Surgical Endoscopy

, Volume 32, Issue 6, pp 2766–2773 | Cite as

Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database

  • Tsuyoshi Etoh
  • Michitaka Honda
  • Hiraku Kumamaru
  • Hiroaki Miyata
  • Kazuhiro Yoshida
  • Yasuhiro Kodera
  • Yoshihiro Kakeji
  • Masafumi Inomata
  • Hiroyuki Konno
  • Yasuyuki Seto
  • Seigo Kitano
  • Naoki Hiki



Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry.


From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG.


The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively).


The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.


National Clinical Database registration system Prospective cohort study Laparoscopic total gastrectomy 



National Clinical Database


Laparoscopic total gastrectomy


Open total gastrectomy


Propensity Score



The authors thank all the data managers and hospitals that participated in the NCD project for their great efforts in entering the data analyzed in this study.

Compliance with ethical standards


Drs. Hiraku Kumamaru and Miyata Hiroaki are affiliated with the department of health quality assessment at the University of Tokyo. The department receives funding from the National Clinical Database for research. The department was formerly supported by endowments from Johnson & Johnson K.K., Nipro Co., Teijin Pharma Ltd., Kaketsuken K.K., St. Jude Medical Japan Co., Ltd., Novartis Pharma K.K., Taiho Pharmaceutical Co., Ltd., W. L. Gore Associates, Co., Ltd., Olympus Corporation, and Chugai Pharmaceutical Co., Ltd. Drs. Tsuyoshi Etoh, Michitaka Honda, Kazuhiro Yoshida, Yasuhiro Kodera, Yoshihiro Kakeji, Masafumi Inomata, Hiroyuki Konno, Yasuyuki Seto, Seigo Kitano, and Naoki Hiki have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Tsuyoshi Etoh
    • 1
  • Michitaka Honda
    • 2
  • Hiraku Kumamaru
    • 3
  • Hiroaki Miyata
    • 4
  • Kazuhiro Yoshida
    • 5
  • Yasuhiro Kodera
    • 6
  • Yoshihiro Kakeji
    • 7
  • Masafumi Inomata
    • 1
  • Hiroyuki Konno
    • 8
  • Yasuyuki Seto
    • 9
  • Seigo Kitano
    • 10
  • Naoki Hiki
    • 11
  1. 1.Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineHasama-machiJapan
  2. 2.Department of Minimal Invasive Surgical and Medical OncologyFukushima Medical UniversityFukushimaJapan
  3. 3.Department of Healthcare Quality Assessment, Graduate School of MedicineUniversity of TokyoTokyoJapan
  4. 4.Department of Health Policy and Management, School of MedicineKeio UniversityTokyoJapan
  5. 5.Department of Surgical Oncology, Graduate School of MedicineGifu UniversityGifuJapan
  6. 6.Department of Gastroenterological SurgeryNagoya University, Graduate School of MedicineNagoyaJapan
  7. 7.Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of MedicineKobe UniversityKobeJapan
  8. 8.Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
  9. 9.The Japanese Society of Gastroenterological SurgeryTokyoJapan
  10. 10.Oita UniversityOitaJapan
  11. 11.Department of Gastroenterological Surgery, Gastroenterological CenterCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan

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