Laparoscopic Compared with Open D2 Gastrectomy on Perioperative and Long-Term, Stage-Stratified Oncological Outcomes for Gastric Cancer: A Propensity Score-Matched Analysis of the IMIGASTRIC Database
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Overall Objective and Type of Study
2.2. Inclusion and Exclusion Criteria
2.3. Data Collection and Outcomes
2.4. Statistical Analysis
3. Results
3.1. Patient Selection
3.2. Patient Characteristics
3.3. Operative Outcomes
3.4. Histology
3.5. Post-Operative Outcomes
3.6. Survival Analysis
4. Discussion
4.1. Study Findings (Short-Term Outcomes)
4.2. Operative Time
4.3. Hospital Stay and Complications
4.4. Lymphadenectomy
4.5. Long-Term Survival and Related Factors
4.6. Strengths and Limitations of the Study
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Matched Cohort | |||
---|---|---|---|
Laparoscopic n = 624 | Open n = 624 | p-Value | |
Age, years | 0.985 # | ||
median (IQR) | 63 (6–72) | 64 (56–72) | |
mean (SD) | 63.2 (11.3) | 63 (11.9) | |
Gender, n (%) | 0.849 | ||
Male | 466 (73.1) | 453 (72.6) | |
Female | 168 (26.9) | 171 (27.4) | |
Geographic area, n (%) | 0.829 | ||
East | 504 (80.8) | 507 (81.3) | |
West | 120 (19.2) | 117 (18.8) | |
Year of surgery, n (%) | 1.000 | ||
2000–2007 | 16 (2.6) | 16 (2.6) | |
2008–2014 | 608 (97.4) | 608 (97.4) | |
Body Mass Index (BMI) | 0.350 # | ||
median (IQR) | 22 (20–24) | 22 (20–24) | |
mean (SD) | 22.3 (3.1) | 22.1 (3.3) | |
ASA score, n (%) | 1.000 | ||
I | 295 (47.3) | 295 (47.3) | |
II | 245 (39.3) | 245 (39.3) | |
III | 84 (13.5) | 84 (13.5) | |
Comorbidities, n (%) | 0.816 | ||
No | 388 (62.2) | 384 (61.5) | |
Yes | 236 (37.8) | 240 (38.5) | |
Type of resection, n (%) | 0.955 | ||
Distal gastrectomy | 293 (47) | 294 (47.1) | |
Total gastrectomy | 331 (53) | 330 (52.9) | |
Tumor location, n (%) | 0.731 | ||
Distal third | 290 (46.5) | 284 (45.5) | |
Middle third | 149 (23.9) | 161 (25.8) | |
Upper third | 185 (29.6) | 179 (28.7) | |
pTNM AJCC stage, 8th edition, n (%) | 0.860 | ||
IA | 101 (16.2) | 91 (14.6) | |
IB | 49 (7.9) | 43 (6.9) | |
IIA | 67 (10.7) | 69 (11.1) | |
IIB | 73 (11.7) | 68 (10.9) | |
IIIA | 112 (17.9) | 117 (18.8) | |
IIIB | 120 (19.2) | 117 (18.8) | |
IIIC | 102 (16.3) | 119 (19.1) | |
Histology, n (%) | 0.767 | ||
Differentiated | 405 (64.9) | 400 (64.1) | |
Poorly differentiated/undifferentiated | 219 (35.1) | 224 (35.9) |
Matched Cohort | |||
---|---|---|---|
LG n = 624 | OG n = 624 | p-Value | |
Total operative time (minutes) | <0.0001 # | ||
Median (IQR) | 180 (150–210) | 240 (180–300) | |
Mean (SD) | 192.7 (72.6) | 243.7 (86.5) | |
Conversion to open surgery, n (%) | 12 (1.9) | N/A | N/A |
N. harvested lymph nodes | <0.0001 # | ||
Median (IQR) | 32 (24–40) | 28 (22–38) | |
Mean (SD) | 33.2 (12.6) | 31.3 (14.1) | |
