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Impact of Laparoscopic Converted to Open Gastrectomy on Short- and Long-Term Outcomes of Patients with Locally Advanced Gastric Cancer: A Propensity Score-Matched Analysis

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

It remains unclear whether laparoscopic conversation to open gastrectomy causes higher morbidity and has an adverse effect on the long-term survival outcomes of patients with gastric cancer. This study was designed to evaluate the impact of the conversion on short and long-term outcomes of patients with locally advanced gastric cancer (AGC).

Methods

We retrospectively investigated 871 patients who initially underwent laparoscopic gastrectomy (LG) for pathologically confirmed diagnosis of AGC between February 2009 and April 2018. The patients were grouped as the conversion (CONV) group and completed laparoscopic (LAP) group. The 1:2 propensity score matching was performed to reduce the effect of bias due to the imbalanced baseline features between the two groups. Multivariate analyses were performed to identify risk factors for conversion and poor survival.

Results

After propensity-score matching, 168 patients (56 in the CONV group and 112 in the LAP group) were studied. The CONV group was associated with significantly longer operation time (252.4 vs. 216.7 min, P < 0.001) and greater estimated blood loss (234.8 vs. 171.2 ml, P < 0.001) as compared with the LAP group. The time to first flatus (3.8 vs. 3.3 days, P = 0.043), time to start a liquid diet (4.1 vs. 3.5 days, P = 0.021), and postoperative hospital stay (8.7 vs. 7.6 days, P = 0.020) were significantly longer in the CONV group than that in the LAP group. The overall complication rate did not differ significantly between the CONV group and the LAP group (16.1% vs. 12.5%, P = 0.692). Both 5-year overall survival (OS) and 5-year disease-free survival (DFS) did not differ significantly between the CONV group and the LAP group (P = 0.805, P = 0.945, respectively). Multivariate analysis showed that lymphovascular invasion and stage III were independent prognostic factors for poor OS and DFS, whereas conversion was not.

Conclusions

The conversion from laparoscopic to open gastrectomy had no negative impact on morbidity and long-term survival outcomes for patients with locally AGC.

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Acknowledgements

The authors are thankful to the medical staff of Xijing Hospital of Digestive Diseases for their management of the database.

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Author notes

  1. Feng-ni Xie, Jie Chen and Zheng-yan Li contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, 710032, Xi’an, China

    Feng-ni Xie, Jie Chen, Zheng-yan Li, Bin Bai, Dan Song, Shuai Xu, Xiao-tian Song & Gang Ji

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Contributions

Fen-gni Xie, Jie Chen, and Zheng-yan Li initiated the study design and wrote the manuscript. Zheng-yan Li and Bing Bai helped with implementation. Dan Song, Shuai Xu, and Xiao-tian Song contributed to the acquisition, analysis, or interpretation of data. Jie Chen and Gang Ji revised and supervised the study. All authors read and approved the final manuscript.

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Correspondence to Gang Ji.

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Fengni Xie, Jie Chen, Zhengyan Li, Bing Bai, Dan Song, Shuai Xu, Xiaotian Song, and Gang Ji have no conflicts of interest or financial ties to disclose.

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Xie, Fn., Chen, J., Li, Zy. et al. Impact of Laparoscopic Converted to Open Gastrectomy on Short- and Long-Term Outcomes of Patients with Locally Advanced Gastric Cancer: A Propensity Score-Matched Analysis. J Gastrointest Surg 25, 2484–2494 (2021). https://doi.org/10.1007/s11605-021-04975-6

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