Short-Term Outcomes of Laparoscopic and Open Total Gastrectomy for Gastric Cancer: A Nationwide Retrospective Cohort Analysis

Sakamoto, Takashi; Fujiogi, Michimasa; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

doi:10.1245/s10434-019-07688-y

Cited by 24 publications

(32 citation statements)

References 27 publications

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“…In our study, the incidence of anastomotic leakage was higher in LATG than OTG group after PSM (4.6% vs. 0.8%, P = 0.120). Although without statistical significance, the results are consistent with the previous studies (Sakamoto et al 2019 ; Petersen et al 2013 ). The complication rate of anastomotic leakage has been reported to be around 1.5–7.4% in LATG (Etoh et al 2018 ; Jeong et al 2009 ; Lee et al 2015 ).…”

Section: Discussionsupporting

confidence: 92%

“…JCOG1401 has reported a 66.4% postoperative complication rate for in-hospital grade II-IV adverse events (Katai et al 2019). Besides, several retrospective studies have demonstrated that increased anastomotic leakage and stenosis were more frequently observed in LATG (Sakamoto et al 2019;Petersen et al 2013). Esophagojejunal anastomotic leakage has been considered as one of the most serious complications after TG.…”

Section: Discussionmentioning

confidence: 99%

“…Besides, the results from retrospective studies also reported contradictory results. Although some studies demonstrated that LATG was associated with better intraoperative parameters and lower incidence of postoperative complications (Etoh et al 2018 ; Lin et al 2017 ), other studies found anastomotic leakage occurred more frequently in LATG than OTG group, even after taking the effect of learning curve into consideration (Sakamoto et al 2019 ; Shim et al 2013 ). More studies are still needed to confirm the non inferiority of LATG to OTG, especially for AGC patients.…”

Section: Introductionmentioning

confidence: 99%

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Surgical and oncological efficacy of laparoscopic-assisted total gastrectomy versus open total gastrectomy for gastric cancer by propensity score matching: a retrospective comparative study

Fan

Liu

et al. 2021

J Cancer Res Clin Oncol

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Purpose The application of laparoscopic-assisted total gastrectomy (LATG) for resectable gastric cancer (GC) remains controversial compared with open total gastrectomy (OTG), especially for advanced gastric cancer (AGC) patients according to the inconsistent results demonstrated in the previous studies. The aim of this study was to evaluate the short-term and long-term outcomes between LATG and OTG in a population with more than 80% AGC patients by applying propensity score matching (PSM) method. Methods The data of 365 clinical stage I–III GC cases who underwent total gastrectomy with D2 lymphadenectomy were retrospectively collected from January 2011 to April 2018 in the Department of Gastrointestinal Surgery IV of Peking University Cancer Hospital. Propensity scores were generated through taking all covariates into consideration and 131 pairs of patients receiving either LATG or OTG were matched. Intraoperative, postoperative, and survival parameters were compared in the matched groups accordingly. Risk factors for postoperative complications and overall survival were further analyzed. Results Patient characteristics in the LATG and OTG groups were well balanced after PSM. LATG showed advantages with respect to shorter time to ambulation, first flatus, and first whole liquid diet intake. No significant differences were found between the two groups with regard to postoperative complications as well as overall survival in terms of different pathological stage. Older age was found as an independent risk factor for postoperative complications, and pathological stage for overall survival as well. Conclusion LATG appears to have comparable surgical and oncological safety with OTG by experienced surgeons.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical and oncological efficacy of laparoscopic-assisted total gastrectomy versus open total gastrectomy for gastric cancer by propensity score matching: a retrospective comparative study

Fan

Liu

et al. 2021

J Cancer Res Clin Oncol

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“…Further, the severe complication metric showed the most negative effect on the textbook outcome in both groups, while the other eight quality metrics were over 90% in both groups. Although minimally invasive total gastrectomy reduced postoperative complications compared with open total gastrectomy [33][34][35], a way to minimise complications after minimally invasive total gastrectomy should be considered.…”

Section: Discussionmentioning

confidence: 99%

Textbook outcome and survival of robotic versus laparoscopic total gastrectomy for gastric cancer: A propensity score matched cohort study