N. metastatic lymph nodes | 0.400 # | ||
Median (IQR) | 3 (0–11) | 3 (0–11) | |
Mean (SD) | 7 (9.1) | 7.6 (10.8) | |
R factors | 0.021 | ||
R0 | 604 (96.8) | 587 (94.1) | |
R + (R1 − R2) | 20 (3.2) | 37 (5.9) | |
Neoadjuvant chemotherapy, n (%) | 0.493 | ||
Yes | 20 (3.2) | 15 (2.4) | |
No | 604 (96.8) | 609 (97.6) | |
Neoadjuvant radiotherapy, n (%) | 1.000 | ||
Yes | 1 (0.2) | 0 (0) | |
No | 623 (99.8) | 624 (100) | |
Histology types in detail, n (%) | 0.767 | ||
Differentiated (total) | 405 (64.9) | 400 (64.1) | |
Tubular well-differentiated | 358 (57.4) | 301 (48.2) | |
Tubular moderately differentiated | 40 (6.4) | 91 (14.6) | |
Papillary | 7 (1.1) | 8 (1.3) | |
Poorly differentiated/Undifferentiated (total) | 219 (35.1) | 224 (35.9) | |
Mucinous | 69 (11.1) | 50 (8) | |
Signet ring cell | 97 (15.5) | 96 (15.4) | |
Poorly differentiated solid/non-solid type * | 43 (6.9) | 76 (12.2) | |
Undifferentiated | 10 (1.6) | 2 (0.3) | |
Postoperative hospital stay (days) | <0.0001 # | ||
Median (IQR) | 10 (9–13) | 14.8 (10–17) | |
Mean (SD) | 12.2 (8.2) | 13 (7.6) | |
Patients with complications, n (%) | 94 (15.1) | 133 (21.3) | 0.004 |
Clavien-Dindo complications, n (%) | 0.433 | ||
I | 9 (6.4) | 16 (9.3) | |
II | 106 (74.6) | 121 (70) | |
IIIa | 8 (5.6) | 7 (4) | |
IIIb | 8 (5.6) | 17 (9.8) | |
IVa | 8 (5.6) | 10 (5.8) | |
IVb | 2 (1.4) | 0 (0) | |
V | 1 (0.8) | 2 (1.1) | |
Total | 142 (100) | 173 (100) | |
Severe in-hospital complications, n (%) | 0.689 | ||
Clavien-Dindo ≥ 3 | 27 (19) | 36 (20.8) | |
Reoperation, n of patients (%) | 10 (1.6) | 17 (2.7) | 0.392 |
In-hospital mortality, n (%) | 1 (0.2) | 2 (0.3) | 0.563 |
Matched Cohort | |||
---|---|---|---|
Laparoscopic n = 624 | Open n = 624 | p-Value | |
Acute pancreatitis | 0 | 0 | 1.000 |
Acute renal failure | 0 | 0 | 1.000 |
Adhesive ileus | 0 | 0 | 1.000 |
Anastomotic stenosis | 2 | 0 | 0.499 |
Anostomosis leakage | 12 | 12 | 1.000 |
Arrhythmias | 4 | 4 | 1.000 |
Atelectasia | 1 | 0 | 1.000 |
Bleeding (intra/extraluminal) | 9 | 10 | 1.000 |
Cholecystitis | 0 | 0 | 1.000 |
Chylous leakage | 6 | 8 | 0.789 |
Congestive heart failure | 3 | 1 | 0.624 |
Cerebrovascular accident | 0 | 0 | 1.000 |
Deep vein thrombosis | 2 | 0 | 0.499 |
Delayed gastric emptying | 8 | 7 | 1.000 |
Delirium | 0 | 0 | 1.000 |
Disseminated intravascular coagul. | 1 | 0 | 1.000 |
Dizziness | 0 | 0 | 1.000 |
Dumping syndrome | 0 | 0 | 1.000 |
Intra-abdominal fluid collection | 14 | 9 | 0.400 |
Incisional hernia | 1 | 2 | 1.000 |
Liver failure | 0 | 0 | 1.000 |
Myocardial infarction | 1 | 0 | 1.000 |
Omental infarction | 0 | 1 | 1.000 |
Pancreatic fistula | 2 | 6 | 0.287 |
Pleural effusion | 3 | 2 | 1.000 |
Pneumonia | 33 | 61 | 0.003 |
Prolonged postoperative ileus | 1 | 1 | 1.000 |
Pseudomembranous colitis | 2 | 2 | 1.000 |
