Liu H, Jin P, Ma FH, Ma S, Xie YB, Li Y, Li WK, Kang WZ, Tian YT. Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer. World J Gastroenterol 2020; 26(43): 6837-6852 [PMID: 33268965 DOI: 10.3748/wjg.v26.i43.6837]
Corresponding Author of This Article
Yan-Tao Tian, MD, PhD, Professor, Surgeon, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
World J Gastroenterol. Nov 21, 2020; 26(43): 6837-6852 Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6837
Table 1 Clinical characteristics of patients in the laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy groups
Characteristic
LaTSG (n = 47)
LaTG (n = 45)
P value
Sex (M/F)
11/36
17/28
0.175
Age
57.0 ± 11.1
58.0 ± 9.9
0.571
BMI (kg/m2)
23.6 ± 3.4
23.7 ± 3.0
0.559
ASA-PS (1/2/3)
2/44/1
2/42/1
0.998
pT stage
0.027
pT1
18 (38.3)
10 (22.2)
pT2
5 (10.6)
4 (8.9)
pT3
8 (17.0)
22 (48.9)
pT4a
16 (34.0)
9 (20.0)
pN stage
0.371
pN0
23 (48.9)
14 (31.2)
pN1
10 (21.3)
14 (31.2)
pN2
6 (12.8)
7 (15.6)
pN3
8 (17.0)
10 (22.2)
pTNM stage
0.217
I
18 (38.3)
11 (24.4)
II
10 (21.3)
16 (35.6)
III
19 (40.4)
18 (40.0)
Previous abdominal operation
4 (8.5)
1 (2.2)
0.362
Neoadjuvant chemotherapy
9 (19.1)
6 (13.3)
0.575
Histological type
0.237
Signet-ring cell carcinoma
20 (42.6)
12 (26.7)
0.187
Blood vessel invasion
30 (63.9)
30 (66.6)
0.829
Neural infiltration
26 (55.4)
27 (60.0)
0.532
Tumor location
0.604
Lesser curvature
25 (53.2)
24 (53.4)
Middle
3 (6.4)
5 (11.1)
Middle and low
19 (40.4)
16 (35.6)
Table 2 Operative findings in the laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy groups
Variable
LaTSG (n = 44)
LaTG (n = 58)
P value
Operation time (min)
210.0 ± 49.8
208.0 ± 50.0
0.684
Estimated blood loss (mL)
152.3 ± 166.1
188.9 ± 167.8
0.141
Intraoperative blood transfusion
6/47
8/45
0.570
Tumor size
3.4 ± 1.2
4.5 ± 1.8
0.020
No. of retrieved lymph nodes
31.8 ± 10.1
44.0 ± 16.5
0.008
Proximal margin
3.7 ± 1.6
3.9 ± 2.0
0.233
Distal margin
5.0 ± 2.6
6.2 ± 3.2
0.149
Table 3 Postoperative complications in the laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy groups, n (%)
Complication
LaTSG (n = 47)
LaTG (n = 45)
P value
Anastomotic leakage
0 (0)
3 (6.7)
Anastomotic stricture
0 (0)
1 (2.2)
Anastomotic bleeding
0 (0)
0 (0)
Duodenal stump leakage
1 (2.1)
0 (0)
Intra-abdominal bleeding
0 (0)
0 (0)
Intra-abdominal abscess
1 (2.1)
3 (6.7)
Lymph leak
0 (0)
1 (2.2)
Ileus
0 (0)
0 (0)
Incision
0 (0)
1 (2.2)
Total
2 (4.2)
8 (17.8)
0.048
Mortality
0 (0)
1 (2.2)
Postoperative hospital stay
8.9 ± 5.0
12.0 ± 7.3
0.025
Reflux esophagitis (LA)
0.002
LA –B
2 (4.2)
5 (11.1)
LA-C
0 (0)
5 (11.1)
Table 4 Nutritional indexes of laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy at 1 year postoperatively
Variable
LaTSG (n = 47)
LaTG (n = 45)
P value
ALB (g/L)
45.2 ± 3.7
45.1 ± 7.2
0.005
PALB (g/L)
21.6 ± 4.7
18.5 ± 5.3
0.015
TP (g/L)
71.0 ± 4.2
67.6 ± 4.6
0.002
Fe
15.6 ± 5.7
13.4 ± 6.9
0.194
HGB (g/L)
133 ± 20.7
120.0 ± 20.1
0.007
