ABSTRACT
Objective:
To compare the
effectiveness of total laparoscopic versus laparoscopic-assisted distal
gastrectomy and investigate the
safety and replicability of total laparoscopic distal
gastrectomy in older
patients.
Methods:
This was a retrospective
cohort study. The inclusion criteria were as follows (1) age ≥65 years; (2) malignant gastric
tumor diagnosed pathologically preoperatively; (3) Eastern Cooperative Oncology Group performance status score 0-1; (4) Grade I-III American Society of
Anesthesiologists physical status; (5) preoperative clinical
tumor stage I-III; (6) total laparoscopic or laparoscopic-assisted distal
gastrectomy performed; and (7)
gastrointestinal tract reconstruction using uncut Roux-en-Y or Billroth-II+Braun
procedure.
Patients who had received
neoadjuvant therapy, undergone
conversion to open surgery, or had serious comorbidities or incomplete data were excluded. The clinical data of 129
patients who met the above criteria and had undergone
laparoscopic surgery for
gastric cancer from January 2012 to December 2021 in the
Gastrointestinal Cancer Center in the
Beijing Cancer Hospital were analyzed. According to the operation
method, the
patients were divided into total laparoscopic group and laparoscopic-assisted group. Variables studied comprised (1)
surgical procedure and postoperative recovery; (2) postoperative pathological findings; and (3)
postoperative complications. Measurement data with skewed distribution are represented as mean(quartile 1, quartile 3). Comparisons between groups were evaluated using the
Mann-Whitney U test.
Results:
After
propensity score matching in a 11 ratio, there were 40
patients in the total laparoscopic distal
gastrectomy group and 40 in the laparoscopic-assisted distal
gastrectomy group. Baseline characteristics did not differ significantly between the two groups (all P>0.05).Compared with the laparoscopic-assisted group, the total laparoscopic group had shorter main incisions (4.1±1.0 cm vs. 8.5±2.8 cm, t=9.375, P<0.001),
time to fluid intake [4.0 (3.0, 4.8) days vs. 5.0 (4.0, 6.0) days, Z=2.167, P=0.030], and duration of indwelling abdominal
drainage catheter [6.0 (6.0, 7.0) days vs. 7.0 (6.0, 8.0) days, Z=2.323, P=0.020]. Numerical Rating Scale scores on postoperative days 1 and 2 were higher in the total laparoscopic than the laparoscopic-assisted group [2.5 (1.0, 3.0) vs. 1.5 (1.0, 2.0), Z=1.980, P=0.048; 2.0 (1.0, 3.0) vs. 1.0 (1.0, 2.0), Z=2.334, P=0.020, respectively]. However, there were no significant differences between the groups in operation
time, intraoperative
blood loss,
white blood cell count,
hemoglobin concentration, or
albumin concentration on postoperative day 1,
time to
ambulation, mean
time to
bowel movement, postoperative admission to the
intensive care unit, length of postoperative
hospital stay, or Numerical Rating Scale scores on postoperative day 3 (all P>0.05). There were also no significant differences between the two groups in maximum
tumor diameter, pathological
tumor type, total number of
lymph nodes dissected, or total number of positive
lymph nodes (all P>0.05). The
incidence of
postoperative complications was 15.0% (6/40) in the total laparoscopic group and the laparoscopic-assisted group; these differences are not significant (χ2<0.001, P>0.999).
Conclusions:
Compared with laparoscopic-assisted radical
gastrectomy for distal
gastric cancer, total
laparoscopic surgery has the advantages of shorter incision, shorter
time to fluid intake, and shorter duration of indwelling abdominal
drainage catheter in older
patients (age ≥65 years). Total laparoscopic radical
gastrectomy for distal
gastric cancer does not increase the
risk of
postoperative complications and could therefore be performed more frequently.