Naoki Hiki1, Michitaka Honda2, Tsuyoshi Etoh3, Kazuhiro Yoshida4, Yasuhiro Kodera5, Yoshihiro Kakeji6, Hikaru Kumamaru7, Hiroaki Miyata8, Yuichi Yamashita9, Masafumi Inomata3, Hiroyuki Konno10, Yasuyuki Seto11, Seigo Kitano12. 1. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan. naoki.hiki@jfcr.or.jp. 2. Department of Disaster and Comprehensive Medicine, Fukushima Medical University, Fukushima, Japan. 3. Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan. 4. Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan. 5. Department of Gastroenterological Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan. 6. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan. 7. Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 8. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan. 9. Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 10. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 11. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 12. Oita University, Oita, Japan.
Abstract
BACKGROUND: Laparoscopic distal gastrectomy (LDG) is becoming the standard procedure for gastric cancer. However, supporting evidence thus far has been derived primarily from randomized control trials conducted by centers of excellence. In the present study we used the National Clinical Database (NCD) in Japan to prospectively accumulate data from diverse types of hospitals and examine whether LDG is a safe and valid standard procedure. METHODS: From the NCD, 169 institutions were selected to form a cohort that was considered to be representative of Japan. From August 2014 to July 2015, 5288 patients who underwent LDG were registered prospectively, and clinical data were acquired through the NCD. To compare surgical outcomes between open distal gastrectomy (ODG) and LDG, we adjusted for confounding factors using propensity score matching, ultimately retrieving data from 1067 patients in each group. RESULTS: There were no significant differences in the number of in-hospital deaths in the ODG and LDG groups (3/1067 vs. 6/1067; P = 0.51) or in the number of reoperations (20/1067 vs. 29/1067; P = 0.19). However, the length of hospital stay was significantly shorter in the LDG. Although wound infection and dehiscence were more common in the ODG group, LDG was more often associated with grade B or higher pancreatic fistulas. CONCLUSION: The safety and minimal invasiveness of LDG were confirmed in the present Japanese nationwide survey. However, care must be taken to prevent the formation of pancreatic fistulas with LDG, and further improvements in surgical quality are warranted in this regard.
BACKGROUND: Laparoscopic distal gastrectomy (LDG) is becoming the standard procedure for gastric cancer. However, supporting evidence thus far has been derived primarily from randomized control trials conducted by centers of excellence. In the present study we used the National Clinical Database (NCD) in Japan to prospectively accumulate data from diverse types of hospitals and examine whether LDG is a safe and valid standard procedure. METHODS: From the NCD, 169 institutions were selected to form a cohort that was considered to be representative of Japan. From August 2014 to July 2015, 5288 patients who underwent LDG were registered prospectively, and clinical data were acquired through the NCD. To compare surgical outcomes between open distal gastrectomy (ODG) and LDG, we adjusted for confounding factors using propensity score matching, ultimately retrieving data from 1067 patients in each group. RESULTS: There were no significant differences in the number of in-hospital deaths in the ODG and LDG groups (3/1067 vs. 6/1067; P = 0.51) or in the number of reoperations (20/1067 vs. 29/1067; P = 0.19). However, the length of hospital stay was significantly shorter in the LDG. Although wound infection and dehiscence were more common in the ODG group, LDG was more often associated with grade B or higher pancreatic fistulas. CONCLUSION: The safety and minimal invasiveness of LDG were confirmed in the present Japanese nationwide survey. However, care must be taken to prevent the formation of pancreatic fistulas with LDG, and further improvements in surgical quality are warranted in this regard.
Authors: Takanobu Yamada; Takaki Yoshikawa; Masataka Taguri; Tsutomu Hayashi; Toru Aoyama; Henry M Sue-Ling; Kiran Bonam; Jeremy D Hayden; Heike I Grabsch Journal: Gastric Cancer Date: 2015-03-12 Impact factor: 7.370
Authors: Hyung-Ho Kim; Sang-Uk Han; Min-Chan Kim; Woo Jin Hyung; Wook Kim; Hyuk-Joon Lee; Seung Wan Ryu; Gyu Seok Cho; Chan Young Kim; Han-Kwang Yang; Do Joong Park; Kyo Young Song; Sang Il Lee; Seong Yeob Ryu; Joo Ho Lee Journal: J Korean Surg Soc Date: 2013-01-29