Laparoscopic versus open surgery for gastrointestinal stromal tumor in esophagogastric junction: A multi-center, retrospective cohort analysis with propensity score matching.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11534-11534
Author(s):  
Wenjun Xiong ◽  
Tao Chen ◽  
Xingyu Feng ◽  
Yuting Xu ◽  
Jin Wan ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Propensity Score ◽  
Blood Loss ◽  
Gastrointestinal Stromal Tumor ◽  
Propensity Score Matching ◽  
Open Surgery ◽  
Esophagogastric Junction ◽  
Operative Time ◽  
Liquid Intake

11534 Background: Laparoscopic resection is increasingly performed for Gastrointestinal stromal tumor (GIST). Nevertheless, laparoscopic approach for the GIST located in the esophagogastric junction (EGJ-GIST) represent a surgical challenge. This study aims to investigate the efficacy of laparoscopic surgery and open procedure for EGJ-GIST through the propensity score matching (PSM) method. Methods: Between April 2006 and April 2018, 1824 patients underwent surgery were finally diagnosed with primary gastric GIST at four medical centers in South China. EGJ-GIST was defined as a GIST with an upper border of less than 5 cm from the EG line. Among them, 228 patients were identified and retrospectively reviewed with regard to clinicopathological characteristics, operative information and long-term outcomes. The PSM methods was used to eliminate the selection bias. Results: After PSM, 102 cases, consisted of 51 laparoscopic (LA) and 51 open surgery (OP), were enrolled. The match factors contained year of surgery, gender, age, BMI, tumor size, mitotic rate, recurrence risk and adjuvant tyrosine kinase inhibitors treatment. The LA group was superior to the OP group in operative time (108.5±56.5 vs. 169.3±79.0 min, P <0.001), blood loss (54.6±81.9 vs. 104.9±156.4 ml, P = 0.042), time to liquid intake (3.1±1.8 vs. 4.3±2.2 d, P = 0.003), hospital stay (6.0±2.3 vs. 9.9±8.1, P = 0.001), and postoperative complication (5.9% vs. 25.5%, P = 0.006). The median follow-up was 55 (range, 2-153) months in the entire cohort. No significant differences were detected in either the relapse-free survival (RFS, P = 0.109) or overall survival (OS, P = 0.113) between two groups. The 1-, 3-, and 5-year RFS in the LA and OP groups were 100.0%, 95.5%, 91.0% and 100.0%, 90.8%, 85.7%, respectively. The 1-, 3-, and 5-year OS in the LA and OP group were 100%, 95.6%, 91.3% and 100.0%, 91.1%, 85.4%, respectively. Conclusions: Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time, reduced blood loss, shorter time to liquid intake and shorter length of stay, all without compromising post-operative outcomes and long-term survival.

scholarly journals Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

2020 ◽  
Author(s):  
Ke Chen ◽  
Yu Pan ◽  
Chao-jie Huang ◽  
Qi-long Chen ◽  
Ren-chao Zhang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Propensity Score Matching ◽  
Distal Pancreatectomy ◽  
Pancreatic Resection ◽  
Open Surgery ◽  
Operative Time ◽  
Ductal Adenocarcinoma ◽  
Survival Outcomes ◽  
Low Grade

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most leading causes of cancer mortality worldwide. Laparoscopic pancreatic resection (LPR) has been widely used in the treatment of benign and low-grade pancreatic diseases. It is necessary to expand the current knowledge on the feasibility and safety of LPR for PDAC. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses, aiming to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD).Methods: Data of patients who underwent DP and PD for PDAC from January 2004 to February 2020 in our hospital were obtained. Baseline characteristics, intraoperative effect, postoperative recovery, and survival outcomes were compared. One-to-one PSM was used to minimize selection biases by balancing factors including age, sex, BMI, and tumor size.Results: Patient demographics were well matched after PSM. The DP subgroup included 86 LDP patients and 86 ODP patients, whereas the PD subgroup included 101 LPD patients and 101 OPD patients. Compared to ODP, LDP was associated with shorter operative time, less blood loss, and comparable overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. LPD was associated with longer operative time, less blood loss, and comparable overall morbidity. For oncological and survival outcomes, there were no significant differences in tumor sizes, R0 resection rate and tumor stage in both DP and PD subgroup. However, laparoscopic procedures seems to have an advantage over open surgery in terms of retrieved lymph node (DP subgroup: 14.4 ± 5.2 vs. 11.7 ± 5.1, p = 0.03; PD subgroup 21.9 ± 6.6 vs. 18.9 ± 5.4, p = 0.07). There was no statistical significance between both groups in recurrence pattern, and 3-year recurrence-free and overall survival were comparable between groups.Conclusions: Both LDP and LPD are feasible and oncologically safe procedures for PDAC. Postoperative outcomes and long-term survival of LDP and LPD are not inferior or superior to open surgery. However, the short-term surgical advantage of LPD is not as obvious as LDP mainly due to the conversions. Our findings should be further evaluated by multicenter or randomized controlled trials.

