OBJECTIVETo explore the technical feasibility, safety, and short-term clinical efficacy of right-to-lateral approach in laparoscopic-assisted radical gastrectomy.

METHODSClinicopathological data of 178 gastric cancer patients undergoing laparoscopic-assisted radical gastrectomy, including 92 patients with right-to-lateral approach(R-LG group) and 86 cases with left-to-lateral approach (L-LG group), in our department from October 2010 to September 2013 were analyzed retrospectively. Short-term efficacy and complication morbidity were compared between R-LG group and L-LG group according to body mass index (BMI).

RESULTSFor those patients with BMI ≥ 24 kg/m², the R-LG group (35 cases) had shorter mean operation time, less intraoperative blood loss, shorter painkiller used time than L-LG group (31 cases)[(227 ± 17) min vs. (262 ± 23) min, (73 ± 9) ml vs. (84 ± 8) ml and (2.1 ± 0.1) d vs. (2.6 ± 0.4) d, all P<0.05]. The average time to ambulation and recovery time of peristalsis in the R-LG group were faster than those in L-LG group [(2.2 ± 0.2) d vs. (2.8 ± 0.6) d and (3.6 ± 0.3) d vs. (4.2 ± 0.5) d, all P<0.05]. The R-LG group had more dissected lymph nodes per patient (35 ± 4) than the L-LG group (30 ± 5) with significant difference (P<0.05). There were no significances in postoperative hospital stay, postoperative complication morbidity and hospitalization expenses between R-LG and L-LG group (all P>0.05). For those patients with BMI<24 kg/m², there were no significant differences in all above parameters between R-LG group (57 cases) and L-LG group (55 cases). No mortality and recurrence was observed during follow-up of 3 to 24 months.

CONCLUSIONRight-to-lateral approach in laparoscopic-assisted radical gastrectomy is a safe and feasible procedure, especially for the obesity patients, which can shorten the operation time, decrease intraoperative blood loss, lead to a faster postoperative recovery and harvest more lymph nodes as compared to L-LG procedure.