Tsuyoshi Etoh1, Michitaka Honda2, Hiraku Kumamaru3, Hiroaki Miyata4, Kazuhiro Yoshida5, Yasuhiro Kodera6, Yoshihiro Kakeji7, Masafumi Inomata8, Hiroyuki Konno9, Yasuyuki Seto10, Seigo Kitano11, Naoki Hiki12. 1. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Hasama-machi, Oita, 879-5593, Japan. teto@oita-u.ac.jp. 2. Department of Minimal Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan. 3. Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 4. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan. 5. Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan. 6. Department of Gastroenterological Surgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan. 7. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan. 8. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Hasama-machi, Oita, 879-5593, Japan. 9. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 10. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 11. Oita University, Oita, Japan. 12. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Abstract
BACKGROUND: Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry. METHODS: From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG. RESULTS: The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively). CONCLUSION: The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.
BACKGROUND: Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry. METHODS: From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG. RESULTS: The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively). CONCLUSION: The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.
Entities:
Keywords:
Laparoscopic total gastrectomy; National Clinical Database registration system; Prospective cohort study