Clinical Research Papers:
Short- and long-term outcomes of laparoscopy-assisted versus open total gastrectomy for gastric cancer: a propensity score-matched analysis
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Jian-Xian Lin1,*, Ju-Li Lin1,*, Chao-Hui Zheng1, Ping Li1, Jian-Wei Xie1, Jia-Bin Wang1, Jun Lu1, Qi-Yue Chen1, Long-Long Cao1, Mi Lin1, Ru-Hong Tu1, Ze-Ning Huang1 and Chang-Ming Huang1
1Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
*These authors contributed equally to this work and should be considered co-first authors
Chang-Ming Huang, email: [email protected]
Keywords: stomach neoplasms, laparoscopy-assisted total gastrectomy, propensity score matching, prognosis
Received: February 14, 2017 Accepted: March 28, 2017 Published: April 05, 2017
Background: Few studies have been designed to evaluate the short- and long-term outcomes of laparoscopy-assisted total gastrectomy (LATG), and a retrospective study of a large patient cohort is valuable before conducting randomized controlled clinical trials.
Results: Among all patients, age, tumor location, histologic type, pT stage, pN stage and pTNM stage significantly differed between the LATG group and OTG group. After the propensity score matching, the clinicopathological characteristics did not significantly differ between groups. The operation time, estimated blood loss, time to first flatus and the number of retrieved lymph nodes (P < 0.05) were better in the LATG group than the OTG group. Morbidity and mortality were lower in the LATG group than the OTG group (P < 0.05) for pre-matched patients. However, significant intergroup differences in morbidity were not identified after propensity matching. Although overall survival did not significantly differ between groups for the pre-matched patients, the 3-year cumulative survival rates were significantly lower in the LATG group (89.9%) than the OTG group (97.7%) for patients with stage I disease (P = 0.028). After propensity score matching, the analysis of the cumulative survival curve did not show a significant difference for any cancer stage.
Materials and Methods: We prospectively collected data from 1096 patients who underwent total gastrectomy for gastric cancer. Propensity score matching was applied to compare the covariates between the LATG group and the open total gastrectomy (OTG) group. Operative outcomes and long-term outcomes were compared between the two groups.
Conclusions: Implementation of LATG for gastric cancer is a safe, reliable and minimally invasive procedure with long-term outcomes similar to those of OTG. Further randomized controlled clinical trials can be conducted to provide valuable evidence of the safety and efficacy of LATG in treating gastric cancer.
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