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Outcomes of minimally invasive surgery for early gastric cancer are comparable with those for open surgery: analysis of 1,013 minimally invasive surgeries at a single institution

Surgical Endoscopy volume 28, pages 789–795 (2014)Cite this article

Abstract

Background

This study aimed to compare the short- and long-term results of minimally invasive surgery (MIS) and open surgery for primary early gastric cancer (EGC) at a single high-volume institution.

Methods

The clinicopathologic and survival data of primary gastric cancer patients who underwent a minimally invasive radical gastrectomy at Seoul National University Hospital from December 2003 to January 2012 were retrospectively analyzed. For comparison of short-term outcomes, the data for 1,112 patients who underwent a radical open gastrectomy from 2007 to 2011 were collected. For long-term outcome analysis, the data for 962 patients who underwent a radical open gastrectomy from 2004 to 2006 were collected. Because the application of MIS was limited to suspected EGC, the control groups were similarly limited to patients deemed to have EGC as shown by preoperative endoscopy, endoscopic ultrasound, or both.

Results

The review of our database identified 1,013 patients who had undergone MIS for gastric cancer. In the short-term outcome analysis, the MIS group showed statistically better results than the open surgery group in terms of postoperative hospital stay (8.7 vs. 11.3 days; p < 0.001), estimated blood loss (75.4 vs. 142.3 ml; p < 0.001), and overall complication rate (17.5 vs. 24.4 %; p < 0.001). In the subset analysis of total gastrectomy, the local complication rate was much higher in the MIS group than in the open surgery group. Both uni- and multivariate analyses showed that not only the surgical approach but also age, chronic liver disease, chronic renal disease, and additional organ resection had significant effects on complications. In the long-term outcome analysis, the two groups showed comparable disease-free survival rates.

Conclusions

The use of MIS for EGC showed a shorter operation time, a shorter postoperative hospital stay, and a lower overall complication rate than open surgery but a comparable disease-free survival rate. Total gastrectomy in the MIS group was associated with a higher complication rate than in the open group. Therefore, a new stable surgical technique needs to be established.

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Acknowledgments

This study was supported by a grant from the Seoul National University Hospital Research Fund (04-2012-1140).

Disclosures

Seung-Young Oh, Sebastianus Kwon, Kyung-Goo Lee, Yun-Suhk Suh, Hwi-Nyeong Choe, Seong-Ho Kong, Hyuk-Joon Lee, Woo Ho Kim, and Han-Kwang Yang have no conflicts of interests or financial ties to disclose.

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Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Seung-Young Oh, Kyung-Goo Lee, Yun-Suhk Suh, Seong-Ho Kong, Hyuk-Joon Lee & Han-Kwang Yang

  2. Northern Oesophago Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK

    Sebastianus Kwon

  3. Department of Nursing, Seoul National University Hospital, Seoul, Korea

    Hwi-Nyeong Choe

  4. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

    Woo Ho Kim

  5. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Hyuk-Joon Lee, Woo Ho Kim & Han-Kwang Yang

Authors
  1. Seung-Young Oh
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  2. Sebastianus Kwon
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  3. Kyung-Goo Lee
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  4. Yun-Suhk Suh
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  5. Hwi-Nyeong Choe
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  6. Seong-Ho Kong
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  7. Hyuk-Joon Lee
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  9. Han-Kwang Yang
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Corresponding author

Correspondence to Han-Kwang Yang.

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Oh, SY., Kwon, S., Lee, KG. et al. Outcomes of minimally invasive surgery for early gastric cancer are comparable with those for open surgery: analysis of 1,013 minimally invasive surgeries at a single institution. Surg Endosc 28, 789–795 (2014). https://doi.org/10.1007/s00464-013-3256-1

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  • DOI: https://doi.org/10.1007/s00464-013-3256-1

Keywords

  • Minimally invasive surgery (MIS)
  • Early gastric cancer (EGC)
  • Short term
  • Long term
  • Complication
  • Disease-free survival