Annals of Surgery

Skip Navigation LinksHome > April 2013 - Volume 257 - Issue 4 > Outcomes After Laparoscopic or Open Distal Gastrectomy for E...
Annals of Surgery:
doi: 10.1097/SLA.0b013e31826fd541
Original Articles

Outcomes After Laparoscopic or Open Distal Gastrectomy for Early-Stage Gastric Cancer: A Propensity-Matched Analysis

Yasunaga, Hideo MD, PhD*,†; Horiguchi, Hiromasa PhD*; Kuwabara, Kazuaki MD, DPH; Matsuda, Shinya MD, PhD§; Fushimi, Kiyohide MD, PhD; Hashimoto, Hideki MD, PhD; Ayanian, John Z. MD, MPP

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Abstract

Objective: In a large nationwide administrative database of hospitalized patients, we investigated postoperative outcomes after laparoscopic or open distal gastrectomy in Japan.

Background: The benefits of laparoscopic gastrectomy, such as decreased length of stay and morbidity, have typically been evaluated only with limited data on the basis of small samples.

Methods: Using the Japanese Diagnosis Procedure Combination Database, we identified 9388 patients who were preoperatively diagnosed with stage I and II gastric cancer and underwent laparoscopic (n = 3937) or open (n = 5451) distal gastrectomy between July and December 2010. One-to-one propensity score matching was performed to compare in-hospital mortality, postoperative complication rates, length of stay, total costs, and 30-day readmission rates between the 2 groups.

Results: Patients with younger age, lower comorbidity index, or stage I cancer were more likely to receive laparoscopic gastrectomy. In the propensity-matched analysis with 2473 pairs, the laparoscopic gastrectomy group in comparison with the open gastrectomy group showed a slight reduction in median postoperative length of stay (13 days vs 15 days, P < 0.001) but a slight increase in median total costs (US $21,510 vs $21,024, P = 0.002). There were no significant differences in in-hospital mortality (0.36% vs 0.28%, P = 0.80), overall postoperative complications (12.9% vs 12.6%, P = 0.73), or 30-day readmission rates (3.2% vs 3.2%, P = 0.94).

Conclusions: In this large nationwide cohort of patients with early-stage gastric cancer, laparoscopic gastrectomy was associated with a statistically significant but slight reduction in postoperative length of stay, but no differences between laparoscopic gastrectomy and open gastrectomy were detected in terms of early mortality and morbidity.

© 2013 Lippincott Williams & Wilkins, Inc.

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