Comparison of long-term survival and immediate postoperative liver function after laparoscopic and open distal gastrectomy for early gastric cancer patients with liver cirrhosis

Abstract

BackgroundSeveral studies have suggested no difference in the liver function of early gastric cancer (EGC) patients with liver cirrhosis (LC) between laparoscopic and open distal gastrectomy. However, the number of patients and comparison of long-term survival rates between the two groups are limited. The purpose of this study was to compare the long-term survival and immediate postoperative liver function of EGC patients with LC after laparoscopic and open distal gastrectomy.Materials and methodsThe clinical data of EGC patients with LC who had no other malignancy and underwent distal gastrectomy at Asan Medical Center between January 2005 and April 2013 were investigated retrospectively. All patients were divided into two groups: the open group (OG) and laparoscopic group (LG). The clinicopathologic data of the two groups were compared.ResultsThe number of patients in each group was 48 and 27 in the OG and LG, respectively. There were no significant differences in the age, sex ratio, ASA score, cause of liver cirrhosis, preoperative Child-Pugh classification, tumor location, TNM stage, total postoperative drain amount, albumin, total bilirubin, alkaline phosphatase, alanine aminotransferase, prothrombin time, morbidity and recurrence rate. Shorter hospital stay, longer operative time and more retrieved lymph nodes were observed in LG. The long-term overall survival rate was not different between the two groups (P = 0.356).ConclusionsFor EGC patients with liver cirrhosis, especially Child A cirrhosis, laparoscopic or laparoscopy-assisted distal gastrectomy can be a safe surgical procedure in comparison to open distal gastrectomy in terms of the long-term survival rate and immediate postoperative liver function.

AGA Clinical Practice Update on Surgical Risk Assessment and Perioperative Management in Cirrhosis: Expert Review

“…Several case series have suggested that, compared with more invasive approaches, laparoscopic and other minimally invasive surgical techniques may lead to favorable outcomes in patients with cirrhosis. [22][23][24][25][26] The lack of concurrent risk-adjusted controls and the small size of most reports make definitive, evidence-based recommendations speculative at best. Similarly, aside from strict avoidance of outdated traditionally hepatotoxic inhalational anesthetic agents, no studies have compared anesthesia techniques in patients with cirrhosis, so decisions regarding the choice of an anesthetic agent must be made on a case-by-case basis.…”

Safety of laparoscopic pancreaticoduodenectomy in patients with liver cirrhosis using propensity score matching

“…In addition, 11 (39%) patients were diagnosed with Child-Pugh A liver function, 17 (61%) patients were diagnosed with Child-Pugh B liver function and none was diagnosed with Child-Pugh C liver function. Median MELD score was 12 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The cirrhotic group showed no statistical difference in baseline conditions compared with the control group.…”

“…Liver cirrhosis was considered a contraindication for pancreatic or biliary tract surgery in the past [ 10 ]. Currently, advances in surgical techniques and medical management have resulted in development of safe and effective surgical procedures for use in cirrhotic patients [ 11 , 12 ]. Previous studies report that laparoscopic surgery is a safe and less invasive alternative to open surgery for cirrhotic patients [ 13 , 14 ].…”

Gastrointestinal Cancers and Liver Cirrhosis: Implications on Treatments and Prognosis

“…After comparing the surgical outcomes of LG and OG in patients, they determined that LG combined with lymph node (LN) dissection is safer than OG in gastric cancer patients with CTP A and B cirrhosis (35). In addition, a retrospective study from Korea concluded that LG is superior to OG in terms of long-term survival and postoperative liver function recovery, and patients with cirrhosis experienced postoperative complications such as bleeding and wound infection (36). Zhu et al showed that the surgical effect of LG is better than that of OG, and the involved patients developed ascites, wound infection, and other complications (37).…”