scholarly journals Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China

2021 ◽  
Vol 11 ◽  
Author(s):  
Xingyu Feng ◽  
Xin Chen ◽  
Zaisheng Ye ◽  
Wenjun Xiong ◽  
Xueqing Yao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Disease Free Survival ◽  
D2 Lymphadenectomy ◽  
Significant Difference ◽  
Open Total Gastrectomy

BackgroundGiven the great technical difficulty and procedural complexity of laparoscopic total gastrectomy (LTG), the technical and oncologic safety of LTG versus open total gastrectomy (OTG) in the field of advanced gastric cancer (AGC) is yet undetermined.ObjectiveThis multicenter cohort study aimed to compare the surgical and oncological outcomes of LTG with those of OTG in AGC patients.Patients and MethodsIn total, 588 patients from 3 centers who underwent primary total gastrectomy with D2 lymphadenectomy, by well-trained surgeons with adequate experience, for pathologically confirmed locally AGC (T2N0–3, T3N0–3, or T4N0–3) between January 1, 2011, and December 31, 2015, were identified, and their clinical data were collected from three participating centers. After 1:1 propensity score matching (PSM), 450 cases (LTG, n = 225; OTG, n = 225) were eligible and assessed.ResultsNo significant difference in the number of retrieved lymph nodes, 5-year disease-free survival (DFS) rates, or 5-year overall survival (OS) rates between both surgical groups were observed. Although LTG had significantly longer surgical time (262 vs. 180 min, p < 0.001), LTG was associated with fewer postoperative complications [relative risk (RR) 0.583, 95% CI 0.353–0.960, p = 0.047), less intraoperative bleeding (120 vs. 200 ml, p < 0.001), longer proximal margin resection (3 vs. 2 cm, p < 0.001), and shorter postoperative hospitalization (11 vs. 13 days, p < 0.001). The mortality rate was comparable in both groups.ConclusionsLTG was not inferior to OTG in terms of survival outcomes and was associated with shorter surgical and postoperative hospitalization time and fewer postoperative complications, suggesting LTG with D2 lymphadenectomy as an important alternative to OTG for patients with AGC, but to be carried out in highly experienced centers.

Long-Term Outcomes of Laparoscopic versus Open Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score-Matched Analysis

2019 ◽  
Vol 37 (3) ◽  
pp. 220-228 ◽  
Author(s):  
Hayemin Lee ◽  
Wook Kim ◽  
Junhyun Lee
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Propensity Score ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Disease Free Survival ◽  
Term Survival ◽  
Open Total Gastrectomy

Background: Laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC) is a technically and oncologically challenging procedure for surgeons. Objectives: The aim of this study was to compare the technical safety and long-term oncological feasibility between LTG and open total gastrectomy (OTG) for patients with AGC using a propensity score (PS)-matched analysis. Methods: Between 2004 and 2014, 185 patients (OTG: 127, LTG: 58) underwent curative total gastrectomy for AGC. PS matching was performed using the patients’ clinicopathological factors, and comparisons were made based on surgical outcomes and long-term survival rates. Results: After PS matching, 102 patients (51 patients in each group) were enrolled. The total numbers of retrieved lymph nodes were similar in both groups. The numbers of retrieved lymph nodes around the splenic hilum were similar in both groups. A longer operation time was required for the LTG group than for the OTG group, but less intraoperative bleeding was observed in the LTG group. The overall morbidity and mortality rates of both groups were similar. Between the 2 groups, there was no difference in the 5-year overall survival rate or disease-free survival rate. Conclusions: For treating proximal AGC, LTG may be a technically and an oncologically safe and feasible method.

scholarly journals Prognostic significance of splenectomy during completion total gastrectomy in patients with remnant gastric cancer: propensity score matching analysis

2021 ◽  
Vol 17 (2) ◽  
pp. 96-103
Author(s):  
Seung Hyun Back ◽  
Sung Eun Oh ◽  
Ji Yeong An ◽  
Min-Gew Choi ◽  
Tae Sung Sohn ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Significant Prognostic Factor ◽  
Remnant Gastric Cancer ◽  
Significant Difference ◽  
The Impact

