Postoperative morbidity and quality of life between totally laparoscopic total gastrectomy and laparoscopy-assisted total gastrectomy: a propensity-score matched analysis

Abstract

Background This study aimed to evaluate the surgical outcome and quality of life (QoL) of totally laparoscopic total gastrectomy (TLTG) compared with laparoscopy-assisted total gastrectomy (LATG) in patients with clinical stage I gastric cancer. Methods From 2012 to 2018, EGC patients who underwent TLTG (n = 223), including the first case with intracorporeal hemi-double stapling, were matched to those who underwent LATG (n = 114) with extracorporeal circular stapling, using 2:1 propensity score matching (PSM). Prospectively collected morbidity was compared between the TLTG and LATG groups in conjunction with the learning curve. The European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires QLQ-C30, STO22, and OG25 were prospectively surveyed during postoperative 1 year for patient subgroups. Results After PSM, grade I pulmonary complication rate was lower in the TLTG group (n = 213) than in the LATG group (n = 111) (0.5% vs. 5.4%, P = 0.007). Other complications were not different between the groups. The learning curve of TLTG was overcome at the 26th case in terms of the comprehensive complication index. The TLTG group after learning curve showed lower grade I pulmonary complication rate than the matched LATG group (0.5% vs. 4.7%, P = 0.024). Regarding postoperative QoL, the TLTG group (n = 63) revealed less dysphagia (P = 0.028), pain (P = 0.028), eating restriction (P = 0.006), eating (P = 0.004), odynophagia (P = 0.023) than the LATG group (n = 21). Multivariate analyses for each QoL item demonstrated that TLTG was the only common independent factor for better QoL. Conclusions TLTG reduced grade I pulmonary complications and provided better QoL in dysphagia, pain, eating, odynophagia than LATG for patients with clinical stage I gastric cancer.

Totally laparoscopic total gastrectomy using the "enjoyable space" approach coupled with self-pulling and latter transection reconstruction versus laparoscopic-assisted total gastrectomy for upper gastric cancer: short-term outcomes.

“…IEJ-related complications are an important topic in terms of using digestive reconstruction methods in TLTG. Previous studies have revealed that the rate of postoperative IEJ-related complications ranged from 0% to 11.7% [ 27 – 29 ]. The majority of the previous comparisons of IEJ-related complications between LS and CS approaches involved retrospective studies with small sample sizes; thus, the results are inconsistent and even contradictory [ 5 , 30 – 32 ].…”

Comparison of short-term efficacy between totally laparoscopic gastrectomy and laparoscopic assisted gastrectomy for elderly patients with gastric cancer

“…Whether TLG can improve the QOL of patients after surgery is still controversial. Park et al [ 7 ] compared QOL within 1 year after TLTG and LATG, and the results indicated that postoperative dysphagia, pain, eating and odynophagia were significantly improved in the TLTG group compared with the LATG group[ 7 ]. Wei et al [ 26 ] used circular anastomosis and found that postoperative constipation, dysphagia and anastomotic complications were significantly improved in TLTG group patients compared with LATG group patients[ 26 ].…”

“…With continuous improvements in surgeons’ skills and improvements in intracorporeal staplers, totally laparoscopic gastrectomy (TLG) with complete intracorporeal anastomosis has become a research hotspot. Previous studies have shown that compared with laparoscopic assisted gastrectomy (LAG) or open gastrectomy, TLG requires a smaller incision, induces less postoperative pain and improves postoperative quality of life (QOL)[ 7 , 8 ]. These advantages are also shown in patients who have received the neoadjuvant chemotherapy[ 9 ].…”

A multi‐institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602)

“…For example, TG may achieve adequate resection margins and radical lymph node dissection; however, it is accompanied by poor postoperative nutritional status, characterized by anemia and weight loss 1,3,4 . PG may improve the postsurgical nutritional status and quality of life (QOL) of patients because of the preserved remnant stomach, which stores food and promotes the absorption of iron, vitamin B12, and other nutrients 5,6 . However, in addition to the risk of remnant cancer, PG raises concerns that the presence of a residual stomach may reduce QOL because of acid reflux esophagitis 7 .…”

“…1,3,4 PG may improve the postsurgical nutritional status and quality of life (QOL) of patients because of the preserved remnant stomach, which stores food and promotes the absorption of iron, vitamin B12, and other nutrients. 5,6 However, in addition to the risk of remnant cancer, PG raises concerns that the presence of a residual stomach may reduce QOL because of acid reflux esophagitis. 7 Thus, the clear advantages gained by improving postoperative QOL must be demonstrated to qualify PG as standard procedure.…”