TY - JOUR
T1 - Feasibility of Laparoscopic Distal Gastrectomy for Stage I Gastric Cancer in Patients Outside of Clinical Trials
AU - Fujiya, Keiichi
AU - Tokunaga, Masanori
AU - Nishiwaki, Noriyuki
AU - Furukawa, Kenichiro
AU - Omori, Hayato
AU - Kaji, Sanae
AU - Makuuchi, Rie
AU - Irino, Tomoyuki
AU - Tanizawa, Yutaka
AU - Bando, Etsuro
AU - Kawamura, Taiichi
AU - Terashima, Masanori
N1 - Funding Information:
Acknowledgements This work was supported in part by The National Cancer Center Research and Development Fund (29-A-3).
Funding Information:
This work was supported in part by The National Cancer Center Research and Development Fund (29-A-3). The present study was approved by the Institutional Review Board of the Shizuoka Cancer Center (Approval no. 28-J160-28-1-3). The authors declare that they have no conflicts of interest.
Publisher Copyright:
© 2018, The Society for Surgery of the Alimentary Tract.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background: Randomized controlled trials, including the Japan Clinical Oncology Group (JCOG) 0912 trial, have shown the safety of laparoscopy-assisted distal gastrectomy (LADG) for select healthy patients. It is unclear whether LADG is feasible in patients who do not meet trial eligibility criteria. Methods: The present study retrospectively reviewed 547 patients with clinical stage I gastric cancer who underwent distal or pylorus-preserving gastrectomy. Of these, 185 were identified as not fulfilling the eligibility criteria of JCOG 0912; the short-term surgical outcomes between LADG and open distal gastrectomy (ODG) were compared in this group before and after propensity score matching. Results: Patients who were not eligible for inclusion in the trial comprised 33.8% of the total. After matching, there were 59 patients each in the LADG and ODG groups, with an improved balance of confounding factors between the two groups. LADG was associated with significantly longer operation time, less blood loss, and shorter postoperative hospital stay than ODG. The rate of overall postoperative complications of Clavien–Dindo Grade II or higher did not differ significantly between the LADG and ODG groups (23.7 vs. 18.6%, respectively; p = 0.653). The incidence of pneumonia (6.8 vs. 5.1%), intra-abdominal infectious complications (5.1 vs. 3.4%), and stasis syndrome (5.1 vs. 3.4%) was also comparable between the two groups. Conclusion: LADG was as safe as ODG in patients who did not meet the eligibility criteria of JCOG 0912. LADG could be a standard treatment option for patients with stage I gastric cancer, regardless of their general condition.
AB - Background: Randomized controlled trials, including the Japan Clinical Oncology Group (JCOG) 0912 trial, have shown the safety of laparoscopy-assisted distal gastrectomy (LADG) for select healthy patients. It is unclear whether LADG is feasible in patients who do not meet trial eligibility criteria. Methods: The present study retrospectively reviewed 547 patients with clinical stage I gastric cancer who underwent distal or pylorus-preserving gastrectomy. Of these, 185 were identified as not fulfilling the eligibility criteria of JCOG 0912; the short-term surgical outcomes between LADG and open distal gastrectomy (ODG) were compared in this group before and after propensity score matching. Results: Patients who were not eligible for inclusion in the trial comprised 33.8% of the total. After matching, there were 59 patients each in the LADG and ODG groups, with an improved balance of confounding factors between the two groups. LADG was associated with significantly longer operation time, less blood loss, and shorter postoperative hospital stay than ODG. The rate of overall postoperative complications of Clavien–Dindo Grade II or higher did not differ significantly between the LADG and ODG groups (23.7 vs. 18.6%, respectively; p = 0.653). The incidence of pneumonia (6.8 vs. 5.1%), intra-abdominal infectious complications (5.1 vs. 3.4%), and stasis syndrome (5.1 vs. 3.4%) was also comparable between the two groups. Conclusion: LADG was as safe as ODG in patients who did not meet the eligibility criteria of JCOG 0912. LADG could be a standard treatment option for patients with stage I gastric cancer, regardless of their general condition.
KW - Comorbidity
KW - Elderly
KW - Postoperative complication
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U2 - 10.1007/s11605-018-3842-6
DO - 10.1007/s11605-018-3842-6
M3 - Article
C2 - 29916107
AN - SCOPUS:85048691081
SN - 1091-255X
VL - 22
SP - 1665
EP - 1671
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 10
ER -
