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Clinical Outcomes of Laparoscopic Versus Laparotomic Distal Gastrectomy in Gastric Cancer Patients: A Multilevel Analysis Based on a Nationwide Administrative Database in Japan

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Abstract

Background

The present study compared the short-term outcomes and costs of laparoscopic distal gastrectomy (LDG) with those of open distal gastrectomy (ODG) for gastric cancer using a nationwide administrative database in Japan.

Method

Overall, 37,752 patients with gastric cancer who underwent distal gastrectomy at 1074 hospitals in the fiscal year 2012–2013 were evaluated using a diagnosis procedure combination database in Japan. We performed a retrospective analysis via a multilevel analysis (MLA) of the short-term surgical results and costs of the LDG and ODG groups. The models included the age, sex, comorbid complications, smoking, body mass index (BMI), activity of daily living (ADL), stage, and the number of cases of gastrectomy per facility for adjustment. The in-hospital mortality relative to the hospital volume was also compared.

Results

The LDG group required postoperative blood transfusion less frequently and had fewer postoperative complications, shorter hospitalization, and lower operative mortality than the ODG group. While this stage did not correlate with the in-hospital mortality, the surgical method, age, sex, ADL, BMI, comorbidity, and yearly volume showed a correlation. A significant association in the in-hospital mortality was observed between low- and very-high-volume hospitals.

Conclusion

In this large nationwide cohort of patients with gastric cancer using an MLA, LDG was shown to be safer with lower mortality and postoperative complication rates than ODG.

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Funding

A part of this study was conducted by the financial support from Ministry of Health, Labour and Welfare, Japan (the Health Labour Sciences Research Grant, H30-Seisaku-Shitei-004).

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Authors and Affiliations

  1. Department of Surgery I, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan

    Kazunori Shibao, Fumi Joden, Tatehide Tajima, Jun Nagata, Nagahiro Sato & Keiji Hirata

  2. Department of Environmental Epidemiology, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan

    Yoshihisa Fujino

  3. Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan

    Kenji Fujimoto & Matsuda Shinya

Authors
  1. Kazunori Shibao
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  2. Yoshihisa Fujino
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  3. Fumi Joden
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  4. Tatehide Tajima
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  5. Jun Nagata
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  6. Nagahiro Sato
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  7. Kenji Fujimoto
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  8. Matsuda Shinya
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  9. Keiji Hirata
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Corresponding author

Correspondence to Kazunori Shibao.

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The authors declare that they have no conflict of interest or financial ties to disclose.

Human and animal rights

All procedures were conducted in accordance with the ethical standards of the respective committees on human experimentation (institutional and national) and with the 1964 Declaration of Helsinki and later versions. This study was approved by the Ethics Committee of University of Occupational and Environmental Health, Kitakyushu, Japan.

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Shibao, K., Fujino, Y., Joden, F. et al. Clinical Outcomes of Laparoscopic Versus Laparotomic Distal Gastrectomy in Gastric Cancer Patients: A Multilevel Analysis Based on a Nationwide Administrative Database in Japan. World J Surg 44, 3852–3861 (2020). https://doi.org/10.1007/s00268-020-05709-6

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