Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan
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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.
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.
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).
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.
KeywordsGastric cancer Laparoscopic surgery Open gastrectomy National Clinical Database Propensity score matching
Compliance with ethical standards
Conflict of interest
Dr. Kodera reports Grants and personal fees from Taiho Pharmaceutical, Grants and personal fees from Chugai Phamaceutical, Grants and personal fees from Sanofi, Grants and personal fees from Merck Serono, Grants and personal fees from Yakult Honsha, Grants and personal fees from Daiichi Sankyo, Grants and personal fees from Otsuka Pharmaceutical Factory, Grants and personal fees from Takeda Pharmaceutical, Grants and personal fees from Johnson & Johnson, Grants and personal fees from Eli Lilly Japan, Grants from Pfizer Japan, Grants from EA Pharma, Grants and personal fees from ONO Pharmaceutical, Grants and personal fees from Kaken Pharmaceutical, Grants from Covidien Japan, Grants from Shionogi, Grants from Bristol Myers Squib, Grants from Japan Blood Products Organization, Grants from AbbVie GK, Grants from Eizai, Grants from Abbott Japan, Grants from CSL Behring, Grants from Tsumura, Grants from Nippon Kayaku, Grants from Novartis Pharmaceuticals Japan, Grants from KCI, Grants from Toyama Chemical, Grants from Maruho, personal fees from MSD, personal fees from Olympus, personal fees from Asahi Kasei Pharma, outside the submitted work. Dr. Yoshida reports Grants, personal fees and non-financial support from Ono Pharm. Co., Ltd., Grants, personal fees and non-financial support from Taiho Pharm. Co., Ltd., Grants, personal fees and non-financial support from EA Pharma, Grants, personal fees and non-financial support from Sanofi, Grants, personal fees and non-financial support from Yakult Honsha, Grants, personal fees and non-financial support from Chugai Pharm., Grants, personal fees and non-financial support from Takeda Pharm., Grants, personal fees and non-financial support from Lilly Japan, Grants, personal fees and non-financial support from Daiichi Sankyo, Grants, personal fees and non-financial support from Merck Serono, Grants, personal fees and non-financial support from Novartis, Grants from Kyowa Hakko Kirin, outside the submitted work. Hiraku Kumamaru is affiliated to the Department of Healthcare Quality Assessment at the University of Tokyo which is a social collaboration department supported by NCD. The department was formerly supported by endowments from Johnson & Johnson K.K., Nipro Corporatio, 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. Hiroaki Miyata is affiliated to the Department of Healthcare Quality Assessment at the University of Tokyo which is a social collaboration department supported by NCD. The department was formerly supported by endowments from Johnson & Johnson K.K., Nipro Corporation, 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. Kakeji, Hiki, Etoh, Honda, Yamashita, Seto, Kitano and Konno have nothing to disclose.
This study conforms to the ethical guidelines of the World Medical Association Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects, and written informed consent for surgery and the use of clinical data was obtained from all patients as required by the institutional review boards of all participating institutes.
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