Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan

Background Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now a...

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Published inGastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 22; no. 1; pp. 202 - 213
Main Authors Kodera, Yasuhiro, Yoshida, Kazuhiro, Kumamaru, Hiraku, Kakeji, Yoshihiro, Hiki, Naoki, Etoh, Tsuyoshi, Honda, Michitaka, Miyata, Hiroaki, Yamashita, Yuichi, Seto, Yasuyuki, Kitano, Seigo, Konno, Hiroyuki
Format Journal Article
LanguageEnglish
Published Tokyo Springer Japan 01.01.2019
Springer Nature B.V
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Summary:Background Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now available for analysis. Methods A retrospective cohort study was conducted using data from 32,144 patients who underwent total gastrectomy and were registered in the NCD database between January 2012 and December 2013. Mortality and morbidities were compared between patients who received LTG and those who underwent open total gastrectomy (OTG) in the propensity score-matched Stage I cohort and Stage II–IV cohort. Results There was no significant difference in mortality rate between LTG and OTG in both cohorts. Operating time was significantly longer in LTG while the blood loss was smaller. In the Stage I cohort, LTG, performed in 33.6% of the patients, was associated with significantly shorter hospital stay but significantly higher incidence of readmission, reoperation, and anastomotic leakage (5.4% vs. 3.6%, p  < 0.01). In the Stage II–IV cohort, LTG was performed in only 8.8% of the patients and was associated with significantly higher incidence of leakage (5.7% vs. 3.6%, p  < 0.02) although the hospital stay was shorter (15 days vs. 17 days, p  < 0.001). Conclusion LTG was more discreetly introduced than distal gastrectomy, but remained a technically demanding procedure as of 2013. This procedure should be performed only among the well-trained and informed laparoscopic team.
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ISSN:1436-3291
1436-3305
DOI:10.1007/s10120-018-0795-0