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Short- and Long-Term Outcomes in Malnourished Patients After Laparoscopic or Open Radical Gastrectomy

World Journal of Surgery volume 42, pages 195–203 (2018)Cite this article

Abstract

Objective

The aim of this study was to compare the short- and long-term outcomes of malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy.

Background

Preoperative malnutrition is an independent risk factor for postoperative mortality and morbidity in major gastrointestinal surgery. However, whether laparoscopic surgery can improve the short- and long-term outcomes of malnourished gastric cancer patients has not been determined.

Methods

We reviewed prospectively collected data from 2441 patients with gastric cancer between January 2009 and December 2014 and compared the short- and long-term outcomes in malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy. Nutritional risk factors included weight loss >10% within 6 months, body mass index <18.5 kg/m2, Subjective Global Assessment Grade C, and serum albumin <3.0 g/dL.

Results

Overall, 501 patients (20.52%) were classified as malnourished. Patients with gastric stump carcinoma, neoadjuvant chemotherapy, distant metastases, palliative operation, or the presence of other malignancies were excluded. Finally, a total of 412 patients were analyzed; 304 in the laparoscopic group and 108 in the open group. There were no significant differences between the two groups regarding the clinicopathological characteristics. However, the operation time (181 ± 53 vs. 253 ± 81 min), intraoperative blood loss (80 ± 116 vs. 322 ± 502 mL), time to first ambulation (2.21 ± 1.04 vs. 2.55 ± 1.50 days), liquid diet (4.91 ± 1.61 vs. 5.72 ± 2.09 days) and semiliquid diet (7.67 ± 1.56 vs. 9.53 ± 2.09 days) as well as the postoperative hospital stay duration (13.00 ± 6.56 vs. 15.22 ± 6.87 days) were significantly lower in the laparoscopic group than those in the open group (p < 0.05). The instances of overall complications (laparoscopic vs. open: 18.4 vs. 30.6%, p = 0.008) and pneumonia (laparoscopic vs. open: 10.9 vs. 19.4%, p = 0.023) were significantly lower in the laparoscopic group. With a median follow-up of 31.0 months (range 1.0–88.0), the 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) rates for the entire cohort were 58.9, 54.0 and 63.0%, respectively. Further analysis showed that the OS (57.5 vs. 59.4%, p = 0.560), RFS (51.8 vs. 54.8%, p = 0.441) and CSS (62.8 vs. 63.0%, p = 0.789) between the laparoscopic and open groups, respectively, were no significantly different. Further analysis showed no significant differences in the OS rates of the two groups of patients stratified by tumor stage (p > 0.05).

Conclusion

Compared with open radical gastrectomy, laparoscopy would reduce the postoperative complications especially pneumonia and shorten the postoperative hospital stay for patients with preoperative malnutrition without affecting their long-term survival.

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Acknowledgements

The authors are thankful to Fujian Medical University Union Hospital for their management of our gastric cancer patient database.

Funding

The study was sponsored by the National Key Clinical Specialty Discipline Construction Program of China (No. [2012]649) and the Key Projects of Science and Technology Plan of Fujian Province (No. 2014Y0025).

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Author notes

  1. Hua-Long Zheng and Jun Lu contributed equally to this work.

Affiliations

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

    Hua-Long Zheng, Jun Lu, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Mi Lin, Ru-Hong Tu & Chang-Ming Huang

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  1. Hua-Long Zheng
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All the authors participated in interpreting the data, drafting the article, critically revising the paper for content, and providing final approval of the version submitted for publication. All the authors have seen, approved, and are completely familiar with the contents of the manuscript.

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Correspondence to Chang-Ming Huang.

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All the authors are responsible for the accuracy of the manuscript, including the statistical calculations. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Zheng, HL., Lu, J., Zheng, CH. et al. Short- and Long-Term Outcomes in Malnourished Patients After Laparoscopic or Open Radical Gastrectomy. World J Surg 42, 195–203 (2018). https://doi.org/10.1007/s00268-017-4138-9

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  • DOI: https://doi.org/10.1007/s00268-017-4138-9