Exploring ideal operative time for best outcomes in gastric cancer surgery: A multi-institutional study based on KLASS-07 database

• Published in: Chinese journal of cancer research Vol. 35; no. 6; pp. 660 - 674
• Main Authors: Park, Shin-Hoo, Shin, Ye-Rim, Hur, Hoon, Lee, Chang Min, Min, Jae Seok, Ryu, Seung Wan, Chae, Hyun Dong, Jeong, Oh, Choi, Chang-In, Song, Kyo-Young, Kim, Ho Goon, Jee, Ye Seob, Kim, Kwang Hee, Kim, Jeong Goo, Yang, Kyung Sook, Huang, Hua, Park, Sungsoo
• Format: Journal Article
• Language: English
• Published: China Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200433,China 30.12.2023; Division of Foregut Surgery,Korea University College of Medicine,Seoul 02841,Republic of Korea; Division of Foregut Surgery,Korea University Anam Hospital,Seoul 02841,Republic of Korea%Department of Surgery,Ajou University School of Medicine,Suwon 16499,Republic of Korea%Division of Foregut Surgery,Korea University Ansan Hospital,Ansan 15355,Republic of Korea%Department of Surgery,Dongnam Institute of Radiological and Medical Sciences,Cancer Center,Busan 46033,Republic of Korea%Department of Surgery,Keimyung University Dongsan Medical Center,Daegu 41931,Republic of Korea%Department of Surgery,Catholic University of Daegu School of Medicine,Daegu 42472,Republic of Korea%Department of Surgery,Chonnam National University Medical School,Hwasun 58128,Republic of Korea%Department of Surgery,Pusan National University Hospital,Pusan 49241,Republic of Korea%Department of Surgery,Catholic University of Seoul St Mary's Hospital,Seoul 06591,Republic of Korea%Department of Surgery,Chonnam National University Medical School,Gwangju 61469,Republic of Korea%Department of Surgery,Dankook University College of Medicine,Cheonan 31116,Republic of Korea%Department of Surgery,Busan Paik Hospital,Inje University,Busan 14905,Republic of Korea%Department of Surgery,Daejeon St.Mary's Hospital,College of Medicine,the Catholic University of Korea,Daejeon 34943,Republic of Korea%Department of Biostatistics,Korea University College of Medicine,Seoul 02841,Republic of Korea%Department of Gastric Cancer and Soft Tissue Sarcoma,Fudan University Shanghai Cancer Center,Shanghai 200433,China; AME Publishing Company
• Subjects: Original; Operative time; gastrectomy; gastric cancer; morbidity; laparoscopic surgery
• ISSN: 1000-9604; 1993-0631
• DOI: 10.21147/j.issn.1000-9604.2023.06.10

While a rushed operation can omit essential procedures, prolonged operative time results in higher morbidity. Nevertheless, the optimal operative time range remains uncertain. This study aimed to estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery. A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed. The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries. Finally, intraoperative and postoperative outcomes were compared among the shorter, ideal, and longer operative time groups. The statistically calculated ideal operative time was 135.4-165.4 min. The longer operative time (LOT) group had a lower rate of uneventful, perfect surgery than the ideal or shorter operative time (IOT/SOT) group (2.8% 8.8% and 2.2% 13.4%, all P<0.05). Longer operative time increased bleeding, postoperative morbidities, and delayed diet and discharge (all P<0.05). Particularly, an uneventful, perfect surgery could not be achieved when the operative time exceeded 240 min. Regardless of ideal time range, SOT group achieved the highest percentage of uneventful surgery (13.4%), which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform ≥150 gastrectomies annually. Operative time longer than the ideal time range (especially ≥240 min) should be avoided. If the essential operative procedure were faithfully conducted without compromising oncological safety, an operative time shorter than the ideal range leaded to a better prognosis. Efforts to minimize operative time should be attempted with sufficient surgical experience.