Yasuhiro Kodera1, Kazuhiro Yoshida2, Hiraku Kumamaru3, Yoshihiro Kakeji4, Naoki Hiki5, Tsuyoshi Etoh6, Michitaka Honda7, Hiroaki Miyata8, Yuichi Yamashita9, Yasuyuki Seto10, Seigo Kitano11, Hiroyuki Konno12. 1. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. ykodera@med.nagoya-y.ac.jp. 2. Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan. 3. Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 4. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan. 5. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan. 6. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan. 7. Department of Minimally Invasive Medical and Surgical Oncology, Fukushima Medical University, Fukushima, Japan. 8. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan. 9. Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan. 10. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 11. Oita University, Oita, Japan. 12. Hamamatsu University School of Medicine, Hamamatsu, Japan.
Abstract
BACKGROUND: Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now available for analysis. METHODS: A retrospective cohort study was conducted using data from 32,144 patients who underwent total gastrectomy and were registered in the NCD database between January 2012 and December 2013. Mortality and morbidities were compared between patients who received LTG and those who underwent open total gastrectomy (OTG) in the propensity score-matched Stage I cohort and Stage II-IV cohort. RESULTS: There was no significant difference in mortality rate between LTG and OTG in both cohorts. Operating time was significantly longer in LTG while the blood loss was smaller. In the Stage I cohort, LTG, performed in 33.6% of the patients, was associated with significantly shorter hospital stay but significantly higher incidence of readmission, reoperation, and anastomotic leakage (5.4% vs. 3.6%, p < 0.01). In the Stage II-IV cohort, LTG was performed in only 8.8% of the patients and was associated with significantly higher incidence of leakage (5.7% vs. 3.6%, p < 0.02) although the hospital stay was shorter (15 days vs. 17 days, p < 0.001). CONCLUSION: LTG was more discreetly introduced than distal gastrectomy, but remained a technically demanding procedure as of 2013. This procedure should be performed only among the well-trained and informed laparoscopic team.
BACKGROUND: Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now available for analysis. METHODS: A retrospective cohort study was conducted using data from 32,144 patients who underwent total gastrectomy and were registered in the NCD database between January 2012 and December 2013. Mortality and morbidities were compared between patients who received LTG and those who underwent open total gastrectomy (OTG) in the propensity score-matched Stage I cohort and Stage II-IV cohort. RESULTS: There was no significant difference in mortality rate between LTG and OTG in both cohorts. Operating time was significantly longer in LTG while the blood loss was smaller. In the Stage I cohort, LTG, performed in 33.6% of the patients, was associated with significantly shorter hospital stay but significantly higher incidence of readmission, reoperation, and anastomotic leakage (5.4% vs. 3.6%, p < 0.01). In the Stage II-IV cohort, LTG was performed in only 8.8% of the patients and was associated with significantly higher incidence of leakage (5.7% vs. 3.6%, p < 0.02) although the hospital stay was shorter (15 days vs. 17 days, p < 0.001). CONCLUSION: LTG was more discreetly introduced than distal gastrectomy, but remained a technically demanding procedure as of 2013. This procedure should be performed only among the well-trained and informed laparoscopic team.
Entities:
Keywords:
Gastric cancer; Laparoscopic surgery; National Clinical Database; Open gastrectomy; Propensity score matching