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
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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.
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.
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).
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.
KeywordsNational Clinical Database registration system Prospective cohort study Laparoscopic total gastrectomy
National Clinical Database
Laparoscopic total gastrectomy
Open total gastrectomy
The authors thank all the data managers and hospitals that participated in the NCD project for their great efforts in entering the data analyzed in this study.
Compliance with ethical standards
Drs. Hiraku Kumamaru and Miyata Hiroaki are affiliated with the department of health quality assessment at the University of Tokyo. The department receives funding from the National Clinical Database for research. The department was formerly supported by endowments from Johnson & Johnson K.K., Nipro Co., Teijin Pharma Ltd., Kaketsuken K.K., St. Jude Medical Japan Co., Ltd., Novartis Pharma K.K., Taiho Pharmaceutical Co., Ltd., W. L. Gore Associates, Co., Ltd., Olympus Corporation, and Chugai Pharmaceutical Co., Ltd. Drs. Tsuyoshi Etoh, Michitaka Honda, Kazuhiro Yoshida, Yasuhiro Kodera, Yoshihiro Kakeji, Masafumi Inomata, Hiroyuki Konno, Yasuyuki Seto, Seigo Kitano, and Naoki Hiki have no conflicts of interest or financial ties to disclose.
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