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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

doi: 10.1097/SLA.0b013e31826fd541
Original Articles

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.

Using a national inpatient database in Japan, we conducted a propensity-matched analysis with 2473 pairs of open and laparoscopic distal gastrectomy patients with stage I and II gastric cancer. The laparoscopic gastrectomy showed a slight reduction in length of stay but no significant reduction in in-hospital mortality, postoperative complications or 30-day readmissions.

*Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Department of Health Care Policy, Harvard Medical School, Boston, MA

Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

§Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan

Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan

Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, Tokyo, Japan.

Reprints: Hideo Yasunaga, MD, PhD, Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 1138555, Japan. E-mail:

Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.