RBC(1012/L)
4.5 ± 0.7
4.0 ± 0.4
0.003
CRP
0.37 ± 0.97
0.05 ± 0.25
0.187
Table 5 Univariate and multivariate analyses of overall survival for included patients
Variable
Univariate
P value
Multivariate
P value
HR (95%CI)
HR (95%CI)
Age, yr (≤ 65)
0.831 (0.301-2.293)
0.721
-
-
Sex (female)
0.493 (0.204-1.192)
0.117
-
-
BMI (≤ 25 kg/m2)
0.703 (0.270-1.832)
0.471
-
-
ASA (I/II/III)
1.440 (0.256-8.086)
0.679
-
-
Previous abdominal operation
0.046 (0.000-250.286)
0.482
-
-
Primary site (L/M/LM)
0.981 (0.707-1.360)
0.908
-
-
Tumor size (> 4 cm)
2.607 (1.064-6.390)
0.036
1.180 (0.906-1.538)
0.219
Neoadjuvant chemotherapy (Yes)
1.369 (0.454-4,129)
0.577
-
-
Tumor grade (W/M/P/U)
0.851 (0.578-1.253)
0.415
-
-
Lauren classification (I/D/M)
0.949 (0.513-1.758)
0.869
-
-
pTNM stage (I/II/III)
3.195 (1.518-6.724)
0.002
3.170 (1.461-6.878)
0.004
Lymphovascular invasion (Yes)
2.203 (0.906-5.358)
0.081
-
-
Neural infiltration (Yes)
1.755 (0.715-4.304)
0.219
-
-
Surgical type (LaTSG/LaTG)
2.977 (1.073-8.263)
0.036
2.876 (1.009-8.195)
0.048
Operation time (> 210 min)
1.130 (0.456-2.803)
0.791
-
-
Estimated blood loss (> 200 mL)
1.261 (0.522-3.048)
0.606
-
-
Intraoperative blood transfusion (Yes)
0.933 (0.273-3.192)
0.912
-
-
No. of retrieved lymph nodes (> 30)
1.631 (0.590-4.511)
0.346
-
-
Proximal margin (> 3 cm)
0.876 (0.362-2.120)
0.770
-
-
Distal margin (> 3 cm)
0.500 (0.203-1.121)
0.132
-
-
Table 6 Univariate and multivariate analyses of disease free survival for included patients
Variable
Univariate
P value
Multivariate
P value
HR (95%CI)
HR (95%CI)
Age, yr (≤ 65)
0.505 (0.209-1.221)
0.129
-
-
Sex (female)
0.795 (0.288-2.192)
0.658
-
-
BMI (≤ 25 kg/m2)
0.675 (0.259-1.761)
0.422
-
ASA (I/II/III)
1.864 (0.277-12.523)
0.522
-
-
Previous abdominal operation
0.045 (0.000-188.621)
0.467
-
-
Primary Site (L/M/LM)
0.993 (0.715-1.377)
0.964
-
-
Tumor size, (> 4 cm)
2.535 (1.035-6.208)
0.042
1.740 (0.706- 4.294)
0.229
Neoadjuvant chemotherapy (Yes)
1.338 (0.442-4.051)
0.606
-
-
Tumor grade (W/M/P/U)
0.852 (0.580-1.252)
0.416
-
-
Lauren classification (I/D/M)
0.970 (0.523-1.798)
0.923
-
-
pTNM stage (I/II/III)
3.317 (1.566-7.023)
0.002
3.353 (1.558-7.214)
0.002
Lymphovascular invasion (Yes)
2.209 (0.906-5.383)
0.081
-
-
Neural infiltration (Yes)
1.729 (0.703-4.253)
0.233
-
-
Surgical type (LaTSG/LaTG)
2.859 (1.027-7.958)
0.044
2.776 (0.981-7.854)
0.054
Operation time (> 210 min)
1.115 (0.450-2.761)
0.814
-
-
Estimated blood loss (> 200 mL)
1.273 (0.526-3.080)
0.592
-
-
Intraoperative blood transfusion (Yes)
0.938 (0.274-3.208)
0.919
-
-
No. of retrieved lymph nodes (> 30)
1.643 (0.593-4.553)
0.339
-
-
Proximal margin (> 3 cm)
0.904 (0.373-2.192)
0.823
-
-
Distal margin (> 3 cm)
0.537 (0.219-1.319)
0.175
-
-
Citation: Liu H, Jin P, Ma FH, Ma S, Xie YB, Li Y, Li WK, Kang WZ, Tian YT. Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer. World J Gastroenterol 2020; 26(43): 6837-6852