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Comparison of short-term and long-term efficacy of laparoscopic and open gastrectomy in high-risk patients with gastric cancer: a propensity score-matching analysis

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Abstract

Background

To determine whether laparoscopic surgery can be used in high-risk patients with gastric cancer.

Methods

The clinicopathological data of 3743 patients with primary gastric adenocarcinoma, collected from January 2007 to December 2014, were retrospectively analyzed. Patients who had ≥ 1 of the following conditions were defined as high-risk patients: (1) age ≥ 80 years; (2) BMI ≥ 30 kg/m2; (3) ASA (American Society of Anesthesiologists) grade ≥ 3; or (4) clinical T stage 4 (cT4). Propensity score matching (PSM) was used to reduce confounding bias; then, we compared the short-term and long-term efficacy of laparoscopic gastrectomy (LG) with open gastrectomy (OG) in high-risk patients with gastric cancer.

Results

A total of 1296 patients were included in PSM. After PSM, no significant difference in clinicopathological data was observed between the LG group (n = 341) and the OG group (n = 341). The operative time (181.70 vs. 266.71 min, p < 0.001) and blood loss during the operation (68.11 vs. 225.54 ml, p < 0.001) in the LG group were significantly lower than those in the OG group. In the LG and OG groups, postoperative complications occurred in 39 (11.4%) and 63 (18.5%) patients, respectively, p = 0.010. Multivariate analysis showed that laparoscopic surgery was an independent protective factor against postoperative complications (p = 0.019). The number of risk factors was an independent risk factor for postoperative complications (p = 0.021). The 5-year overall survival rate in the LG group was comparable to that in the OG group (55.0 vs. 52.0%, p = 0.086). Hierarchical analysis further confirmed that the LG and OG groups exhibited comparable survival rates among patients with stages cI, pI, cII, pII, cIII, and pIII (all p > 0.05).

Conclusions

For high-risk patients with gastric cancer, LG not only exhibits better short-term efficacy than OG but also has a comparable 5-year survival rate to OG.

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Acknowledgements

This work was supported by the Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031). Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171). The second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013). Startup Fund for scientific research, Fujian Medical University (Grant Number: 2016QH024). Fujian province medical innovation project (2015-CXB-16). Fujian provincial health and family planning commission joint project (WKJ2016-2-27). Chinese physicians association young physician respiratory research fund.

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Author notes

  1. Bin-bin Xu and Jun Lu have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China

    Bin-bin Xu, Jun Lu, Zhi-fang Zheng, Chang-ming Huang, Chao-hui Zheng, Jian-wei Xie, Jia-bin Wang, Jian-xian Lin, Qi-yue Chen, Long-long Cao, Mi Lin, Ru-hong Tu, Ze-ning Huang, Ping Li & Ju-li Lin

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Bin-bin Xu, Jun Lu, Zhi-fang Zheng, Chang-ming Huang, Chao-hui Zheng, Jian-wei Xie, Jia-bin Wang, Jian-xian Lin, Qi-yue Chen, Long-long Cao, Mi Lin, Ru-hong Tu, Ze-ning Huang, Ping Li & Ju-li Lin

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China

    Bin-bin Xu, Jun Lu, Zhi-fang Zheng, Chang-ming Huang, Chao-hui Zheng, Jian-wei Xie, Jia-bin Wang, Jian-xian Lin, Qi-yue Chen, Long-long Cao, Mi Lin, Ru-hong Tu, Ze-ning Huang, Ping Li & Ju-li Lin

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  1. Bin-bin Xu
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Correspondence to Chang-ming Huang, Chao-hui Zheng or Ping Li.

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Drs. Bin-bin Xu, Jun Lu, Zhi-fang Zheng, Jian-wei Xie, Jia-bin Wang, Jian-xian Lin, Qi-yue Chen, Long–long Cao, Mi Lin, Ru-hong Tu, Ze-ning Huang, Ju-li Lin, Chao-hui Zheng, Ping Li, and Chang-ming Huang have no conflicts of interest or financial ties to disclose.

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Xu, Bb., Lu, J., Zheng, Zf. et al. Comparison of short-term and long-term efficacy of laparoscopic and open gastrectomy in high-risk patients with gastric cancer: a propensity score-matching analysis. Surg Endosc 33, 58–70 (2019). https://doi.org/10.1007/s00464-018-6268-z

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