Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan

Yasuhiro Kodera, Kazuhiro Yoshida, Hiraku Kumamaru, Yoshihiro Kakeji, Naoki Hiki, Tsuyoshi Etoh, Michitaka Honda, Hiroaki Miyata, Yuichi Yamashita, Yasuyuki Seto, Seigo Kitano, Hiroyuki Konno

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now available for analysis. Methods: A retrospective cohort study was conducted using data from 32,144 patients who underwent total gastrectomy and were registered in the NCD database between January 2012 and December 2013. Mortality and morbidities were compared between patients who received LTG and those who underwent open total gastrectomy (OTG) in the propensity score-matched Stage I cohort and Stage II–IV cohort. Results: There was no significant difference in mortality rate between LTG and OTG in both cohorts. Operating time was significantly longer in LTG while the blood loss was smaller. In the Stage I cohort, LTG, performed in 33.6% of the patients, was associated with significantly shorter hospital stay but significantly higher incidence of readmission, reoperation, and anastomotic leakage (5.4% vs. 3.6%, p < 0.01). In the Stage II–IV cohort, LTG was performed in only 8.8% of the patients and was associated with significantly higher incidence of leakage (5.7% vs. 3.6%, p < 0.02) although the hospital stay was shorter (15 days vs. 17 days, p < 0.001). Conclusion: LTG was more discreetly introduced than distal gastrectomy, but remained a technically demanding procedure as of 2013. This procedure should be performed only among the well-trained and informed laparoscopic team.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalGastric Cancer
DOIs
Publication statusAccepted/In press - 2018 Feb 9

Fingerprint

Gastrectomy
General Practice
Stomach Neoplasms
Registries
Japan
Cohort Studies
Retrospective Studies
Databases
Length of Stay
Propensity Score
Anastomotic Leak
Mortality
Incidence
Reoperation
Information Systems
Morbidity
Safety

Keywords

  • Gastric cancer
  • Laparoscopic surgery
  • National Clinical Database
  • Open gastrectomy
  • Propensity score matching

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Introducing laparoscopic total gastrectomy for gastric cancer in general practice : a retrospective cohort study based on a nationwide registry database in Japan. / Kodera, Yasuhiro; Yoshida, Kazuhiro; Kumamaru, Hiraku; Kakeji, Yoshihiro; Hiki, Naoki; Etoh, Tsuyoshi; Honda, Michitaka; Miyata, Hiroaki; Yamashita, Yuichi; Seto, Yasuyuki; Kitano, Seigo; Konno, Hiroyuki.

In: Gastric Cancer, 09.02.2018, p. 1-12.

Research output: Contribution to journalArticle

Kodera, Yasuhiro ; Yoshida, Kazuhiro ; Kumamaru, Hiraku ; Kakeji, Yoshihiro ; Hiki, Naoki ; Etoh, Tsuyoshi ; Honda, Michitaka ; Miyata, Hiroaki ; Yamashita, Yuichi ; Seto, Yasuyuki ; Kitano, Seigo ; Konno, Hiroyuki. / Introducing laparoscopic total gastrectomy for gastric cancer in general practice : a retrospective cohort study based on a nationwide registry database in Japan. In: Gastric Cancer. 2018 ; pp. 1-12.
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T2 - a retrospective cohort study based on a nationwide registry database in Japan

AU - Kodera, Yasuhiro

AU - Yoshida, Kazuhiro

AU - Kumamaru, Hiraku

AU - Kakeji, Yoshihiro

AU - Hiki, Naoki

AU - Etoh, Tsuyoshi

AU - Honda, Michitaka

AU - Miyata, Hiroaki

AU - Yamashita, Yuichi

AU - Seto, Yasuyuki

AU - Kitano, Seigo

AU - Konno, Hiroyuki

PY - 2018/2/9

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N2 - Background: Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now available for analysis. Methods: A retrospective cohort study was conducted using data from 32,144 patients who underwent total gastrectomy and were registered in the NCD database between January 2012 and December 2013. Mortality and morbidities were compared between patients who received LTG and those who underwent open total gastrectomy (OTG) in the propensity score-matched Stage I cohort and Stage II–IV cohort. Results: There was no significant difference in mortality rate between LTG and OTG in both cohorts. Operating time was significantly longer in LTG while the blood loss was smaller. In the Stage I cohort, LTG, performed in 33.6% of the patients, was associated with significantly shorter hospital stay but significantly higher incidence of readmission, reoperation, and anastomotic leakage (5.4% vs. 3.6%, p < 0.01). In the Stage II–IV cohort, LTG was performed in only 8.8% of the patients and was associated with significantly higher incidence of leakage (5.7% vs. 3.6%, p < 0.02) although the hospital stay was shorter (15 days vs. 17 days, p < 0.001). Conclusion: LTG was more discreetly introduced than distal gastrectomy, but remained a technically demanding procedure as of 2013. This procedure should be performed only among the well-trained and informed laparoscopic team.

AB - Background: Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now available for analysis. Methods: A retrospective cohort study was conducted using data from 32,144 patients who underwent total gastrectomy and were registered in the NCD database between January 2012 and December 2013. Mortality and morbidities were compared between patients who received LTG and those who underwent open total gastrectomy (OTG) in the propensity score-matched Stage I cohort and Stage II–IV cohort. Results: There was no significant difference in mortality rate between LTG and OTG in both cohorts. Operating time was significantly longer in LTG while the blood loss was smaller. In the Stage I cohort, LTG, performed in 33.6% of the patients, was associated with significantly shorter hospital stay but significantly higher incidence of readmission, reoperation, and anastomotic leakage (5.4% vs. 3.6%, p < 0.01). In the Stage II–IV cohort, LTG was performed in only 8.8% of the patients and was associated with significantly higher incidence of leakage (5.7% vs. 3.6%, p < 0.02) although the hospital stay was shorter (15 days vs. 17 days, p < 0.001). Conclusion: LTG was more discreetly introduced than distal gastrectomy, but remained a technically demanding procedure as of 2013. This procedure should be performed only among the well-trained and informed laparoscopic team.

KW - Gastric cancer

KW - Laparoscopic surgery

KW - National Clinical Database

KW - Open gastrectomy

KW - Propensity score matching

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