Comparison of short- and long-term outcomes following laparoscopy and open total gastrectomy for gastric cancer: a propensity score-matched analysis

Abstract

Background: The aim of this study was to compare the short- and long-term outcomes of laparoscopic total gastrectomy (LTG) with those of open total gastrectomy (OTG) for the upper part of clinical Stage I gastric cancer.

Methods: Between 2000 and 2015, 122 and 96 consecutive gastric cancer patients who had undergone curative LTG and OTG with lymphadenectomy were enrolled in the study. We performed the simple intracorporeal techniqueof esophagojejunostomy using a circular stapler in LTG. This technique comprised of laparoscopic trans-abdominal anvil insertion into the esophagus, which was assisted by lifting up the nasogastric tube connected to the anvil head.

Results: By the Clavien-Dindo classification defined as grade II or high, the rate of postoperative complications was 14.8% (14/112: Grade II (7), IIIa (4), and IIIb (3)) in LTG and 15.6% (15/96) in OTG. There was no anastomotic leakage (0% (0/122)) and only 3.3% (4/122) of anastomotic stenosis in LTG. There was no significant difference in the short-term outcomes between both groups in all enrolled and propensity score-matched patients (LTG vs. OTG: 15.4% (10/65) vs. 16.9% (11/65)). Regarding the long-term outcomes, there was no significant difference in overall survival between both groups in all enrolled (P = 0.190) and propensity score-matched patients (P = 0.643).

Conclusions: LTG for the upper part of clinical Stage I gastric cancer is a safe and reliable procedure and could have similar short- and long-term outcomes as OTG.

Keywords: Laparoscopic total gastrectomy; complication; esophagojejunostomy; gastric cancer; prognosis.

Figure 1

The anvil head of a 25-mm circular stapler (CDH; Ethicon Endosurgery, Cincinnati, OH, USA) was prepared with 4-0 PDS sutures and the anvil tip capped with an 8-cm length of 10-Fr nasogastric tube using 3-0 nylon (A). Then, the anvil 4-0 PDS sutures were tied to the nasogastric tube (B).

Figure 2

The 8-cm length of 10-Fr nasogastric tube, which was connected with the tip of the anvil, was positioned in the middle of the esophageal incision, and the entry hole was grasped by the assistant and tightly closed by a linear stapler (A). Schema (B).

Figure 3

The Kaplan-Meier plots show 5-year overall survival (OS) according to the operative approach. In all patients, OS tended to be better in patients who underwent laparoscopic total gastrectomy (LTG) than in patients who underwent open total gastrectomy (OTG) (A, P = 0.190). In the propensity score-matched cohorts, we found no significant differences between both groups (B, P = 0.643).