Clinical comparison of laparoscopic vs open distal gastrectomy for advanced gastric cancer: Perioperative safety, recovery, and survival

Table 1 Baseline demographic and clinical characteristics, n (%)/mean ± SD

Parameters	Laparoscopy (n = 213)	Open surgery (n = 207)	t/χ2	P value
Age (years)	59.54 ± 6.12	59.58 ± 6.47	0.071	0.943
Gender			0.163	0.687
Male	152 (71.36)	144 (69.57)
Female	61 (28.64)	63 (30.43)
Body mass index (kg/m²)	23.55 ± 2.41	23.70 ± 2.54	0.635	0.525
ASA score			0.165	0.921
I	102 (47.89)	101 (48.79)
II	100 (46.95)	97 (46.86)
III	11 (5.16)	9 (4.35)
ECOG			0.067	0.796
0	184 (86.38)	177 (85.51)
1	29 (13.62)	30 (14.49)
Comorbidity	95 (44.6)	93 (44.93)	0.005	0.946
Previous abdominal operation	32 (15.02)	28 (13.53)	0.192	0.661
Clinical T stage			0.112	0.946
T2	91 (42.72)	86 (41.55)
T3	81 (38.03)	82 (39.61)
T4a	41 (19.25)	39 (18.84)
Clinical N stage			0.287	0.592
N0	94 (44.13)	86 (41.55)
N1	119 (55.87)	121 (58.45)
Clinical tumor-node-metastasis stage			0.643	0.886
I	58 (27.23)	50 (24.15)
IIA	33 (15.49)	36 (17.39)
IIB	36 (16.9)	36 (17.39)
III	86 (40.38)	85 (41.06)

ASA: American Society of Anesthesiology score; I: Normal and healthy patients; II: Patients with mild systemic diseases but no functional limitations; ECOG: Eastern Cooperative Oncology Group; 0: The activity ability is completely normal, with no symptoms or signs; 1: Can move freely and engage in light physical activities, including general household or office work, but cannot engage in heavier physical activities; Clinical T stage: T2: Tumor invades the intrinsic muscle layer; T3: Tumor penetrates the subserosal layer; T4a: Tumor invades the serosa (visceral peritoneum); Clinical N stage: N0: No regional lymph node metastasis; N1: There are 1 to 2 regional lymph node metastases; Clinical tumor-node-metastasis stage: I: Early gastric cancer, with tumor localization and no lymph node metastasis or only a small amount of lymph node metastasis; IIA and IIB: Locally advanced gastric cancer, the tumor may have invaded deeper tissue layers, and the number of lymph node metastases has increased, but distant metastases have not yet appeared; III: Locally advanced gastric cancer, the tumor may have invaded the serosal layer or adjacent organs, accompanied by significant lymph node metastasis.

Table 2 Perioperative outcomes, n (%)/mean ± SD

Parameters	Laparoscopy (n = 213)	Open surgery (n = 207)	t/χ2	P value
Incision length (cm)	4.51 ± 0.52	17.64 ± 3.25	57.358	< 0.001
Operation time (minutes)	227.01 ± 54.08	164.41 ± 45.89	12.803	< 0.001
Blood loss (mL)	152.44 ± 26.55	220.07 ± 21.58	28.680	< 0.001
Extent of resection			0.066	0.797
Distal gastrectomy	207 (97.18)	202 (97.58)
Total gastrectomy	6 (2.82)	5 (2.42)
Extent of lymphadenectomy			None	0.493
< D2	0 (0.00)	1 (0.48)
D2	213 (100.00)	206 (99.52)
Proximal resection margin (cm)	5.27 ± 1.76	5.05 ± 1.63	1.320	0.188
R0 resection	206 (96.71)	196 (94.69)	1.052	0.305
Anastomosis			0.687	0.709
Billroth I	76 (35.68)	66 (31.88)
Billroth II	115 (53.99)	119 (57.49)
Roux-en-Y	22 (10.33)	22 (10.63)

Table 3 Postoperative oncological pathology results, n (%)/mean ± SD

Parameters	Laparoscopy (n = 213)	Open surgery (n = 207)	t/χ2/Fisher	P value
Mean tumor size (cm)	4.64 ± 0.95	4.63 ± 0.89	0.062	0.951
Mean number of retrieved lymph nodes			None	0.493
≥ 16 nodes	213 (100.00)	206 (99.52)
< 16 nodes	0 (0.00)	1 (0.48)
Number of metastatic lymph nodes (number)	3.54 ± 0.61	3.48 ± 0.57	1.054	0.293
Histology			0.950	0.622
Differentiated	85 (39.91)	80 (38.65)
Undifferentiated	124 (58.22)	120 (57.97)
Other	4 (1.88)	7 (3.38)
Pathologic T stage			0.494	0.920
T1	59 (27.70)	54 (26.09)
T2	45 (21.13)	48 (23.19)
T3	57 (26.76)	58 (28.02)
T4	52 (24.41)	47 (22.71)
Pathologic N stage			0.005	0.944
N0	96 (45.07)	94 (45.41)
N+	117 (54.93)	113 (54.59)
Pathologic tumor-node-metastasis stage			1.099	0.577
I	77 (36.15)	71 (34.30)
II	64 (30.05)	72 (34.78)
III	72 (33.80)	64 (30.92)

