Comparison of Laparoscopic Versus Open Gastrectomy for Treatment of Gastric Cancer: Analysis of a Textbook Outcome.

Abstract

Open gastrectomy (OG) has long been the preferred surgical approach worldwide for treatment of gastric cancer (GC). Nowadays, several randomized prospective trials have confirmed improvements in postoperative outcomes for laparoscopic gastrectomy (LG) compared with open procedures, with similar oncologic outcomes. However, many of these studies come from Eastern countries. A prospective nonrandomized study was conducted with all patients operated of GC at Ramón y Cajal University Hospital from January 2015 to December 2017. Of the 96 patients enrolled, 47 patients underwent LG and 49 OG. Textbook outcome was defined as the percentage of patients who underwent a complete tumor resection with at least 15 lymph nodes (LNs) in the resected specimen and an uneventful postoperative course, without hospital readmission. A textbook outcome was achieved in 51.04% of patients operated of GC. The outcome parameter "no severe postoperative complication" had the greatest negative impact on the textbook outcome. A statistically higher number of patients with early cancer (40% versus 16.3%) and subtotal gastrectomy (57.5% versus 34.7%) were found in the laparoscopic group. No statistical differences were found between open and laparoscopic approaches regarding operating time, rate of microscopic margin positivity, hospital stay, number of retrieved LNs, complications, reinterventions, mortality, and readmissions. No statistical differences in textbook outcome were found between both groups (57.14% versus 45%; P = .25). LG for treatment of GC seems to be safe and feasible with similar textbook outcomes compared with OG.