Totally Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Matched Cohort Study

Abstract

Background: The role of laparoscopic surgery for the treatment of gastric cancer is still controversial, particularly in terms of oncologic efficacy. The aim of this study was to compare short-term outcomes of laparoscopic and open resection for gastric cancer at a single Western institution. Subjects and Methods: This study was designed as a matched cohort study from a prospective gastric cancer database. Forty-one patients undergoing laparoscopic gastrectomy for gastric cancer between June 2008 and January 2012 were matched with 41 patients undergoing open gastrectomy in the same time period. Patient pairing was done according to age, gender, type of gastrectomy (subtotal or total), and tumor stage via a randomized statistical method. The short-term outcomes and oncologic adequacy of the laparoscopic and open procedures were compared. A D2 lymph node dissection was performed in the majority of patients in both groups. Results: The two study groups were similar with respect to patient and tumor characteristics. Laparoscopic procedures were associated with a decreased blood loss (118.7 versus 312.4 mL, P < .005), incidence of surgeryunrelated complications (3 versus 9 patients, P < .05), and duration of hospital stay (8.1 versus 11.5 days, P < .05) but increased operative time for both subtotal (223.5 versus 158.2 minutes, P < .001) and total (298.1 versus 185.5 minutes, P < .001) gastrectomies. The mean number of retrieved lymph nodes after D2 dissection was similar: 30.0 for laparoscopic and 29.7 for open patients. Conclusions: Within the limitations of a nonrandomized analysis, this study shows that the laparoscopic approach is a safe and oncologically adequate option for the treatment of gastric cancer, which compares favorably with open gastrectomy in short-term outcomes.

Minimally invasive gastrectomy for gastric adenocarcinoma in the United States: Utilization and short‐term oncologic outcomes

“…Additionally, lymph node dissection did not differ between the minimally invasive and open group. This is in accordance with several Western studies . However, minimally invasive gastrectomy was mostly performed on patients with stage IB cancer, making it susceptible for bias.…”

Comparison of laparoscopic total gastrectomy and laparotomic total gastrectomy for gastric cancer

“…Kim et al. (2013) compared 139 totally laparoscopic total gastrectomy operations with 207 patients undergoing laparotomy, noting that the return of oral diet was significantly faster in laparoscopic surgery (p=0.018) 13 , corroborating the data from many studies in the literature 6 , 20 , 26 . On the other hand, Jeong et al (2013) in their series found no significant difference with regard to the time of return to oral diet 12 .…”

“…Series of published reports have addressed the estimated blood loss during the operation. In general, the blood loss during the laparoscopic procedure was significantly lower than during the open procedures 5 , 6 , 9 , 21 , 26 , 27 , 29 . In this study there was no significant difference as to the average of blood units received in both groups (p=0.127).…”

“…As to the surgical time of laparoscopic surgeries, the learning curve is part of a natural process. The literature data are conflicting, presenting papers in which the surgical time is significantly higher in the laparoscopic surgery and, in others, the difference between groups was not significant 6 , 15 , 20 , 21 , 29 .…”

Optimal Management of Gastric Cancer

“…An important previous finding is that laparoscopic gastrectomy showed similar results to open gastrectomy with regard to quality of oncological resection, as measured by the number of retrieved lymph nodes and 5-year survival, 7 whereas patient recovery was faster and admission duration shorter. 8,9 However, these studies were underpowered and do not take into account neoadjuvant therapy and long-term follow-up.…”