J Gastric Cancer.  2019 Mar;19(1):83-91. 10.5230/jgc.2019.19.e4.

Oncologic Outcomes after Laparoscopic and Open Distal Gastrectomy for Advanced Gastric Cancer: Propensity Score Matching Analysis

• Kim SH
• Chung Y
• Kim YH
• Choi SI

• KMID: 2458820
• DOI: http://doi.org/10.5230/jgc.2019.19.e4

Abstract

PURPOSE
This study aimed to compare the oncologic and short-term outcomes of laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) for advanced gastric cancer (AGC).
MATERIALS AND METHODS
From July 2006 to November 2016, 384 patients underwent distal gastrectomy for AGC. Data on short- and long-term outcomes were prospectively collected and reviewed. Propensity score matching was applied at a ratio of 1:1 to compare the LDG and ODG groups.
RESULTS
The operative times were longer for the LDG group than for the ODG group. However, the time to resumption of diet and the length of hospital stay were shorter in the LDG group than in the ODG group (4.7 vs. 5.6 days, P=0.049 and 9.6 vs. 11.5 days, P=0.035, respectively). The extent of lymph node dissection in the LDG group was more limited than in the ODG group (P=0.002), although there was no difference in the number of retrieved lymph nodes between the 2 groups. The 3-year overall survival rates were 98% and 86.9% (P=0.018), and the 3-year recurrence-free survival rates were 86.3% and 75.3% (P=0.259), respectively, in the LDG and ODG groups.
CONCLUSIONS
LDG is safe and feasible for AGC, with earlier recovery after surgery and long-term oncologic outcomes comparable to those of ODG.

Keyword

Stomach neoplasms; Laparoscopy; Disease-free survival

MeSH Terms

Diet
Disease-Free Survival
Gastrectomy*
Humans
Laparoscopy
Length of Stay
Lymph Node Excision
Lymph Nodes
Operative Time
Propensity Score*
Prospective Studies
Stomach Neoplasms*
Survival Rate

Figure

• 

  Fig. 1 RFS after propensity score matching analysis. RFS = recurrence-free survival; LDG = laparoscopic distal gastrectomy; ODG = open distal gastrectomy.

• 

  Fig. 2 OS after propensity score matching analysis. OS = overall survival; LDG = laparoscopic distal gastrectomy; ODG = open distal gastrectomy.

Reference

1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994; 4:146–148.

2. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016; 263:28–35.

3. Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017; 20:699–708.

4. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol. 2016; 34:1350–1357.

5. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg. 2015; 39:2734–2741.

6. Huang YL, Lin HG, Yang JW, Jiang FQ, Zhang T, Yang HM, et al. Laparoscopy-assisted versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer: a meta-analysis. Int J Clin Exp Med. 2014; 7:1490–1499.

7. Zou ZH, Zhao LY, Mou TY, Hu YF, Yu J, Liu H, et al. Laparoscopic vs open D2 gastrectomy for locally advanced gastric cancer: a meta-analysis. World J Gastroenterol. 2014; 20:16750–16764.

8. Li Q, Wang J, Zhang G, Wang J, Yang B, Zhang Z. Feasibility and safety comparison of laparoscopy-assisted versus open gastrectomy for advanced gastric carcinoma with D2 lymphadenectomy. Jpn J Clin Oncol. 2016; 46:323–328.

9. Quan Y, Huang A, Ye M, Xu M, Zhuang B, Zhang P, et al. Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer. 2016; 19:939–950.

10. Cai J, Wei D, Gao CF, Zhang CS, Zhang H, Zhao T. A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig Surg. 2011; 28:331–337.

11. Zhao Y, Yu P, Hao Y, Qian F, Tang B, Shi Y, et al. Comparison of outcomes for laparoscopically assisted and open radical distal gastrectomy with lymphadenectomy for advanced gastric cancer. Surg Endosc. 2011; 25:2960–2966.