Roh

Lee

Son

et al. 2021

Preprint

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Introduction Textbook outcome is a composite quality measurement of short-term outcomes for evaluating complex surgical procedures. We compared textbook outcome and survival of robotic total gastrectomy(RTG) with those of laparoscopic total gastrectomy(LTG).Methods We retrospectively reviewed 395patients(RTG,n = 74;LTG,n = 321) who underwent curative total gastrectomy for gastric cancer via minimally invasive approaches from 2009 to 2018. We performed propensity score matched analysis to adjust for potential selection bias. Textbook outcome included a negative resection margin, no intraoperative complication, retrieved lymph nodes > 15, no severe complication, no reintervention, no unplanned intensive care unit admission, hospitalisation ≤ 21days, no readmission after discharge, and no postoperative mortality. Survival outcomes included 5-year overall and relapse-free survival rates.Results After matching, 74patients in each group were selected. Textbook outcome was similar in the RTG and LTG groups(70.3% and 75.7%,respectively), although RTG required a longer operative time. The quality metric least often achieved was the presence of severe complications in both groups(77.0% in both groups). There were no differences in the 5-year overall survival rate(90.7% and 85.9%,respectively;log-rank P = 0.144) and relapse-free survival rate between the RTG and LTG groups(89.5% and 85.2%,respectively;log-rank P = 0.167).Conclusion Textbook outcome and survival outcome of RTG were comparable to those of LTG for gastric cancer.

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“…When it comes to LTG, the scientific evidence is scarce; a Japanese retrospective nationwide study by Sakamoto et al, including patients with clinical stage I-III gastric cancer, confirmed the advantages of LTG in terms of time to first oral intake and length of hospital stay; however, the study highlighted a higher incidence of anastomotic leakage after LTG when compared to OTG. Despite this finding, no difference in in-hospital mortality was found [ 19 ]. The higher incidence of anastomotic leakage is not surprising, as laparoscopic construction of the esophagojejunostomy is technically more challenging, which has also been demonstrated in a population-based cohort study from the Netherlands [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Implementation of minimally invasive gastrectomy for gastric cancer in a western tertiary referral center

et al. 2020

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Background: Minimally invasive techniques have gradually come to take a leading position in the surgical treatment of gastrointestinal malignancies. In order to define an effective process for the implementation of similar techniques in the treatment of gastric cancer, patient caseload represents a pivotal factor for education and training, but is a prerequisite not fulfilled in most Western countries. Additionally, as opposed to the East, a variety of additional factors such as the usually advanced stage of the disease and differences in patient characteristics are prevailing and raise further obstacles. Hereby we report a strategy for a safe and effective process for the implementation of laparoscopic gastric cancer surgery in a Western tertiary referral center. Methods: The present study describes the stepwise implementation of laparoscopic gastrectomy for the treatment of gastric cancer at a tertiary referral center, comprising the time period 2012-2019. This process was facilitated by a close collaboration with two high-volume centers in Japan, as well as exchanging fellowships and observerships between the Karolinska University Hospital and other European centers. From the initially strict selection of cases for laparoscopic surgery, laparoscopic gastrectomy has gradually become the preferred approach also in patients with locally advanced tumors. Results: From January 1st 2010 until December 31st 2019, 249 patients were operated for gastric cancer, of whom 141 (56.6%) had an open and 108 (43.4%) a laparoscopic procedure. In the latter group, total gastrectomy was performed in 33.3% of the patients. While blood loss, operation time and length of stay decreased during the first years after implementation, these variables increased slightly during the last years of the study period, probably due to the higher proportion of advanced gastric cancer cases, as well as the higher rate of laparoscopic total gastrectomy with more extended lymphadenectomy. Conclusions: Laparoscopic surgery is currently a valid therapeutic option for gastric cancer, which has expanded to also embrace total gastrectomy and locally advanced tumors. Collaboration between centers in the East and West, centralization to high-volume centers and application of enhanced recovery protocols are essential components in the implementation and further refinement of minimally invasive gastrectomy.

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Short-Term Outcomes of Laparoscopic and Open Total Gastrectomy for Gastric Cancer: A Nationwide Retrospective Cohort Analysis

Cited by 24 publications

References 27 publications

Surgical and oncological efficacy of laparoscopic-assisted total gastrectomy versus open total gastrectomy for gastric cancer by propensity score matching: a retrospective comparative study

Surgical and oncological efficacy of laparoscopic-assisted total gastrectomy versus open total gastrectomy for gastric cancer by propensity score matching: a retrospective comparative study

Textbook outcome and survival of robotic versus laparoscopic total gastrectomy for gastric cancer: A propensity score matched cohort study

Implementation of minimally invasive gastrectomy for gastric cancer in a western tertiary referral center

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