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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 10/2018

01-10-2018 | Original Article

Feasibility of Laparoscopic Distal Gastrectomy for Stage I Gastric Cancer in Patients Outside of Clinical Trials

Authors: Keiichi Fujiya, Masanori Tokunaga, Noriyuki Nishiwaki, Kenichiro Furukawa, Hayato Omori, Sanae Kaji, Rie Makuuchi, Tomoyuki Irino, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Masanori Terashima

Published in: Journal of Gastrointestinal Surgery | Issue 10/2018

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Abstract

Background

Randomized controlled trials, including the Japan Clinical Oncology Group (JCOG) 0912 trial, have shown the safety of laparoscopy-assisted distal gastrectomy (LADG) for select healthy patients. It is unclear whether LADG is feasible in patients who do not meet trial eligibility criteria.

Methods

The present study retrospectively reviewed 547 patients with clinical stage I gastric cancer who underwent distal or pylorus-preserving gastrectomy. Of these, 185 were identified as not fulfilling the eligibility criteria of JCOG 0912; the short-term surgical outcomes between LADG and open distal gastrectomy (ODG) were compared in this group before and after propensity score matching.

Results

Patients who were not eligible for inclusion in the trial comprised 33.8% of the total. After matching, there were 59 patients each in the LADG and ODG groups, with an improved balance of confounding factors between the two groups. LADG was associated with significantly longer operation time, less blood loss, and shorter postoperative hospital stay than ODG. The rate of overall postoperative complications of Clavien–Dindo Grade II or higher did not differ significantly between the LADG and ODG groups (23.7 vs. 18.6%, respectively; p = 0.653). The incidence of pneumonia (6.8 vs. 5.1%), intra-abdominal infectious complications (5.1 vs. 3.4%), and stasis syndrome (5.1 vs. 3.4%) was also comparable between the two groups.

Conclusion

LADG was as safe as ODG in patients who did not meet the eligibility criteria of JCOG 0912. LADG could be a standard treatment option for patients with stage I gastric cancer, regardless of their general condition.
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Metadata
Title
Feasibility of Laparoscopic Distal Gastrectomy for Stage I Gastric Cancer in Patients Outside of Clinical Trials
Authors
Keiichi Fujiya
Masanori Tokunaga
Noriyuki Nishiwaki
Kenichiro Furukawa
Hayato Omori
Sanae Kaji
Rie Makuuchi
Tomoyuki Irino
Yutaka Tanizawa
Etsuro Bando
Taiichi Kawamura
Masanori Terashima
Publication date
01-10-2018
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 10/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-3842-6

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