILS group (68098.89±11774.51 vs. 73019.76±13373.34, P=0.011). SILS patients also exhibited better nutritional recovery (PNI on day 3: 41.44±4.29 vs. 39.23±3.88) and faster resolution of inflammation (CRP on day 3: 111.70±65.73 vs. 140.88±62.94 mg/L) (both P<0.05). No significant differences were observed in operative time, blood loss, major complications (Clavien-Dindo ≥II: 11.63% vs. 13.95%), or 1-year QoL scores (P>0.05 for all domains).
Conclusions: This study is the first to prove that single-incision laparoscopic D2 radical distal gastrectomy assisted by our self-developed mobile dual-suspension technique is safe and feasible for distal gastric cancer, providing equivalent oncological radicality to multi-port laparoscopy. It offers significant advantages in early postoperative recovery, pain control, nutritional preservation, inflammation reduction, and cost-effectiveness, without compromising 1-year postoperative quality of life.
Keywords: Gastric Cancer; Single-Incision Laparoscopic Surgery; Multi-Port Laparoscopic Surgery; Propensity Score Matching; Quality of Life; Health Economics.