Purpose: Splenectomy for patients with remnant gastric cancer has been controversial. The purpose of this study is to identify the impact of splenectomy in the treatment of remnant gastric cancer.Methods: We retrospectively analyzed 285 patients with remnant gastric cancer who underwent completion total gastrectomy with or without splenectomy in Samsung Medical Center, between September 1996 and December 2017. We used a 1:1 propensity score matching method for the analysis. The matching factors were age, sex, and pathologic stage. After the matching process, we compared the 5-year overall survival (OS) and the disease-free survival (DFS) between patients with and without splenectomy during completion total gastrectomy.Results: The median duration of follow-up was 58.0 months (range, 0–132 months). After propensity score matching, there were no statistically significant differences between the splenectomy group (n = 77) and no splenectomy group (n = 77) in terms of clinicopathological features. The 5-year OS rate between the no splenectomy and splenectomy group were not significantly different. There was no significant difference between 5-year DFS of the matched groups. Multivariate analysis revealed that splenectomy is not a significant prognostic factor in terms of 5-year OS (no splenectomy vs. splenectomy; 61.5% vs. 60.2%, P = 0.884) or DFS (74.9% vs. 69.8%, P = 0.880).Conclusion: Splenectomy has no impact on the OS and DFS in patients with remnant gastric cancer. Splenectomy during completion total gastrectomy may not be necessary.

scholarly journals Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Changdong Yang ◽  
Yan Shi ◽  
Shaohui Xie ◽  
Jun Chen ◽  
Yongliang Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Surgical Outcomes ◽  
Resection Margin ◽  
Short Term ◽  
Conversion Rates ◽  
Significant Difference

Abstract Background: Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had a longer mean operation time (291.14±59.18 vs. 270.34±52.22 min, p=0.003), less intraoperative bleeding (154.37±89.68 vs. 183.77±95.39 ml, p=0.004) and more N2 tier RLNs (9.07±5.34 vs. 7.56±4.50, p=0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90±13.05 vs. 31.91±12.46, p=0.065).Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p=0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55% and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p=0.145), and the ratio of splenectomy were 1.59% and 0.39% (p=0.253). The mortality rates were 0.8% and 0.4% for the RATG and LATG groups, respectively (p=1.000). Conclusion : This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

scholarly journals Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Changdong Yang ◽  
Yan Shi ◽  
Shaohui Xie ◽  
Jun Chen ◽  
Yongliang Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Surgical Outcomes ◽  
Resection Margin ◽  
Short Term ◽  
Conversion Rates ◽  
Significant Difference

Abstract Background: Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had a longer mean operation time (291.14±59.18 vs. 270.34±52.22 min, p=0.003), less intraoperative bleeding (154.37±89.68 vs. 183.77±95.39 ml, p=0.004) and more N2 tier RLNs (9.07±5.34 vs. 7.56±4.50, p=0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90±13.05 vs. 31.91±12.46, p=0.065).Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p=0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55% and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p=0.145), and the ratio of splenectomy were 1.59% and 0.39% (p=0.253). The mortality rates were 0.8% and 0.4% for the RATG and LATG groups, respectively (p=1.000).Conclusion: This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

scholarly journals Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Changdong Yang ◽  
Yan Shi ◽  
Shaohui Xie ◽  
Jun Chen ◽  
Yongliang Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Surgical Outcomes ◽  
Resection Margin ◽  
Short Term ◽  
Conversion Rates ◽  
Significant Difference

Abstract Background: Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had a longer mean operation time (291.14±59.18 vs. 270.34±52.22 min, p=0.003), less intraoperative bleeding (154.37±89.68 vs. 183.77±95.39 ml, p=0.004) and more N2 tier RLNs (9.07±5.34 vs. 7.56±4.50, p=0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90±13.05 vs. 31.91±12.46, p=0.065).Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p=0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55% and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p=0.145), and the ratio of splenectomy were 1.59% and 0.39% (p=0.253). The mortality rates were 0.8% and 0.4% for the RATG and LATG groups, respectively (p=1.000). Conclusion : This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

Long-term outcome of laparoscopic versus open total gastrectomy for advanced gastric cancer: A propensity score-matched analysis.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 77-77
Author(s):  
Hayemin Lee ◽  
Junhyun Lee
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Term Survival ◽  
Long Term Outcome ◽  
Open Total Gastrectomy