scholarly journals Survival outcomes following laparoscopic vs open surgery for non-metastatic rectal cancer: a two-center cohort study with propensity score matching

2020 ◽  
Vol 8 (4) ◽  
pp. 319-325
Author(s):  
Kang-Lian Tan ◽  
Hai-Jun Deng ◽  
Zhi-Qiang Chen ◽  
Ting-Yu Mou ◽  
Hao Liu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Survival Rate ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Open Surgery ◽  
Laparoscopic Group ◽  
Term Survival ◽  
Free Survival

Abstract Background:?&gt; Laparoscopic surgery for rectal cancer is commonly performed in China. However, compared with open surgery, the effectiveness of laparoscopic surgery, especially the long-term survival, has not been sufficiently proved. Methods:?&gt; Data of eligible patients with non-metastatic rectal cancer at Nanfang Hospital of Southern Medical University and Guangdong Provincial Hospital of Chinese Medicine between 2012 and 2014 were retrospectively reviewed. Long-term survival outcomes and short-term surgical safety were analysed with propensity score matching between groups. Results Of 430 cases collated from two institutes, 103 matched pairs were analysed after propensity score matching. The estimated blood loss during laparoscopic surgery was significantly less than that during open surgery (P = 0.019) and the operative time and hospital stay were shorter in the laparoscopic group (both P &lt; 0.001). The post-operative complications rate was 9.7% in the laparoscopic group and 10.7% in the open group (P = 0.818). No significant difference was observed between the laparoscopic group and the open group in the 5-year overall survival rate (75.7% vs 80.6%, P = 0.346), 5-year relapse-free survival rate (74.8% vs 76.7%, P = 0.527), or 5-year cancer-specific survival rate (79.6% vs 87.4%, P = 0.219). An elevated carcinoembryonic antigen, &lt;12 harvested lymph nodes, and perineural invasion were independent prognostic factors affecting overall survival and relapse-free survival. Conclusions:?&gt; Our findings suggest that open surgery should still be the priority recommendation, but laparoscopic surgery is also an acceptable treatment for non-metastatic rectal cancer.

scholarly journals Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ke Chen ◽  
Yu Pan ◽  
Chao-jie Huang ◽  
Qi-long Chen ◽  
Ren-chao Zhang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Propensity Score Matching ◽  
Distal Pancreatectomy ◽  
Pancreatic Resection ◽  
Open Surgery ◽  
Operative Time ◽  
Tumour Size ◽  
Ductal Adenocarcinoma ◽  
Survival Outcomes

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is a leading causes of cancer mortality worldwide. Currently, laparoscopic pancreatic resection (LPR) is extensively applied to treat benign and low-grade diseases related to the pancreas. The viability and safety of LPR for PDAC needs to be understood better. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are the two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD). Methods We assessed the data of patients who underwent distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) for PDAC between January 2004 and February 2020 at our hospital. A one-to-one PSM was applied to prevent selection bias by accounting for factors such as age, sex, body mass index, and tumour size. The DP group included 86 LDP patients and 86 ODP patients, whereas the PD group included 101 LPD patients and 101 OPD patients. Baseline characteristics, intraoperative effects, postoperative recovery, and survival outcomes were compared. Results Compared to ODP, LDP was associated with shorter operative time, lesser blood loss, and similar overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. The short-term surgical advantage of LPD is not as apparent as that of LDP due to conversions. Compared with OPD, LPD was associated with longer operative time, lesser blood loss, and similar overall morbidity. For oncological and survival outcomes, there were no significant differences in tumour size, R0 resection rate, and tumour stage in both the DP and PD subgroups. However, laparoscopic procedures appear to have an advantage over open surgery in terms of retrieved lymph nodes (DP subgroup: 14.4 ± 5.2 vs. 11.7 ± 5.1, p = 0.03; PD subgroup 21.9 ± 6.6 vs. 18.9 ± 5.4, p = 0.07). These two groups did not show a significant difference in the pattern of recurrence and overall survival rate. Conclusions Laparoscopic DP and PD are feasible and oncologically safe procedures for PDAC, with similar postoperative outcomes and long-term survival among patients who underwent open surgery.

scholarly journals Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

2020 ◽  
Author(s):  
Ke Chen ◽  
Yu Pan ◽  
Chao-jie Huang ◽  
Qi-long Chen ◽  
Ren-chao Zhang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Propensity Score Matching ◽  
Distal Pancreatectomy ◽  
Pancreatic Resection ◽  
Open Surgery ◽  
Operative Time ◽  
Tumour Size ◽  
Ductal Adenocarcinoma ◽  
Survival Outcomes

