Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1094-1100
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1094
Feasibility of laparoscopic total gastrectomy in overweight patients: Implications of less impact of overweight on laparoscopic versus open approach
Masatoshi Nakagawa, Kazuyuki Kojima, Mikito Inokuchi, Kenta Kobayashi, Toshiro Tanioka, Keisuke Okuno, Kentaro Gokita
Masatoshi Nakagawa, Kazuyuki Kojima, Mikito Inokuchi, Kenta Kobayashi, Toshiro Tanioka, Keisuke Okuno, Kentaro Gokita, Department of Gastric Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Kazuyuki Kojima, Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Author contributions: Nakagawa M and Kojima K designed research; Inokuchi M, Kobayashi K, Tanioka T, Okuno K and Gokita K collected clinical data from the patients and analyzed them; Nakagawa M wrote the paper.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Tokyo Medical and Dental University (M2017-034).
Informed consent statement: Patients were not required to give informed consent for participation in the study because the analysis used anonymous clinical data obtained after each patient provided written consent agreeing to treatment. For full disclosure, the details of the study are published on the homepage of Tokyo Medical and Dental University.
Conflict-of-interest statement: The authors do not have any financial ties to disclose.
STROBE Statement: The guidelines of the STROBE statement have been adopted and a fulfilled version of the checklist has been attached with the submission of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Masatoshi Nakagawa, PhD, Doctor, Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. nakagawa.srg1@tmd.ac.jp
Telephone: +81-3-38136111 Fax: +81-3-58030139
Received: August 23, 2018
Peer-review started: August 23, 2018
First decision: October 5, 2018
Revised: October 16, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 26, 2018
ARTICLE HIGHLIGHTS
Research background

While the proportion of gastric cancer in upper third stomach is increasing, increased number of overweight (OW) patients is an important health issue. Consequently, laparoscopic total gastrectomy (LTG) to OW patients is increasing.

Research motivation

Total gastrectomy and OW seems among the worst combinations for the laparoscopic approach. However, whether OW really has a worse impact on LTG compared to open total gastrectomy remains unknown.

Research objectives

The main objectives of this retrospective study were to investigate safety and oncological feasibility of LTG in OW patients.

Research methods

Propensity score matching selected 152 patients (76 laparoscopic, 76 open), from 321 patients who underwent total gastrectomy from 1999 to 2016. The patients were subsequently divided into the OW (≥ 25) or non-OW (< 25) group by body mass index. Postoperative outcomes of laparoscopic versus open approaches were compared between OW and non-OW groups.

Research results

In the laparoscopy group, operative time was longer (P = 0.01) in the OW group, however, other perioperative results were comparable between the non-OW and OW groups. In the open group, number of retrieved lymph nodes were less (P = 0.03) and local complication rate was more frequent (P = 0.03) in the OW group.

Research conclusions

LTG in OW patients remains technically challenging but can be performed safely. Our findings imply that OW has a lesser effect on the laparoscopic versus open approach to total gastrectomy.

Research perspectives

Laparoscopic approach can be a choice for total gastrectomy in OW patients in experienced institutions.