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
- 150 Downloads
To determine whether laparoscopic surgery can be used in high-risk patients with gastric cancer.
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.
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).
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.
KeywordsGastric cancer High-risk patients Propensity score matching Laparoscopic gastrectomy Complication Prognosis
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. 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
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.
- 2.Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148Google Scholar
- 4.Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, Terashima M, Misawa K, Teshima S, Koeda K, Nunobe S, Fukushima N, Yasuda T, Asao Y, Fujiwara Y, Sasako M (2016) Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer 20:699–708CrossRefGoogle Scholar
- 5.Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357CrossRefGoogle Scholar
- 9.Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Lee HJ, Cho GS, Han SU, Hyung WJ, Korean Laparoscopic Gastrointestinal Surgery Study G (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol 15:2692–2700CrossRefGoogle Scholar
- 19.Tu R-H, Huang C-M, Lin J-X, Chen Q-Y, Zheng C-H, Li P, Xie J-W, Wang J-B, Lu J, Cao L-L, Lin M (2015) A scoring system to predict the risk of organ/space surgical site infections after laparoscopic gastrectomy for gastric cancer based on a large-scale retrospective study. Surg Endosc 30:3026–3034CrossRefGoogle Scholar
- 26.Wang JB, Zheng CH, Li P, Xie JW, Lin JX, Lu J, Chen QY, Cao LL, Lin M, Huang CM (2017) Effect of comorbidities on postoperative complications in patients with gastric cancer after laparoscopy-assisted total gastrectomy: results from an 8-year experience at a large-scale single center. Surg Endosc 31:2651–2660CrossRefGoogle Scholar
- 28.Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Lee HJ (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35CrossRefGoogle Scholar
- 35.Dell’Oglio P, Tian Z, Leyh-Bannurah S, Trudeau V, Larcher A, Moschini M, Di Trapani E, Capitanio U, Briganti A, Montorsi F, Saad F, Karakiewicz P (2017) Short-form Charlson Comorbidity index for assessment of perioperative mortality after radical cystectomy. J Natl Compr Cancer Netw 15:327–333CrossRefGoogle Scholar
- 37.Claassen YHM, Hartgrink HH, Dikken JL, de Steur WO, van Sandick JW, van Grieken NCT, Cats A, Trip AK, Jansen EPM, Kranenbarg WMMK, Braak J, Putter H, van Berge Henegouwen MI, Verheij M, van de Velde CJH (2018) Surgical morbidity and mortality after neoadjuvant chemotherapy in the CRITICS gastric cancer trial. Eur J Surg Oncol 44:613–619CrossRefGoogle Scholar
- 39.Hu Y, Ying M, Huang C, Wei H, Jiang Z, Peng X, Hu J, Du X, Wang B, Lin F, Xu J, Dong G, Mou T, Li G, Chinese Laparoscopic Gastrointestinal Surgery Study G (2014) Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective cohort study from China. Surg Endosc 28:2048–2056CrossRefGoogle Scholar