Gastric cancer: laparoscopic vs open total gastrectomy

  • Sakamoto T & al.
  • Ann Surg Oncol
  • 12 Aug 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Laparoscopic total gastrectomy (LTG) for gastric cancer is associated with shorter time to first oral intake and postoperative stay than open surgery, but also a greater incidence of anastomotic leakage.

Why this matters

  • LTG has become more commonly performed, but it is technically challenging, and its safety has not been fully established.
  • Most prior studies supporting LTG safety were conducted at single institutions.

Study design

  • Propensity-matched analysis of 12,229 patient pairs derived from the Japanese Diagnosis Procedure Combination database.
  • Funding: Government of Japan.

Key results

  • In-hospital mortality (0.6% vs 0.7%; P=.58) and postoperative complications (17.5% vs 17.3%; P=.66) were similar between groups for propensity-matched patients.
  • LTG was associated with higher rates of anastomotic leakage (2.9% vs 1.7%, P<.001 and stenosis vs p=".02)" compared with open surgery.>
  • LTG was associated with lower rates of pancreatic injury (1.4% vs 1.8%; P=.01), endoscopic hemostasis (0.9% vs 1.7%; P<.001 blood transfusion vs p and readmission>
  • LTG was associated with greater duration of anesthesia (323 vs 304 minutes; P<.001 shorter time to first oral intake days vs p and postoperative length of stay>

Limitations

  • Retrospective.
  • Japanese population.