Laparoscopic Versus Open Gastrectomy for Cancer: A Western Center Cohort Study

J Surg Res. 2020 Mar:247:372-379. doi: 10.1016/j.jss.2019.10.006. Epub 2019 Oct 31.

Abstract

Background: Laparoscopic gastrectomy (LG) for cancer has been introduced in institutions worldwide in an effort to minimize surgical trauma, while aiming to provide comparable oncological outcomes to conventional open gastrectomy (OG). The aim of this study was to present our results during the period of implementation of the laparoscopic technique.

Materials and methods: In 2012, LG for the treatment of gastric cancer was introduced at our institution. The results presented are based on a retrospective analysis of data from a cohort of all patients treated with curative intent over the period 2010-2018.

Results: During the study period, 206 patients underwent surgery for gastric cancer: 129 patients (62.6%) had an OG and 77 patients (37.4%) an LG. The conversion rate due to technical reasons was 2.6%. LG was associated with significantly less intraoperative blood loss [mean (mL), OG 544 versus LG 176] and shorter hospital stay than OG [mean (d), OG 12 versus LG 8], fewer severe complications (Clavien-Dindo grade ≥ IIIb) [OG 29 (22.5%) versus LG 9 (11.7%), P = 0.081], significantly lower anastomotic leak rate [OG 18 (14.0%) versus LG 1 (1.3%)] and no 90-day mortality. The percentage of R0 resections was similar between the two groups (OG 82.2% versus LG 85.7%, P = 0.507), while the mean number of resected lymph nodes was significantly higher in the laparoscopic group [OG 34 versus LG 39, P = 0.030].

Conclusions: Our data suggest that similar and, in some aspects, better short-term outcomes can be achieved with LG with maintained oncological quality.

Keywords: Gastric cancer; Laparoscopic gastrectomy; Surgical outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Loss, Surgical / statistics & numerical data
  • Conversion to Open Surgery / statistics & numerical data
  • Female
  • Gastrectomy / adverse effects*
  • Gastrectomy / methods
  • Gastrectomy / statistics & numerical data
  • Hospital Mortality
  • Humans
  • Laparoscopy / adverse effects*
  • Laparoscopy / methods
  • Laparoscopy / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Lymph Node Excision / statistics & numerical data
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Severity of Illness Index
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / surgery*
  • Time Factors
  • Treatment Outcome