Short- and long-term outcomes after laparoscopic versus open total gastrectomy for stage 0-I gastric cancer: A multicenter, retrospective analysis

Abstract

Background The efficacy and safety of laparoscopic total gastrectomy for early gastric cancer need to be further investigated. Methods A retrospective analysis was conducted on the clinicopathological data of 122 patients with stage 0-I gastric cancer underwent radical laparoscopic total gastrectomy (LTG) or open total gastrectomy (OTG) from January 2010 to December 2013. Multivariate regression with a generalized estimation equation (GEE) was used to analyze the differences in total complications, LTG-related complications and OTG-related complications between the laparoscopic and open groups. The inverse probability of treatment weighting (IPTW) Kaplan-Meier survival curve was used to compare the long-term survival of the two groups. The primary outcome was the short-term outcomes and long-term survival of LTG with traditional OTG for stage 0-I gastric cancer. Results The incidence of postoperative complications was 16.4% in the LTG group and 18.4% in the OTG group, with no statistically significant difference between the two groups (P > 0.05). In the adjusted multivariate GEE regression for OTG-related complications, the risk of OTG-related complications in the laparoscopic group was 0.111 (95% CI: 0.016–0.771, P = 0.026). Before and after IPTW adjustment, there was no statistically significant difference in survival between the LTG group and the OTG group (P = 0.28 and P = 0.34). Conclusions LTG is safe and feasible to apply in stage 0-I gastric cancer. Comparing OTG, LTG with a similar overall complication rate and long-term survival, but reduce the incidence of OTG-related complications and does not increase the risk of LTG-related complications in stage 0-I gastric cancer. However, these findings still need to be confirmed in a large clinical trial.