Feasibility of Laparoscopic Distal Gastrectomy for Stage I Gastric Cancer in Patients Outside of Clinical Trials

Keiichi Fujiya, Masanori Tokunaga, Noriyuki Nishiwaki, Kenichiro Furukawa, Hayato Omori, Sanae Kaji, Rie Makuuchi, Tomoyuki Irino, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Masanori Terashima

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)1665-1671
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume22
Issue number10
DOIs
Publication statusPublished - 2018 Oct 1
Externally publishedYes

Keywords

  • Comorbidity
  • Elderly
  • Postoperative complication

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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    Fujiya, K., Tokunaga, M., Nishiwaki, N., Furukawa, K., Omori, H., Kaji, S., Makuuchi, R., Irino, T., Tanizawa, Y., Bando, E., Kawamura, T., & Terashima, M. (2018). Feasibility of Laparoscopic Distal Gastrectomy for Stage I Gastric Cancer in Patients Outside of Clinical Trials. Journal of Gastrointestinal Surgery, 22(10), 1665-1671. https://doi.org/10.1007/s11605-018-3842-6