Pulmonary edema | 0 | 1 | 1.000 |
Pulmonary embolism | 1 | 0 | 1.000 |
Remnant stomach necrosis | 1 | 0 | 1.000 |
Sepsis | 1 | 0 | 1.000 |
Small bowel infarction | 0 | 2 | 0.499 |
Small bowel perforation | 0 | 3 | 0.249 |
Unexplained postoperative fever | 2 | 1 | 1.000 |
Wound infection | 9 | 15 | 0.302 |
Wound seroma | 0 | 1 | 1.000 |
Other complications | 23 | 24 | 1.000 |
Total | 142 | 173 | 0.043 |
N of Patients | Five-Year Survival Rate | p-Value * | |||
---|---|---|---|---|---|
Laparoscopy | Open | Laparoscopy % | Open % | ||
Entire cohort | |||||
All patients | 1812 | 1221 | 81.1 | 66.4 | <0.0001 |
Stage IA | 358 | 199 | 97.4 | 93.5 | 0.029 |
Stage IB | 156 | 130 | 94.2 | 75 | <0.0001 |
Stage IIA | 191 | 161 | 90.4 | 70.3 | <0.0001 |
Stage IIB | 213 | 144 | 88.5 | 79 | 0.002 |
Stage IIIA | 309 | 231 | 78.5 | 56.6 | <0.0001 |
Stage IIIB | 352 | 195 | 69 | 51 | <0.0001 |
Stage IIIC | 233 | 161 | 60.1 | 48.5 | 0.001 |
Matched cohort | |||||
All patients | 624 | 624 | 77.4 | 75.2 | 0.202 |
Stage I | 150 | 134 | 96.4 | 94 | 0.432 |
Stage IA | 101 | 91 | 95 | 98 | 0.189 |
Stage IB | 49 | 43 | 100 | 82 | 0.011 |
Stage II | 140 | 137 | 86.7 | 83.8 | 0.469 |
Stage IIA | 67 | 69 | 87 | 77.2 | 0.146 |
Stage IIB | 73 | 68 | 86.6 | 91 | 0.509 |
Stage III | 334 | 353 | 67.8 | 65 | 0.264 |
Stage IIIA | 112 | 117 | 74.8 | 74.6 | 0.679 |
Stage IIIB | 120 | 117 | 69 | 63.7 | 0.406 |
Stage IIIC | 102 | 119 | 59.5 | 58.2 | 0.621 |
Overall Cohort | Univariable Cox Regression | Multivariable Cox Regression | ||||
---|---|---|---|---|---|---|
N | Hazard Rate (95% CI) | p-Value | Hazard Rate (95% CI) | p-Value | ||
Age, years | 3033 | 1.029 (1.021–1.036) | <0.0001 | 1.019 (1.011–1.027) | <0.0001 | |
Gender | ||||||
Male | 2165 | Reference | ||||
Female | 868 | 1.249 (1.050–1.485) | 0.012 | |||
Geographic area | ||||||
East | 2187 | Reference | Reference | |||
West | 846 | 3.718 (3.137–4.406) | <0.0001 | 6.482 (5.322–7.895) | <0.0001 | |
Year of surgery | ||||||
2000–2007 | 433 | Reference | ||||
2008–2014 | 2600 | 0.342 (0.281–0.415) | <0.0001 | |||
Body mass index (BMI) | 3033 | 1.027 (1.004–1.050) | 0.021 | |||
ASA score | ||||||
I | 1508 | Reference | Reference | |||
II | 1211 | 1.674 (1.413–1.982) | <0.0001 | 1.273 (1.065–1.521) | 0.008 | |
III | 314 | 2.387 (1.789–3.184) | <0.0001 | 1.338 (0.980–1.827) | 0.067 | |
Operative time | 3033 | 1.002 (1.001–1.003) | <0.0001 | |||
Surgical approach | ||||||
Open | 1221 | Reference | ||||
Laparoscopic | 1812 | 0.426 (0.363–0.500) | <0.0001 | |||
Length of hospital stay | 3033 | 1.010 (1.001–1.018) | 0.012 | |||
Type of resection | ||||||
Distal gastrectomy | 1365 | Reference | ||||
Total gastrectomy | 1668 | 2.011 (1.685–2.400) | <0.0001 | |||
Tumor location | ||||||
Upper third | 894 | Reference | Reference | |||