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is a leading causes of cancer mortality worldwide. Currently, laparoscopic pancreatic resection (LPR) is extensively applied to treat benign and low-grade diseases related to the pancreas. The viability and safety of LPR for PDAC needs to be understood better. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are the two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD). Methods: We assessed the data of patients who underwent distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) for PDAC between January 2004 and February 2020 at our hospital. A one-to-one PSM was applied to prevent selection bias by accounting for factors such as age, sex, body mass index, and tumour size. The DP group included 86 LDP patients and 86 ODP patients, whereas the PD group included 101 LPD patients and 101 OPD patients. Baseline characteristics, intraoperative effects, postoperative recovery, and survival outcomes were compared. Results: Compared to ODP, LDP was associated with shorter operative time, lesser blood loss, and similar overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. The short-term surgical advantage of LPD is not as apparent as that of LDP due to conversions. Compared with OPD, LPD was associated with longer operative time, lesser blood loss, and similar overall morbidity. For oncological and survival outcomes, there were no significant differences in tumour size, R0 resection rate, and tumour stage in both the DP and PD subgroups. However, laparoscopic procedures appear to have an advantage over open surgery in terms of retrieved lymph nodes. These two groups did not show a significant difference in the pattern of recurrence and overall survival rate. Conclusions: Laparoscopic DP and PD are feasible and oncologically safe procedures for PDAC, with similar postoperative outcomes and long-term survival among patients who underwent open surgery.

scholarly journals Minimally invasive versus open right hepatectomy: Comparative study with propensity score matching analysis

2020 ◽  
Author(s):  
Vinicius Campos Duarte ◽  
Fabricio Coelho ◽  
Alain Valverde ◽  
Divia Danoussou ◽  
Jaime Kruger ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Liver Tumors ◽  
Perioperative Complications ◽  
Resection Margins ◽  
Long Term Outcomes ◽  
Invasive Approach

Abstract Background Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs). Methods Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups. Results During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle’s maneuver, operative time, major complications or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). Conclusions MIRHs are feasible and safe. Minimally invasive approach is associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.

scholarly journals Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Vinícius Campos Duarte ◽  
Fabricio Ferreira Coelho ◽  
Alain Valverde ◽  
Divia Danoussou ◽  
Jaime Arthur Pirola Kruger ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Liver Tumors ◽  
Perioperative Complications ◽  
Resection Margins ◽  
Long Term Outcomes ◽  
Invasive Approach

Abstract Background Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs) Methods Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups Results During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle’s maneuver, operative time, overall morbidity or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). Conclusions MIRHs are feasible and safe in experienced hands. Minimally invasive approach was associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.

scholarly journals Introduction of gasless laparoscopic surgery as a minimally invasive procedure for endometrial cancer and its usefulness from the viewpoint of the learning curve

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hiroe Ito ◽  
Tetsuya Moritake ◽  
Fumitoshi Terauchi ◽  
Keiichi Isaka
Keyword(s):  
Endometrial Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Open Surgery ◽  
Operative Time ◽  
Perioperative Complications ◽  
Survival Rates ◽  
Significant Difference

Abstract Background We investigated the usefulness of gasless laparoscopic surgery (GLS) using a subcutaneous abdominal wall lifting method for endometrial cancer. Methods We studied 105 patients with early endometrial cancer who underwent GLS (55) or open surgery (50). A uterine manipulator was used in all GLS cases. We compared operative time, blood loss, number of lymph nodes removed, hospital stay, perioperative complications, cases converted to laparotomy, and recurrence and survival rates. We also studied the learning curve and proficiency of GLS. Results The GLS group had significantly longer operative time (265 vs. 191 min), reduced blood loss (184 vs. 425 mL), shorter hospital stay (9.9 vs. 17.6 days), and fewer postoperative complications (1.8 vs. 12.0%) than the open group. No case was converted to laparotomy. Disease-free and overall survival rates at 4 years postoperatively (GLS vs. open groups) were 98.0 versus 97.8 and 100 versus 95.7%, respectively, and there was no significant difference between the groups. Regarding the learning curve for GLS, two different phases were observed in approximately 10 cases. Operator 2, who was not accustomed to laparoscopic surgery, showed a significant reduction in operative time in the later phase 2. Conclusions GLS for endometrial cancer results in less bleeding, shorter hospital stay, and fewer complications than open surgery. Recurrence and survival rates were not significantly different from those of open surgery. This technique may be introduced in a short time for operators who are skilled at open surgery but not used to laparoscopic surgery.

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