Comparison of short-term and long-term efficacy of laparoscopic and open gastrectomy in high-risk patients with gastric cancer: a propensity score-matching analysis

BackgroundTo determine whether laparoscopic surgery can be used in high-risk patients with gastric cancer.MethodsThe clinicopathological data of 3743 patients with primary gastric adenocarcinoma, collected from January 2007 to December 2014, were retrospectively analyzed. Patients who had1 of the following conditions were defined as high-risk patients: (1) age80 years; (2) BMI30kg/m(2); (3) ASA (American Society of Anesthesiologists) grade3; or (4) clinical T stage 4 (cT4). Propensity score matching (PSM) was used to reduce confounding bias; then, we compared the short-term and long-term efficacy of laparoscopic gastrectomy (LG) with open gastrectomy (OG) in high-risk patients with gastric cancer.ResultsA total of 1296 patients were included in PSM. After PSM, no significant difference in clinicopathological data was observed between the LG group (n=341) and the OG group (n=341). The operative time (181.70 vs. 266.71min, p<0.001) and blood loss during the operation (68.11 vs. 225.54ml, p<0.001) in the LG group were significantly lower than those in the OG group. In the LG and OG groups, postoperative complications occurred in 39 (11.4%) and 63 (18.5%) patients, respectively, p=0.010. Multivariate analysis showed that laparoscopic surgery was an independent protective factor against postoperative complications (p=0.019). The number of risk factors was an independent risk factor for postoperative complications (p=0.021). The 5-year overall survival rate in the LG group was comparable to that in the OG group (55.0 vs. 52.0%, p=0.086). Hierarchical analysis further confirmed that the LG and OG groups exhibited comparable survival rates among patients with stages cI, pI, cII, pII, cIII, and pIII (all p>0.05).ConclusionsFor high-risk patients with gastric cancer, LG not only exhibits better short-term efficacy than OG but also has a comparable 5-year survival rate to OG.