Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: A retrospective cohort study based on a nationwide registry database in Japan

Abstract

To clarify the safety profile of laparoscopic distal gastrectomy (LDG) for gastric cancer patients, the short‐term outcome of LDG was compared to that of open distal gastrectomy (ODG) by propensity score matching using data from the Japanese National Clinical Database (NCD). We conducted a retrospective cohort study of patients undergoing distal gastrectomy between January 2012 and December 2013. Using the data for 70 346 patients registered in the NCD, incidences of mortality and morbidities were compared between LDG patients and ODG patients in the propensity score matched stage I patients (ODG: n = 14 386, LDG: n = 14 386) and stage II‐IV patients (ODG: n = 3738, LDG: n = 3738), respectively. There was no significant difference in mortality rates between LDG and ODG at all stages. Operating time was significantly longer in LDG compared to ODG, whereas blood loss and incidences of superficial surgical site infection (SSI), deep SSI, and wound dehiscence were significantly higher in ODG at all stages. Interestingly, pancreatic fistula was found significantly more often in LDG (1%) compared to ODG (0.8%) (P = .01) in stage I patients; however, it was not different in stage II‐IV patients. The length of postoperative stay was significantly longer in patients undergoing ODG compared to LDG at all stages. LDG in general practice might be a feasible therapeutic option in patients with both advanced gastric cancer and those with early gastric cancer in Japan.

Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015

“…In the present survey, although the background of surgical procedures as well as the classification of benign or malignant disease differed between endoscopic and open surgery, PI were less frequent after endoscopic surgery, especially for esophageal surgery, gastrointestinal surgery, colorectal surgery, and cholecystectomy. Previous studies reported similar results regarding endoscopic surgery versus open surgery in esophageal surgery (23.5% vs 46.7%), gastrointestinal surgery (1.0% vs 1.8%‐8.9%), colorectal surgery (7.0%‐11.3% vs 15.7%‐25.0%), and cholecystectomy (0.6%‐5.9% vs 4.9%‐19.9%) . In the present survey, there was no incidence of PI after endoscopic esophageal surgery, although the procedures included only esophageal surgery for benign disease, such as esophageal achalasia, hiatus hernia, and selective vagotomy.…”

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

“…The laparoscopic approach is a complex procedure compared with open surgery, requiring a specialized surgeon and unit. Recent study based on NCD data in Japan showed the incidence of pancreatic fistula was significantly higher in laparoscopic distal gastrectomy compared to open distal gastrectomy [29,30]. In the current study, the incidence of pancreatic fistula was higher in high-volume hospitals partly because laparoscopic gastrectomy were performed in the high-volume hospitals.…”

Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan

“…During the two years between January 2012 and December 2013, the laparoscopic approach was selected for 33.6% of the Stage I gastric cancer patients who were treated by total gastrectomy. This percentage is rather low, considering the fact that the laparoscopic approach was selected for as many as 55.4% of patients with Stage I cancer who underwent distal gastrectomy during the same period [25]. This possibly reflected the technical difficulty as well as the fact that only laparoscopic distal gastrectomy for Stage I cancer is currently recommended as an optional standard procedure in the Japanese Gastric Cancer Treatment Guidelines [2].…”