Feasibility of laparoscopic gastrectomy for patients with poor physical status: a retrospective cohort study based on a nationwide registry database in Japan

Abstract

Background Laparoscopic gastrectomy (LG) is an established minimally invasive procedure for gastric cancer. However, it is controversial whether LG is useful for patients with poor physical status classified into higher classes of the American Society of Anesthesiologists physical status (ASA-PS) classification. The aim of this study was to determine the feasibility of LG in patients with ASA-PS class ≥ 3. Methods We extracted data for a total of 28,160 patients with an ASA-PS class ≥ 3 who underwent distal or total gastrectomy for gastric cancer between January 2013 and December 2017 from the National Clinical Database Japan society for gastroenterological surgery registry. We developed a propensity score model from baseline demographics and comorbidities and matched patients undergoing LG to those undergoing open gastrectomy (OG) using a 1:1 ratio. Mortality and morbidities (within 30 days and in-hospital) were compared between the 6998 matched patient pairs. Results In-hospital mortality was significantly lower in patients undergoing LG than in those undergoing OG (2.3% vs. 3.0%, p = 0.01), while the 30-day mortality was similar (1.6% vs. 1.5%). The length of hospital stay was significantly shorter in the LG group (median, 14 days vs. 17 days, p < 0.001). The LG group had a significantly lower incidence of postoperative complications in patients with any grade complication (20.3% vs. 22.5%, p = 0.002) as well as those with ≥ grade 3 complications (8.7% vs. 9.8%, p = 0.03). Conclusion LG was associated with decreased in-hospital mortality and a lower incidence of several postoperative complications when compared to OG among patients with poor physical condition.

Surgical outcomes in gastroenterological surgery in Japan: Report of the National Clinical Database 2011‐2018

“…Laparoscopic liver resection has been safely developed with a low mortality and complication rates relative to open liver resection 32 . Laparoscopic gastrectomy is also safe and feasible even for elderly patients 33 or those with poor physical status, such as the American Society of Anesthesiologists physical status (ASA‐PS) class ≥3 34 …”

Preoperative risk factors for postoperative intra-abdominal infectious complication after gastrectomy for gastric cancer using a Japanese web-based nationwide database

“…Male, obese, advanced cancer stage, and total gastrectomy strongly affected morbidity incidence. Patients were stratified into three risk groups (low-risk group, 0-7; middle-risk group, 8-15; and high-risk group, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] according to the SIGN score. The predicted probabilities for PIIC in the low-, middle-, and high-risk groups were 1.8%, 4.1%, and 7.8%, respectively, using the development cohort.…”

“…The Japanese Society of Gastroenterological Surgery (JSGS) registry started to collect data in 2011 and has accumulated over 1.2 million gastroenterological surgery records from over 5000 hospitals throughout Japan. The endpoints of previous research in gastric cancer using the NCD were mainly mortality or overall morbidity, and PIIC was not yet recognized [2,3,[14][15][16][17][18][19][20][21].…”

Preoperative Risk Factors and Prognostic Impact of Postoperative Complications Associated with Total Gastrectomy

“…Rosa et al [23] reported that preoperative ASA-PS was not associated with short-term and long-term prognosis in GC, while several reports showed that it was an independent predictor of poor prognosis for overall survival [17, 24]. There were several reports that laparoscopic gastrectomy for patients with poor ASA-PS was associated with a lower incidence of postoperative complications when compared to open gastrectomy [25, 26]. We considered that ASA-PS of 3 or 4 was an independent prognostic factor for postoperative complications, partly because the high number of open gastrectomy was involved.…”