Comparison of short-term results of open and laparoscopic surgery in gastric cancer at a new regional hospital: a single surgeon experience

Abstract

Aim To compare the short-term results of open and laparoscopic gastrectomy in gastric cancer surgery. Material and Method From 15 May 2018 to 28 June 2021, patients who underwent open and laparoscopic gastrectomy for gastric cancer by a single surgeon between were retrospectively analyzed from a prospectively maintained database. Patients were compared in terms of early intraoperative and postoperative outcomes. Both surgical methods were compared in terms of early intraoperative and postoperative outcomes. Results A total of 34 patients (open n = 23, laparoscopic n = 11) were included in the study. While the mean number of lymph nodes was similar between the groups, more metastatic lymph nodes and more advanced disease were detected in the open group (p = 0.007, p = 0.002, respectively). According to tumor location, patients who underwent laparoscopic gastrectomy were more distally located (p = 0.01). The mean operative time was shorter in the open group (171.5 min and 206 min, p = 0.006, respectively), while the estimated blood loss was less in the laparoscopic group (158.2 mL vs 186.7 mL, p = 0.003). Four patients (17.4%) in the open group and two patients (18%) in the laparoscopic group had at least Clavien-Dindo grade III complications (p=0.96). Earlier gas output was seen in the laparoscopic group (p = 0.002), while other postoperative outcomes were similar between the groups. Mean follow-up time was longer in the open group (13.4 months and 7.6 months, respectively, p = 0.004). Conclusion Until sufficient experience is reached in laparoscopic gastrectomy, choosing earlier stage and distally located tumors is a safe method with postoperative results similar to open gastrectomy.

Keywords

• gastric cancer
• open gastrectomy
• laparoscopic gastrectomy
• experience

References

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71: 209-49.
2. Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. The Lancet. 2020; 396: 635–48.
3. Kim HH, Han SU, Kim MC, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric cancer: the KLASS-01 randomized clinical trial. JAMA Oncol 2019; 5: 506-13.
4. Kim W, Kim HH, Han SU, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage ı gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 2016; 263: 28–35.
5. Hyung WJ, Yang HK, Park YK, et al. Long-term outcomes of laparoscopic distal gastrectomy for locally advanced gastric cancer: the KLASS-02-RCT randomized clinical trial. JCO 2020; 38: 3304–13.
6. van der Wielen N, Straatman J, Daams F, et al. Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial. Gastric Cancer 2021; 24: 258–71.
7. Lee H-J, Hyung WJ, Yang H-K, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 2019; 270: 983–91.
8. Yu J, Huang C, Sun Y, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer. JAMA 2019; 321: 1983–92.

9. Liu F, Huang C, Xu Z, et al. Morbidity and mortality of laparoscopic vs open total gastrectomy for clinical stage i gastric cancer: the CLASS02 multicenter randomized clinical trial. JAMA Oncol 2020; 6: 1590-97.
10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications. Ann Surg 2004; 240: 205–13.
11. Berlth F, Bollschweiler E, Drebber U, Hoelscher AH, Moenig S. Pathohistological classification systems in gastric cancer: Diagnostic relevance and prognostic value. World J Gastroenterol 2014; 20: 5679–84.
12. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021; 24: 1–21.
13. Zeng F, Chen L, Liao M, et al. Laparoscopic versus open gastrectomy for gastric cancer. World J Surg Oncol 2020; 18: 20.
14. Zhang W, Huang Z, Zhang J, Che X. Long-term and short-term outcomes after laparoscopic versus open surgery for advanced gastric cancer: An updated meta-analysis. J Minim Access Surg. 2021 May 6. doi: 10.4103/jmas.JMAS_219_20. Epub ahead of print. PMID: 34045399.
15. Ammori BJ, Asmer H, Al-Najjar H, et al. Laparoscopic versus open D2 gastrectomy for gastric cancer: a case-matched comparative study. J Laparoendosc Adv Surg Tech A 2020; 30: 777–82.
16. Li B, Yu-Hong Wong I, Siu-Yin Chan F, et al. Comparison of laparoscopic versus open gastrectomy for gastric cancer. Surg Oncol 2020; 35: 14–21.
17. Jung DH, Son S-Y, Park YS, et al. The learning curve associated with laparoscopic total gastrectomy. Gastric Cancer 2016; 19: 264–72.
18. Chi F, Lan Y, Zhou S, Yang L, Chen M, Bi T. Learning curve of totally laparoscopic distal gastrectomy for gastric cancer: a single teaching hospital study. Wideochir Inne Tech Maloinwazyjne. 2018; 13: 442–7.
19. Goksoy B. Simultaneous totally laparoscopic distal gastrectomy and anterior resection for synchronous gastric and colon cancer. Cureus 2021; 13: e15692.
20. Seevaratnam R, Bocicariu A, Cardoso R, et al. A meta-analysis of D1 versus D2 lymph node dissection. Gastric Cancer 2012; 15: 60–9.
21. Naffouje SA, Salti GI. Extensive lymph node dissection improves survival among american patients with gastric adenocarcinoma treated surgically: analysis of the national cancer database. J Gastric Cancer 2017; 17: 319–30.