Comparison of short-term and long-term efficacy of laparoscopic and open gastrectomy in high-risk patients with gastric cancer: a propensity score-matching analysis

Surg Endosc. 2019 Jan;33(1):58-70. doi: 10.1007/s00464-018-6268-z. Epub 2018 Jun 21.

Abstract

Background: To determine whether laparoscopic surgery can be used in high-risk patients with gastric cancer.

Methods: The clinicopathological data of 3743 patients with primary gastric adenocarcinoma, collected from January 2007 to December 2014, were retrospectively analyzed. Patients who had ≥ 1 of the following conditions were defined as high-risk patients: (1) age ≥ 80 years; (2) BMI ≥ 30 kg/m2; (3) ASA (American Society of Anesthesiologists) grade ≥ 3; or (4) clinical T stage 4 (cT4). Propensity score matching (PSM) was used to reduce confounding bias; then, we compared the short-term and long-term efficacy of laparoscopic gastrectomy (LG) with open gastrectomy (OG) in high-risk patients with gastric cancer.

Results: A total of 1296 patients were included in PSM. After PSM, no significant difference in clinicopathological data was observed between the LG group (n = 341) and the OG group (n = 341). The operative time (181.70 vs. 266.71 min, p < 0.001) and blood loss during the operation (68.11 vs. 225.54 ml, p < 0.001) in the LG group were significantly lower than those in the OG group. In the LG and OG groups, postoperative complications occurred in 39 (11.4%) and 63 (18.5%) patients, respectively, p = 0.010. Multivariate analysis showed that laparoscopic surgery was an independent protective factor against postoperative complications (p = 0.019). The number of risk factors was an independent risk factor for postoperative complications (p = 0.021). The 5-year overall survival rate in the LG group was comparable to that in the OG group (55.0 vs. 52.0%, p = 0.086). Hierarchical analysis further confirmed that the LG and OG groups exhibited comparable survival rates among patients with stages cI, pI, cII, pII, cIII, and pIII (all p > 0.05).

Conclusions: For high-risk patients with gastric cancer, LG not only exhibits better short-term efficacy than OG but also has a comparable 5-year survival rate to OG.

Keywords: Complication; Gastric cancer; High-risk patients; Laparoscopic gastrectomy; Prognosis; Propensity score matching.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / surgery*
  • Adult
  • Aged
  • Female
  • Gastrectomy / adverse effects
  • Gastrectomy / methods*
  • Humans
  • Kaplan-Meier Estimate
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Operative Time
  • Postoperative Complications / etiology
  • Propensity Score
  • Retrospective Studies
  • Risk Factors
  • Stomach Neoplasms / surgery*
  • Survival Rate