Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer

data from a nationwide web-based database

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

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry. Methods: From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG. Results: The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively). Conclusion: The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
Publication statusAccepted/In press - 2017 Dec 7

Fingerprint

Propensity Score
Gastrectomy
Stomach Neoplasms
Cohort Studies
Databases
Prospective Studies
Morbidity
Mortality
Pancreatic Fistula

Keywords

  • Laparoscopic total gastrectomy
  • National Clinical Database registration system
  • Prospective cohort study

ASJC Scopus subject areas

  • Surgery

Cite this

Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer : data from a nationwide web-based database. / Etoh, Tsuyoshi; Honda, Michitaka; Kumamaru, Hiraku; Miyata, Hiroaki; Yoshida, Kazuhiro; Kodera, Yasuhiro; Kakeji, Yoshihiro; Inomata, Masafumi; Konno, Hiroyuki; Seto, Yasuyuki; Kitano, Seigo; Hiki, Naoki.

In: Surgical Endoscopy and Other Interventional Techniques, 07.12.2017, p. 1-8.

Research output: Contribution to journalArticle

Etoh, Tsuyoshi ; Honda, Michitaka ; Kumamaru, Hiraku ; Miyata, Hiroaki ; Yoshida, Kazuhiro ; Kodera, Yasuhiro ; Kakeji, Yoshihiro ; Inomata, Masafumi ; Konno, Hiroyuki ; Seto, Yasuyuki ; Kitano, Seigo ; Hiki, Naoki. / Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer : data from a nationwide web-based database. In: Surgical Endoscopy and Other Interventional Techniques. 2017 ; pp. 1-8.
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abstract = "Background: Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry. Methods: From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG. Results: The incidence of overall morbidity were 84 (16.4{\%}) in the OTG and 54 (10.3{\%}) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3{\%} vs. OTG 6.1{\%}, p = 0.59, LTG 2.7{\%} vs. OTG 3.7{\%}, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2{\%} vs. OTG 0.4{\%}, p = 0.56; LTG 0.4{\%} vs. OTG 0.4{\%}, p = 1.00, respectively). Conclusion: The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.",
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T1 - Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer

T2 - data from a nationwide web-based database

AU - Etoh, Tsuyoshi

AU - Honda, Michitaka

AU - Kumamaru, Hiraku

AU - Miyata, Hiroaki

AU - Yoshida, Kazuhiro

AU - Kodera, Yasuhiro

AU - Kakeji, Yoshihiro

AU - Inomata, Masafumi

AU - Konno, Hiroyuki

AU - Seto, Yasuyuki

AU - Kitano, Seigo

AU - Hiki, Naoki

PY - 2017/12/7

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N2 - Background: Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry. Methods: From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG. Results: The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively). Conclusion: The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.

AB - Background: Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry. Methods: From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG. Results: The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively). Conclusion: The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.

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KW - Prospective cohort study

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