Feasibility of laparoscopic gastrectomy for patients with poor physical status

a retrospective cohort study based on a nationwide registry database in Japan

Mikito Inokuchi, Hiraku Kumamaru, Masatoshi Nakagawa, Hiroaki Miyata, Yoshihiro Kakeji, Yasuyuki Seto, Kazuyuki Kojima

Research output: Contribution to journalArticle

Abstract

Background: Laparoscopic gastrectomy (LG) is an established minimally invasive procedure for gastric cancer. However, it is controversial whether LG is useful for patients with poor physical status classified into higher classes of the American Society of Anesthesiologists physical status (ASA-PS) classification. The aim of this study was to determine the feasibility of LG in patients with ASA-PS class ≥ 3. Methods: We extracted data for a total of 28,160 patients with an ASA-PS class ≥ 3 who underwent distal or total gastrectomy for gastric cancer between January 2013 and December 2017 from the National Clinical Database Japan society for gastroenterological surgery registry. We developed a propensity score model from baseline demographics and comorbidities and matched patients undergoing LG to those undergoing open gastrectomy (OG) using a 1:1 ratio. Mortality and morbidities (within 30 days and in-hospital) were compared between the 6998 matched patient pairs. Results: In-hospital mortality was significantly lower in patients undergoing LG than in those undergoing OG (2.3% vs. 3.0%, p = 0.01), while the 30-day mortality was similar (1.6% vs. 1.5%). The length of hospital stay was significantly shorter in the LG group (median, 14 days vs. 17 days, p < 0.001). The LG group had a significantly lower incidence of postoperative complications in patients with any grade complication (20.3% vs. 22.5%, p = 0.002) as well as those with ≥ grade 3 complications (8.7% vs. 9.8%, p = 0.03). Conclusion: LG was associated with decreased in-hospital mortality and a lower incidence of several postoperative complications when compared to OG among patients with poor physical condition.

Original languageEnglish
JournalGastric Cancer
DOIs
Publication statusPublished - 2019 Jan 1

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Gastrectomy
Registries
Japan
Cohort Studies
Retrospective Studies
Databases
Hospital Mortality
Stomach Neoplasms
Length of Stay
Propensity Score
Mortality
Incidence
Comorbidity
Demography
Morbidity

Keywords

  • American society of anesthesiologists’ performance status
  • Gastric cancer
  • Laparoscopic gastrectomy
  • Open gastrectomy
  • Postoperative complications

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Feasibility of laparoscopic gastrectomy for patients with poor physical status : a retrospective cohort study based on a nationwide registry database in Japan. / Inokuchi, Mikito; Kumamaru, Hiraku; Nakagawa, Masatoshi; Miyata, Hiroaki; Kakeji, Yoshihiro; Seto, Yasuyuki; Kojima, Kazuyuki.

In: Gastric Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Inokuchi, Mikito ; Kumamaru, Hiraku ; Nakagawa, Masatoshi ; Miyata, Hiroaki ; Kakeji, Yoshihiro ; Seto, Yasuyuki ; Kojima, Kazuyuki. / Feasibility of laparoscopic gastrectomy for patients with poor physical status : a retrospective cohort study based on a nationwide registry database in Japan. In: Gastric Cancer. 2019.
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abstract = "Background: Laparoscopic gastrectomy (LG) is an established minimally invasive procedure for gastric cancer. However, it is controversial whether LG is useful for patients with poor physical status classified into higher classes of the American Society of Anesthesiologists physical status (ASA-PS) classification. The aim of this study was to determine the feasibility of LG in patients with ASA-PS class ≥ 3. Methods: We extracted data for a total of 28,160 patients with an ASA-PS class ≥ 3 who underwent distal or total gastrectomy for gastric cancer between January 2013 and December 2017 from the National Clinical Database Japan society for gastroenterological surgery registry. We developed a propensity score model from baseline demographics and comorbidities and matched patients undergoing LG to those undergoing open gastrectomy (OG) using a 1:1 ratio. Mortality and morbidities (within 30 days and in-hospital) were compared between the 6998 matched patient pairs. Results: In-hospital mortality was significantly lower in patients undergoing LG than in those undergoing OG (2.3{\%} vs. 3.0{\%}, p = 0.01), while the 30-day mortality was similar (1.6{\%} vs. 1.5{\%}). The length of hospital stay was significantly shorter in the LG group (median, 14 days vs. 17 days, p < 0.001). The LG group had a significantly lower incidence of postoperative complications in patients with any grade complication (20.3{\%} vs. 22.5{\%}, p = 0.002) as well as those with ≥ grade 3 complications (8.7{\%} vs. 9.8{\%}, p = 0.03). Conclusion: LG was associated with decreased in-hospital mortality and a lower incidence of several postoperative complications when compared to OG among patients with poor physical condition.",
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T2 - a retrospective cohort study based on a nationwide registry database in Japan

AU - Inokuchi, Mikito

AU - Kumamaru, Hiraku

AU - Nakagawa, Masatoshi

AU - Miyata, Hiroaki

AU - Kakeji, Yoshihiro

AU - Seto, Yasuyuki

AU - Kojima, Kazuyuki

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KW - American society of anesthesiologists’ performance status

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KW - Open gastrectomy

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