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Short- and long-term survival after laparoscopic versus open total gastrectomy for gastric adenocarcinoma: a National database study

机译：腹腔镜后的短期和长期存活与胃腺癌的开放总胃切除术：国家数据库研究

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Background The use of laparoscopic total gastrectomy for gastric cancer remains controversial. Our objective was to compare outcomes of laparoscopic total gastrectomy (LTG) vs. open total gastrectomy (OTG) for gastric adenocarcinoma using a national cancer database. Methods The National Cancer Database (2010-2014) was analyzed for total gastrectomy cases performed for gastric adenocarcinoma. Patient demographics and surgical outcomes were stratified by stage and compared based on laparoscopic vs. open surgical approach. Primary outcome measures included 30-day and 90-day mortality and Kaplan-Meier curves to estimate long-term survival. Results There were 2584 cases analyzed, including 592 (22.9%) stage I, 710 (27.5%) stage II, and 1282 (49.6%) stage III cases. The distribution of LTG vs. OTG cases was 156 (26.4%) vs. 436 (73.6%) for stage I, 163 (23.0%) vs. 547 (77.0%) for stage II, and 241 (18.8%) vs. 1041 (81.2%) for stage III. For all stages analyzed, there was no difference between laparoscopic vs. open approach for adjusted 30-day mortality (stage I: adjusted odds ratio (AOR) 0.52, p = 0.75; stage II: AOR 1.36, p > 0.99; stage III: AOR 0.46, p = 0.29) or 90-day mortality (stage I: AOR 0.46, p = 0.99; stage II: AOR 1.17, p = 0.99; stage III: 0.57, p = 0.29). There was no difference between LTG vs. OTG 5-year Kaplan-Meier estimated survival curves for any stage (stage I: p = 0.20; stage II: p = 0.83; stage III: p = 0.46). When compared to OTG, LTG had a similar hazard ratio (HR) for mortality (HR 0.89 p = 0.20). Conclusions Laparoscopic total gastrectomy and OTG have comparable 30-day mortality, 90-day mortality, and long-term survival.
机译：背景：腹腔镜全胃切除术在胃癌治疗中的应用仍然存在争议。我们的目的是利用国家癌症数据库比较腹腔镜全胃切除术（LTG）和开放式全胃切除术（OTG）治疗胃腺癌的疗效。方法对2010-2014年国家癌症数据库中胃腺癌全胃切除术病例进行分析。患者人口统计学和手术结果按分期分层，并基于腹腔镜手术和开放手术方法进行比较。主要观察指标包括30天和90天死亡率，以及估计长期生存率的Kaplan-Meier曲线。结果共分析2584例，其中Ⅰ期592例（22.9%），Ⅱ期710例（27.5%），Ⅲ期1282例（49.6%）。LTG和OTG病例的分布在第一阶段分别为156例（26.4%）和436例（73.6%），在第二阶段分别为163例（23.0%）和547例（77.0%），在第三阶段分别为241例（18.8%）和1041例（81.2%）；第二阶段：AOR 1.36，p>0.99；第三阶段：AOR 0.46，p=0.29）或90天死亡率（第一阶段：AOR 0.46，p=0.99；第二阶段：AOR 1.17，p=0.99；第三阶段：0.57，p=0.29）。在任何阶段，LTG和OTG的5年Kaplan-Meier估计生存曲线之间没有差异（第一阶段：p=0.20；第二阶段：p=0.83；第三阶段：p=0.46）。与OTG相比，LTG的死亡率风险比（HR）相似（HR 0.89 p=0.20）。结论腹腔镜全胃切除术和OTG的30天死亡率、90天死亡率和长期生存率相当。

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