National outcomes and uptake of laparoscopic gastrectomy for cancer in England

Abstract

Gastrectomy remains the mainstay of curative treatment for gastric cancer, yet it is associated with significant postoperative mortality. The laparoscopic approach has been introduced in an attempt to improve surgical outcomes. This study examines the uptake of laparoscopic gastrectomy in England and quantifies postoperative mortality and morbidity following gastrectomy for cancer. A population-based study of a national administrative database was undertaken. Patients undergoing gastrectomy for cancer in any National Health Services hospital in England between April 2000 and March 2010 were included. The main outcome measures were mortality, morbidity and length of stay. A total of 10,713 patients underwent gastrectomy, of which 10,233 (95.5%) underwent open gastrectomy (OG), and 480 (4.5%) underwent laparoscopic gastrectomy (LG). There was no significant difference in 30-day in-hospital mortality between OG and LG (5.6% vs. 4.8%; p = 0.461). Medical complications occurred in 2,311 (22.6%) and 120 (25%) patients from OG and LG groups respectively (p = 0.217). Patients in the LG groups had a shorter hospital stay than OG with median (interquartile range) of 11 (8-17) versus 14 (11-19) days respectively (p < 0.001). Readmission and reoperation rates were 10.2 versus 12.1% (p = 0.175) and 4 versus 4.6% (p = 0.523) for OG and LG respectively. LG is increasingly being performed in England. Postoperative morbidity and mortality of LG is similar to that of OG, but it is associated with a shorter hospital stay. Data from randomised controlled trials evaluating long term survival and patients' reported outcomes are essential before the final judgement on the value of LG in the management of gastric cancer.