Laparoscopy-Assisted versus Open Gastrectomy for Gastric Cancer: A Case-matched Cohort Study

Ke Chen, MS, Weiwei Jin, MS, Yiping Mou, MD, FACS. Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.

INTRODUCTION: To evaluate short- and long-term outcomes of laparoscopy-assisted gastrectomy (LAG) for gastric cancer.

METHODS : There were 85 patients who underwent LAG were individually matched to 85 patients who underwent OG between October 2004 and March 2008 at Sir Run Run Shaw Hospital. Beyond the patients’ demographic data (age and gender), extent of gastrectomy and lymphadenectomy, as well as differentiation and TNM stage of the tumor are as matched index. The operative time, intraoperative blood loss, postoperative recovery, complications, pathological findings, and follow-up data were compared between the two groups.

RESULTS: The mean operative time was significantly longer in the LAG group than in the OG group (276.5 ± 61.5 min vs. 210.7 ± 46.2 min, P<0.05), whereas intraoperative blood loss was significantly lower (161.3 ± 89.9 ml vs. 267.2 ± 140.5 ml, P<0.05). In addition, the LAG group in comparison with the OG group showed a significant reduction in the time to first flatus and postoperative hospital stay (3.7 ± 1.3 days vs. 4.2 ± 1.1 days and 10.2 ± 3.0 days vs. 11.8 ± 5.6 days, respectively; P<0.05). There was no signi?cant difference between the LAG group and OG group with regard to the number of harvested lymph nodes and overall postoperative complications. The 5-year disease-free survival rates and overall survival rates were 76.4%, 77.6%, respectively, in the LAG group and 74.9%, 72.8%, respectively, in the OG group. There was no signi?cant difference between the two groups with regard to the survival rate. Comparing the survival rates of LAG and OG with regard to different TNM stage of the tumor, and the survival rates were still not significantly different between all specific groups.

CONCLUSIONS: LAG is suitable and minimally invasive for treating gastric cancer. Compared to OG, the LAG does not increase the risk of recurrence and death after surgery.

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