77 Background: Laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC) is technically and oncologically challenging procedure for surgeons. The aim of this study is to compare technical safety and long-term oncologic feasibility of LTG for AGC patients compared to open total gastrectomy (OTG) using propensity score (PS)-matched analysis. Methods: Between 2004 and 2014, 185 patients (OTG: 127, LTG: 58) underwent total gastrectomy due to advanced gastric cancer. PS-matching was done using patients’ age, sex, American Society of Anesthesiologist (ASA) physical status, extent of lymph node dissection, presence of combined resection and pathological stage of gastric cancer. Comparisons were made based on surgical outcomes and long-term survival rates. Results: After PS-matching, 102 patients, respectively 51 patients for each group, were enrolled. LTG had longer tumor-free proximal resection margin (OTG 2.5 cm vs. LTG 3.0 cm, p = 0.008). Total number of retrieved lymph node and metastasized lymph node was similar in both groups. The retrieved number of lymph nodes around splenic hilum (#10 and #11d) was similar in both groups (p = 0.105). Longer operation time was required in LTG (OTG 240 min. vs. LTG 320 min, p = 0.002) but less intraoperative bleeding was observed in LTG (OTG 390 cc vs. LTG 276 cc, p < 0.001). Patients of LTG were discharged earlier than OTG (OTG 12 days vs. LTG 10 days, p = 0.043). Overall morbidity and mortality of both group was similar. Between two groups, there was not a difference in 5-year overall survival rate (OTG 56.3% vs. LTG 56.5%, p = 0.597) or disease free survival rate (OTG 59.0% vs. LTG 67.6%, p = 0.455). Conclusions: For treating proximal AGC, LTG may be a technically and oncologically safe and feasible method.

scholarly journals Surgical and oncological efficacy of laparoscopic-assisted total gastrectomy versus open total gastrectomy for gastric cancer by propensity score matching: a retrospective comparative study

2021 ◽  
Author(s):  
Yingcong Fan ◽  
Maoxing Liu ◽  
Shijie Li ◽  
Jianhong Yu ◽  
Xinyu Qi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Gastrointestinal Surgery ◽  
Pathological Stage ◽  
Open Total Gastrectomy ◽  
Laparoscopic Assisted

Abstract Purpose The application of laparoscopic-assisted total gastrectomy (LATG) for resectable gastric cancer (GC) remains controversial compared with open total gastrectomy (OTG), especially for advanced gastric cancer (AGC) patients according to the inconsistent results demonstrated in the previous studies. The aim of this study was to evaluate the short-term and long-term outcomes between LATG and OTG in a population with more than 80% AGC patients by applying propensity score matching (PSM) method. Methods The data of 365 clinical stage I–III GC cases who underwent total gastrectomy with D2 lymphadenectomy were retrospectively collected from January 2011 to April 2018 in the Department of Gastrointestinal Surgery IV of Peking University Cancer Hospital. Propensity scores were generated through taking all covariates into consideration and 131 pairs of patients receiving either LATG or OTG were matched. Intraoperative, postoperative, and survival parameters were compared in the matched groups accordingly. Risk factors for postoperative complications and overall survival were further analyzed. Results Patient characteristics in the LATG and OTG groups were well balanced after PSM. LATG showed advantages with respect to shorter time to ambulation, first flatus, and first whole liquid diet intake. No significant differences were found between the two groups with regard to postoperative complications as well as overall survival in terms of different pathological stage. Older age was found as an independent risk factor for postoperative complications, and pathological stage for overall survival as well. Conclusion LATG appears to have comparable surgical and oncological safety with OTG by experienced surgeons.

scholarly journals Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

2019 ◽  
Author(s):  
Changdong Yang ◽  
Yan Shi ◽  
Shaohui Xie ◽  
Jun Chen ◽  
Yongliang Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Total Gastrectomy ◽  
Resection Margin ◽  
Operation Time ◽  
Clinicopathological Characteristics ◽  
Short Term ◽  
Significant Difference

Abstract Background Few studies have been designed to evaluate the short-term outcomes for advanced gastric cancer (AGC) between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) alone. The purpose of this study was to assess short-term outcomes of RATG compared with LATG for AGC.Methods We retrospectively evaluated 116 and 244 patients who underwent RATG or LATG respectively. Besides, we performed a propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes.Results After PSM, the RTAG group had longer mean operation time (291.09±58.41 vs. 271.99±48.41min, p=0.007), less intraoperative bleeding (151.98±92.83 vs. 172.59±97.01ml, p=0.032) and more N2 tier RLNs (9.33±5.46 vs. 7.50±3.86, p=0.018) than the LATG group. Besides, the total RLNs of RATG was at the brink of significance compared to LATG (35.09±12.93 vs.32.34±12.05, p=0.062). However, no significant differences were found between the two groups in terms of length of incision, proximal resection margin, distal resection margin, postoperative hospital stay. The conversion rate was 4.92% and 8.61% in the RATG and LATG groups, respectively, with no significant difference. The ratio of splenectomy was 1.7% and 0.4% respectively. There was no significant difference in overall complication rate between RATG and LATG groups before PSM (24.1% vs. 28.7%; p=0.341) and after PSM (24.1% vs. 33.6%; p=0.102). The grade II complications accounted for most of all complications in the two cohorts both before and after PSM.Conclusion This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

Sign in / Sign up

Export Citation Format

Share Document