Middle third | 819 | 0.968 (0.798–1.174) | 0.740 | 0.859 (0.707–1.045) | 0.129 | |
Distal third | 1320 | 0.519 (0.427–0.632) | <0.0001 | 0.772 (0.633–0.941) | 0.011 | |
N. harvested lymph nodes | 3033 | 1.009 (1.003–1.015) | 0.003 | |||
Margin status | ||||||
Free | 2939 | Reference | ||||
Infiltrated | 94 | 3.072 (2.192–4.306) | <0.0001 | |||
pTNM stage, 8th edition | ||||||
IIIC | 394 | Reference | Reference | |||
IIIB | 547 | 0.809 (0.651–1.006) | 0.056 | 0.810 (0.604–1.805) | 0.157 | |
IIIA | 540 | 0.657 (0.521–0.827) | <0.0001 | 0.645 (0.454–0.916) | 0.014 | |
IIB | 357 | 0.305 (0.217–0.429) | <0.0001 | 0.282 (0.179–0.443) | <0.0001 | |
IIA | 352 | 0.345 (0.248–0.480) | <0.0001 | 0.261 (0.165–0.412) | <0.0001 | |
IB | 286 | 0.258 (0.173–0.386) | <0.0001 | 0.171 (0.102–0.288) | <0.0001 | |
IA | 557 | 0.073 (0.045–0.118) | <0.0001 | 0.057 (0.032–0.102) | 0.0004 | |
N. of metastatic lymph nodes | 3111 | 1.040 (1.034–1.045) | 0.039 | <0.0001 | 1.018 (1.006–1.030) | 0.004 |
Histology, n (%) | ||||||
Tubular, Well-diff. (tub1) | 1596 | Reference | ||||
Tubular, mod. diff. (tub2) | 368 | 3.331 (2.541–4.367) | <0.0001 | |||
Papillary (pap) | 51 | 1.535 (0.840–2.805) | 0.163 | |||
Mucinous (muc) | 236 | 1.422 (1.062–1.905) | 0.018 | |||
Signet ring cell (sig) | 484 | 1.801 (1.452–2.235) | <0.0001 | |||
Poorly diff. solid/non-solid (por1/2) * | ||||||
Undifferentiated | 275 | 4.573 (3.481–6.008) | <0.0001 | |||
carcinoma | 23 | 3.907 (1.933–7.897) | <0.0001 |
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Trastulli, S.; Desiderio, J.; Lin, J.-X.; Reim, D.; Zheng, C.-H.; Borghi, F.; Cianchi, F.; Norero, E.; Nguyen, N.T.; Qi, F.; et al. Laparoscopic Compared with Open D2 Gastrectomy on Perioperative and Long-Term, Stage-Stratified Oncological Outcomes for Gastric Cancer: A Propensity Score-Matched Analysis of the IMIGASTRIC Database. Cancers 2021, 13, 4526. https://doi.org/10.3390/cancers13184526
Trastulli S, Desiderio J, Lin J-X, Reim D, Zheng C-H, Borghi F, Cianchi F, Norero E, Nguyen NT, Qi F, et al. Laparoscopic Compared with Open D2 Gastrectomy on Perioperative and Long-Term, Stage-Stratified Oncological Outcomes for Gastric Cancer: A Propensity Score-Matched Analysis of the IMIGASTRIC Database. Cancers. 2021; 13(18):4526. https://doi.org/10.3390/cancers13184526
Chicago/Turabian StyleTrastulli, Stefano, Jacopo Desiderio, Jian-Xian Lin, Daniel Reim, Chao-Hui Zheng, Felice Borghi, Fabio Cianchi, Enrique Norero, Ninh T. Nguyen, Feng Qi, and et al. 2021. "Laparoscopic Compared with Open D2 Gastrectomy on Perioperative and Long-Term, Stage-Stratified Oncological Outcomes for Gastric Cancer: A Propensity Score-Matched Analysis of the IMIGASTRIC Database" Cancers 13, no. 18: 4526. https://doi.org/10.3390/cancers13184526