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Surgical Endoscopy

, Volume 33, Issue 1, pp 58–70 | Cite as

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

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

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.

Keywords

Gastric cancer High-risk patients Propensity score matching Laparoscopic gastrectomy Complication Prognosis 

Notes

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.

Compliance with ethical standards

Disclosures

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.

Supplementary material

464_2018_6268_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 19 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
  2. 2.Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
  3. 3.Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina

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