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Short- and long-term survival after laparoscopic versus open total gastrectomy for gastric adenocarcinoma: a National database study

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Abstract

Background

The use of laparoscopic total gastrectomy for gastric cancer remains controversial. Our objective was to compare outcomes of laparoscopic total gastrectomy (LTG) vs. open total gastrectomy (OTG) for gastric adenocarcinoma using a national cancer database.

Methods

The National Cancer Database (2010–2014) was analyzed for total gastrectomy cases performed for gastric adenocarcinoma. Patient demographics and surgical outcomes were stratified by stage and compared based on laparoscopic vs. open surgical approach. Primary outcome measures included 30-day and 90-day mortality and Kaplan–Meier curves to estimate long-term survival.

Results

There were 2584 cases analyzed, including 592 (22.9%) stage I, 710 (27.5%) stage II, and 1282 (49.6%) stage III cases. The distribution of LTG vs. OTG cases was 156 (26.4%) vs. 436 (73.6%) for stage I, 163 (23.0%) vs. 547 (77.0%) for stage II, and 241 (18.8%) vs. 1041 (81.2%) for stage III. For all stages analyzed, there was no difference between laparoscopic vs. open approach for adjusted 30-day mortality (stage I: adjusted odds ratio (AOR) 0.52, p = 0.75; stage II: AOR 1.36, p > 0.99; stage III: AOR 0.46, p = 0.29) or 90-day mortality (stage I: AOR 0.46, p = 0.99; stage II: AOR 1.17, p = 0.99; stage III: 0.57, p = 0.29). There was no difference between LTG vs. OTG 5-year Kaplan–Meier estimated survival curves for any stage (stage I: p = 0.20; stage II: p = 0.83; stage III: p = 0.46). When compared to OTG, LTG had a similar hazard ratio (HR) for mortality (HR 0.89 p = 0.20).

Conclusions

Laparoscopic total gastrectomy and OTG have comparable 30-day mortality, 90-day mortality, and long-term survival.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, University of California Irvine Medical Center, 333 City Blvd West, Suite 1600, Orange, CA, 92868, USA

    Sahil Gambhir, Colette S. Inaba, Matthew Whealon, Sarath Sujatha-Bhaskar & Ninh T. Nguyen

  2. Center for Statistical Consulting, University of California Irvine, Irvine, CA, 92697, USA

    Marija Pejcinovska

Authors
  1. Sahil Gambhir
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  2. Colette S. Inaba
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  3. Matthew Whealon
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  4. Sarath Sujatha-Bhaskar
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  5. Marija Pejcinovska
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  6. Ninh T. Nguyen
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Corresponding author

Correspondence to Ninh T. Nguyen.

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Disclosures

Ninh T. Nguyen received honorarium as a speaker for Covidien, Gore, Novadaq, and Olympus. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. All authors have approved the final article. Sahil Gambhir, Colette S. Inaba, Matthew Whealon, Sarath Sujatha-Bhaskar, and Marija Pecinovska have no conflicts of interest or financial ties to disclose.

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Gambhir, S., Inaba, C.S., Whealon, M. et al. Short- and long-term survival after laparoscopic versus open total gastrectomy for gastric adenocarcinoma: a National database study. Surg Endosc 35, 1872–1878 (2021). https://doi.org/10.1007/s00464-020-07591-8

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  • DOI: https://doi.org/10.1007/s00464-020-07591-8

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