Pathologic T stage: T1: Tumor invasion of mucosal layer or submucosal layer; T2: Tumor invades the intrinsic muscle layer; T3: Tumor penetrates the subserosal layer; T4: Tumor invades deeper or adjacent organs/structures; Pathologic N stage: N0: No cancer cells were found to have spread to regional lymph nodes; N+: There is evidence to suggest that cancer cells have spread to one or more regional lymph nodes; Pathologic tumor-node-metastasis stage: I: Cancer is limited to the gastric wall or only slightly extends to adjacent structures, and no lymph node or distant metastasis has been found; II: Cancer may have spread to deeper layers of the gastric wall or adjacent structures, and may involve a small amount of lymph node metastasis, but no distant metastasis; III: Cancer significantly extends to the deep or adjacent structures of the gastric wall, accompanied by more lymph node metastasis, but there is still no distant metastasis.

Table 4 Postoperative blood test results, mean ± SD

Parameters	Laparoscopy (n = 213)	Open surgery (n = 207)	t	P value
WBC (× 109/L)
Preop	6.72 ± 1.14	6.71 ± 1.07	0.096	0.924
POD1	11.18 ± 2.11	11.81 ± 2.22	2.978	0.003
POD5	7.15 ± 2.51	7.20 ± 2.70	0.209	0.835
Hb (g/dL)
Preop	13.44 ± 2.01	13.30 ± 2.04	0.709	0.479
POD1	12.15 ± 1.64	11.89± 1.81	1.546	0.123
POD5	11.51 ± 1.41	11.14 ± 1.61	2.490	0.013
Platelet (× 109/L)
Preop	257.39 ± 66.51	258.28 ± 63.91	0.139	0.889
POD1	208.24 ± 51.99	217.14 ± 53.85	1.723	0.086
POD5	240.01 ± 66.64	253.44 ± 70.84	2.002	0.046
Total bilirubin (mg/dL)
Preop	0.76 ± 0.21	0.77 ± 0.24	0.143	0.887
POD1	0.91 ± 0.23	0.92 ± 0.26	0.278	0.781
POD5	0.84 ± 0.25	0.83 ± 0.26	0.224	0.823
Amylase (U/dL)
Preop	73.21 ± 20.68	71.42 ± 20.13	0.902	0.368
POD1	137.21 ± 33.41	133.59 ± 35.77	1.071	0.285
POD5	92.34 ± 26.51	91.35 ± 20.81	0.429	0.668

WBC: White blood cell count; POD: Postoperative day; Hb: Hemoglobin.

Table 5 Postoperative complications, n (%)

Parameters	Laparoscopy (n = 213)	Open surgery (n = 207)	χ2/Fisher	P value
Surgery related complications
Wound complications	11 (5.16)	15 (7.25)	0.784	0.376
Intraabdominal fluid collection or abscess	6 (2.82)	11 (5.31)	1.685	0.194
Intraabdominal hemorrhage	1 (0.47)	4 (1.93)	0.869	0.351
Intraluminal hemorrhage	1 (0.47)	1 (0.48)	0.000	1.000
Intestinal obstruction	7 (3.29)	15 (7.25)	3.317	0.069
Anastomotic stricture	0 (0.00)	1 (0.48)	None	0.493
Anastomotic leak	4 (1.88)	2 (0.97)	0.141	0.707
Pancreatitis/pancreatic fistula	4 (1.88)	1 (0.48)	0.753	0.386
Gastrointestinal functional complications
Delayed gastric emptying	1 (0.47)	2 (0.97)	0.001	0.980
Reflux symptoms	0 (0.00)	1 (0.48)	None	0.493
Postgastrectomy syndrome	0 (0.11)	1 (0.48)	None	0.493
Systemic complications
Pulmonary complications	5 (2.35)	6 (2.90)	0.125	0.724
Urinary tract complications	2 (0.94)	1 (0.48)	0.000	1.000
Renal insufficiency	1 (0.47)	0 (0.00)	None	1.000
Hepatic insufficiency	1 (0.47)	2 (0.97)	0.001	0.980
Cardiac complications	0 (0.00)	1 (0.48)	None	0.493
Others	6 (2.82)	8 (3.86)	0.358	0.550
Total Clavien-Dindo complication grade of early and late complications
I or II	22 (10.33)	36 (17.39)	4.399	0.036
≥ III	17 (7.98)	24 (11.59)	1.556	0.212
Readmission	8 (3.76)	9 (4.35)	0.095	0.758
90 days mortality rate	1 (0.47)	1 (0.48)	0.000	1.000