12. Hamabe A, Omori T, Tanaka K, Nishida T. Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc. 2012; 26:1702–1709.

13. Gordon AC, Kojima K, Inokuchi M, Kato K, Sugihara K. Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gastrectomy in advanced gastric cancer. Surg Endosc. 2013; 27:462–470.

14. Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, et al. Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc. 2013; 27:286–294.

15. Choi YY, Bae JM, An JY, Hyung WJ, Noh SH. Laparoscopic gastrectomy for advanced gastric cancer: are the long-term results comparable with conventional open gastrectomy? A systematic review and meta-analysis. J Surg Oncol. 2013; 108:550–556.

16. Kim KH, Kim MC, Jung GJ, Choi HJ, Jang JS, Kwon HC. Comparative analysis of five-year survival results of laparoscopy-assisted gastrectomy versus open gastrectomy for advanced gastric cancer: a case-control study using a propensity score method. Dig Surg. 2012; 29:165–171.

17. Lin JX, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, et al. Is all advanced gastric cancer suitable for laparoscopy-assisted gastrectomy with extended lymphadenectomy? A case-control study using a propensity score method. Ann Surg Oncol. 2016; 23:1252–1260.

18. Inokuchi M, Nakagawa M, Tanioka T, Okuno K, Gokita K, Kojima K. Long- and short-term outcomes of laparoscopic gastrectomy versus open gastrectomy in patients with clinically and pathological locally advanced gastric cancer: a propensity-score matching analysis. Surg Endosc. 2018; 32:735–742.

19. Zhang Y, Qi F, Jiang Y, Zhai H, Ji Y. Long-term follow-up after laparoscopic versus open distal gastrectomy for advanced gastric cancer. Int J Clin Exp Med. 2015; 8:13564–13570.

20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213.

21. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017; 20:1–19.

22. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, et al. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg. 2008; 248:1–7.

23. Kelly KJ, Selby L, Chou JF, Dukleska K, Capanu M, Coit DG, et al. Laparoscopic versus open gastrectomy for gastric adenocarcinoma in the west: a case-control study. Ann Surg Oncol. 2015; 22:3590–3596.

24. Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011; 253:900–911.

25. Seevaratnam R, Bocicariu A, Cardoso R, Mahar A, Kiss A, Helyer L, et al. A meta-analysis of D1 versus D2 lymph node dissection. Gastric Cancer. 2012; 15:Suppl 1. S60–S69.

26. An JY, Heo GU, Cheong JH, Hyung WJ, Choi SH, Noh SH. Assessment of open versus laparoscopy-assisted gastrectomy in lymph node-positive early gastric cancer: a retrospective cohort analysis. J Surg Oncol. 2010; 102:77–81.

27. Park YK, Yoon HM, Kim YW, Park JY, Ryu KW, Lee YJ, et al. Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer: results from a randomized phase II multicenter clinical trial (COACT 1001). Ann Surg. 2018; 267:638–645.

28. Kim J, Eom B, Nam B, Yoon H, Kim Y. 423. ADDICT – a multicenter randomized clinical trial of D1+ versus D2 distal gastrectomy for stage IB & II advanced gastric cancer: design and rationale. Eur J Surg Oncol. 2014; 40:S162.

29. Hur H, Si Y, Kang WK, Kim W, Jeon HM. Effects of early oral feeding on surgical outcomes and recovery after curative surgery for gastric cancer: pilot study results. World J Surg. 2009; 33:1454–1458.

30. Grantcharov TP, Kehlet H. Laparoscopic gastric surgery in an enhanced recovery programme. Br J Surg. 2010; 97:1547–1551.

31. Wang D, Kong Y, Zhong B, Zhou X, Zhou Y. Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg. 2010; 14:620–627.

32. Kim JW, Kim WS, Cheong JH, Hyung WJ, Choi SH, Noh SH. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg. 2012; 36:2879–2887.

33. Yamada T, Hayashi T, Cho H, Yoshikawa T, Taniguchi H, Fukushima R, et al. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer. 2012; 15:34–41.