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Outcomes and Use of Laparoscopic Versus Open Gastric Resection. JSLS 2015;19(4)

Date

03/05/2016

Pubmed ID

26941544

Pubmed Central ID

PMC4756354

DOI

10.4293/JSLS.2015.00095

Scopus ID

2-s2.0-84960469991 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND AND OBJECTIVES: The advantages of laparoscopy over open surgery are well established. Laparoscopic resection for gastric cancer is safe and results in equivalent oncologic outcomes when compared with open resection. The purpose of this study was to assess the use of laparoscopy to treat gastric cancer and the associated outcomes.

METHODS: The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) dataset was queried for patients with gastric cancer (ICD-9 Code 151.0-151.9) from January 2005 through December 2012. Logistic regression was used to evaluate the 30-day morbidity and mortality of open gastrectomy (CPT code 43620-2, 43631-4) versus that of the laparoscopic procedure on the stomach (CPT code 43650), while adjusting for preoperative risk factors.

RESULTS: A total of 4116 patients with gastric cancer were identified and divided by surgical approach into 2 groups: open gastrectomy (n = 3725; 90.5%) and laparoscopic procedure on the stomach (n = 391; 9.5%). After adjustment for preoperative risk factors, complications were significantly fewer in laparoscopic versus open gastric resection (odds ratio [OR] 0.61, 95% confidence interval [CI] = 0.45-0.82; P = .001). After adjusting for preoperative risk factors, there was no statistically significant difference in mortality with laparoscopic compared to open gastric resection (OR 0.74; 95% CI = 0.32-1.72; P = .481).

CONCLUSIONS: Laparoscopy is underused in the treatment of gastric cancer. Given that laparoscopic gastric resection has a lower morbidity in comparison to open resection, steps should be made toward advancing the use of laparoscopy for gastric cancer.

Author List

Higgins RM, Kubasiak JC, Jacobson RA, Janssen I, Myers JA, Millikan KW, Deziel DJ, Luu MB

Author

Rana Higgins MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Female
Gastrectomy
Humans
Laparoscopy
Logistic Models
Male
Middle Aged
Postoperative Complications
Risk Factors
Stomach Neoplasms
Survival Analysis