Feasibility of single-incision distal gastrectomy for advanced gastric cancer

Background: While single-incision distal gastrectomy (SIDG) has been reported to be a potentially safe and feasible procedure for early gastric cancer (EGC), there is currently no study demonstrating the feasibility of SIDG for advanced gastric cancer (AGC) alone. Methods: Database of patients clinically diagnosed as AGC who underwent SIDG from November 2017 to September 2023 was retrospectively analyzed. Those who had distant metastasis, and those who underwent palliative surgery were excluded. Patient demographics, operation data, and postoperative complications were reviewed. Results: A total of 116 patients were included for the final analysis. Among them, 75 (64.7%) were male, and mean age was 62.7 ± 10.9 years. Average body mass index was 23.7 ± 3.3 kg/m2. The number of patients with stage pT2, pT3, and pT4a after surgery was 26 (22.4%), 31 (26.7%) and 23 (19.8%) respectively. Mean operation time was 158.3 ± 56.8 min. and average estimated blood loss was 28.4 ± 60.4 ml. Average number of retrieved lymph nodes was 59.9 ± 21.6. Patients started their first soft fluid diet on an average of 2.3 ± 0.9 postoperative days, and first flatus was observed after 3.1 ± 0.9 postoperative days. Overall mean hospital stay was 7.5 ± 3.5 days. Early complications (within 30 days) greater than Clavien-Dindo grade III were found in 7 patients (6.0%) and late complications (after 30 days) were found in 4 patients (4.0%). No recurrence was observed during the follow-up period. Conclusion: Single-incision distal gastrectomy appears to be technically feasible and safe in carefully selected patients with clinically diagnosed advanced gastric cancer. However, further comparative studies with long-term follow-up are necessary to confirm its oncologic validity.