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

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.

Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer

“…A lower conversion rate has been reported as a theoretical advantage of robotic surgery over conventional laparoscopic surgery [33,34].…”

“…Conversion negatively impacts postoperative outcomes, may postpone the initiation of adjuvant treatments, and ultimately translate into poorer long-term survivals [33,34,39].…”

“…Unplanned conversion into an open procedure has been conventionally utilized to evaluate the proficiency of minimally invasive surgery. A lower conversion rate has been reported as a theoretical advantage of robotic surgery over conventional laparoscopic surgery [33,34]. Emerging data from a recent meta-analysis, including 40 retrospective studies and 17.712 patients, demonstrated no statistical difference in conversion rate between RG and LG.…”

Surgical considerations and outcomes of minimally invasive approaches for gastric cancer resection

“…Conversion of minimally invasive to open surgery is a key variable to evaluate when considering the selection of LG or RG. Cases requiring conversion have been shown in surgical fields, including gastrectomy, to be associated with worse outcomes 61–63 . For example, LOS was significantly longer for patients who had LG converted to OG compared with those who remained laparoscopic (8.7 vs. 7.6 days; p = .02) 62 .…”

“…Cases requiring conversion have been shown in surgical fields, including gastrectomy, to be associated with worse outcomes 61–63 . For example, LOS was significantly longer for patients who had LG converted to OG compared with those who remained laparoscopic (8.7 vs. 7.6 days; p = .02) 62 . Whereas meta‐analyses have quoted similar conversion rates between robotic and laparoscopic cohorts, 56,57 single‐institution reviews have reported that RG was associated with significantly lower conversion rates 52,58 .…”