Abstract
To clarify the safety profile of laparoscopic distal gastrectomy (LDG) for gastric cancer patients, the short‐term outcome of LDG was compared to that of open distal gastrectomy (ODG) by propensity score matching using data from the Japanese National Clinical Database (NCD). We conducted a retrospective cohort study of patients undergoing distal gastrectomy between January 2012 and December 2013. Using the data for 70 346 patients registered in the NCD, incidences of mortality and morbidities were compared between LDG patients and ODG patients in the propensity score matched stage I patients (ODG: n = 14 386, LDG: n = 14 386) and stage II‐IV patients (ODG: n = 3738, LDG: n = 3738), respectively. There was no significant difference in mortality rates between LDG and ODG at all stages. Operating time was significantly longer in LDG compared to ODG, whereas blood loss and incidences of superficial surgical site infection (SSI), deep SSI, and wound dehiscence were significantly higher in ODG at all stages. Interestingly, pancreatic fistula was found significantly more often in LDG (1%) compared to ODG (0.8%) (P = .01) in stage I patients; however, it was not different in stage II‐IV patients. The length of postoperative stay was significantly longer in patients undergoing ODG compared to LDG at all stages. LDG in general practice might be a feasible therapeutic option in patients with both advanced gastric cancer and those with early gastric cancer in Japan.
Highlights
Background characteristics of the surgical stageI patients are it was 27 (0.2%) in laparoscopic distal gastrectomy (LDG) (P < .001)
It is obvious to postal gastrectomy during the enrollment period between January 2012 tulate that there should be differences in treatment outcomes and December 2013 and the study was conducted as a collaborative between high-volume centers and hospitals in general and between study with Japanese Gastric Cancer Association, Japan Society for doctors with and without board certification by special academic
Because many confounding factors were expected when comparing more than 90% of the general clinical practice data relating to surconventional open distal gastrectomy (ODG) against LDG for the incigery and surveying the operative risks and complications of approxidences of perioperative events, we held a consensus meeting that mately 1.2 million cases from 4105 institutions per year
Summary
Founded in April 2010 by the Japan Surgical Society and other societies. According to the annual report of the NCD in 2013, the total. This study was a retrospective cohort study enrolling patients regisfield of laparoscopic surgery, which requires special training to tered in the NCD gastrointestinal surgery registry as undergoing disacquire proficiency in high-quality techniques.[8] It is obvious to postal gastrectomy during the enrollment period between January 2012 tulate that there should be differences in treatment outcomes and December 2013 and the study was conducted as a collaborative between high-volume centers and hospitals in general and between study with Japanese Gastric Cancer Association, Japan Society for doctors with and without board certification by special academic. Because many confounding factors were expected when comparing more than 90% of the general clinical practice data relating to surconventional open distal gastrectomy (ODG) against LDG for the incigery and surveying the operative risks and complications of approxidences of perioperative events, we held a consensus meeting that mately 1.2 million cases from 4105 institutions per year It was included members such as laparoscopy surgeons, gastroenterology.
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