Outcomes and Use of Laparoscopic Versus Open Gastric Resection

JSLS. Oct-Dec 2015;19(4):e2015.00095. doi: 10.4293/JSLS.2015.00095.

Abstract

Background and objectives: The advantages of laparoscopy over open surgery are well established. Laparoscopic resection for gastric cancer is safe and results in equivalent oncologic outcomes when compared with open resection. The purpose of this study was to assess the use of laparoscopy to treat gastric cancer and the associated outcomes.

Methods: The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) dataset was queried for patients with gastric cancer (ICD-9 Code 151.0-151.9) from January 2005 through December 2012. Logistic regression was used to evaluate the 30-day morbidity and mortality of open gastrectomy (CPT code 43620-2, 43631-4) versus that of the laparoscopic procedure on the stomach (CPT code 43650), while adjusting for preoperative risk factors.

Results: A total of 4116 patients with gastric cancer were identified and divided by surgical approach into 2 groups: open gastrectomy (n = 3725; 90.5%) and laparoscopic procedure on the stomach (n = 391; 9.5%). After adjustment for preoperative risk factors, complications were significantly fewer in laparoscopic versus open gastric resection (odds ratio [OR] 0.61, 95% confidence interval [CI] = 0.45-0.82; P = .001). After adjusting for preoperative risk factors, there was no statistically significant difference in mortality with laparoscopic compared to open gastric resection (OR 0.74; 95% CI = 0.32-1.72; P = .481).

Conclusions: Laparoscopy is underused in the treatment of gastric cancer. Given that laparoscopic gastric resection has a lower morbidity in comparison to open resection, steps should be made toward advancing the use of laparoscopy for gastric cancer.

Keywords: Gastric cancer; Laparoscopic gastrectomy; Laparoscopic perioperative outcomes.

Publication types

  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Female
  • Gastrectomy / methods*
  • Gastrectomy / mortality
  • Humans
  • Laparoscopy / methods*
  • Laparoscopy / mortality
  • Logistic Models
  • Male
  • Middle Aged
  • Postoperative Complications / mortality*
  • Risk Factors
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / surgery*
  • Survival Analysis