Clinical Outcomes of Laparoscopic Versus Laparotomic Distal Gastrectomy in Gastric Cancer Patients: A Multilevel Analysi
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ORIGINAL SCIENTIFIC REPORT
Clinical Outcomes of Laparoscopic Versus Laparotomic Distal Gastrectomy in Gastric Cancer Patients: A Multilevel Analysis Based on a Nationwide Administrative Database in Japan Kazunori Shibao1 • Yoshihisa Fujino2 • Fumi Joden1 • Tatehide Tajima1 • Jun Nagata1 Nagahiro Sato1 • Kenji Fujimoto3 • Matsuda Shinya3 • Keiji Hirata1
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Accepted: 13 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The present study compared the short-term outcomes and costs of laparoscopic distal gastrectomy (LDG) with those of open distal gastrectomy (ODG) for gastric cancer using a nationwide administrative database in Japan. Method Overall, 37,752 patients with gastric cancer who underwent distal gastrectomy at 1074 hospitals in the fiscal year 2012–2013 were evaluated using a diagnosis procedure combination database in Japan. We performed a retrospective analysis via a multilevel analysis (MLA) of the short-term surgical results and costs of the LDG and ODG groups. The models included the age, sex, comorbid complications, smoking, body mass index (BMI), activity of daily living (ADL), stage, and the number of cases of gastrectomy per facility for adjustment. The in-hospital mortality relative to the hospital volume was also compared. Results The LDG group required postoperative blood transfusion less frequently and had fewer postoperative complications, shorter hospitalization, and lower operative mortality than the ODG group. While this stage did not correlate with the in-hospital mortality, the surgical method, age, sex, ADL, BMI, comorbidity, and yearly volume showed a correlation. A significant association in the in-hospital mortality was observed between low- and very-highvolume hospitals. Conclusion In this large nationwide cohort of patients with gastric cancer using an MLA, LDG was shown to be safer with lower mortality and postoperative complication rates than ODG.
Introduction
& Kazunori Shibao [email protected] 1
Department of Surgery I, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
2
Department of Environmental Epidemiology, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
3
Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
In spite of declining its incidence and mortality, gastric cancer still is the fifth-most common malignancy and the third leading cause of cancer-related death in the world (783,000 deaths, 8.2% of the total) according to GLOBOCAN, 2018. Half of the total global incidence occurs in Eastern Asia [1]. In Japan, gastric cancer causes about 45,000 deaths annually, accounting for 15% of cancer-related deaths [2]. Since the first performance of laparoscopy-assisted distal gastrectomy (LDG) for the treatment of gastric cancer was reported in 1994, the growing number of reports has shown the clinical outcomes of LDG to be
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