Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer

doi:10.3748/wjg.v26.i43.6837

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastroenterol. Nov 21, 2020; 26(43): 6837-6852
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6837

Table 1 Clinical characteristics of patients in the laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy groups

Characteristic	LaTSG (n = 47)	LaTG (n = 45)	P value
Sex (M/F)	11/36	17/28	0.175
Age	57.0 ± 11.1	58.0 ± 9.9	0.571
BMI (kg/m²)	23.6 ± 3.4	23.7 ± 3.0	0.559
ASA-PS (1/2/3)	2/44/1	2/42/1	0.998
pT stage			0.027
pT1	18 (38.3)	10 (22.2)
pT2	5 (10.6)	4 (8.9)
pT3	8 (17.0)	22 (48.9)
pT4a	16 (34.0)	9 (20.0)
pN stage			0.371
pN0	23 (48.9)	14 (31.2)
pN1	10 (21.3)	14 (31.2)
pN2	6 (12.8)	7 (15.6)
pN3	8 (17.0)	10 (22.2)
pTNM stage			0.217
I	18 (38.3)	11 (24.4)
II	10 (21.3)	16 (35.6)
III	19 (40.4)	18 (40.0)
Previous abdominal operation	4 (8.5)	1 (2.2)	0.362
Neoadjuvant chemotherapy	9 (19.1)	6 (13.3)	0.575
Histological type			0.237
Signet-ring cell carcinoma	20 (42.6)	12 (26.7)	0.187
Blood vessel invasion	30 (63.9)	30 (66.6)	0.829
Neural infiltration	26 (55.4)	27 (60.0)	0.532
Tumor location			0.604
Lesser curvature	25 (53.2)	24 (53.4)
Middle	3 (6.4)	5 (11.1)
Middle and low	19 (40.4)	16 (35.6)

LaTSG: Laparoscopic-assisted tailored subtotal gastrectomy; LaTG: Laparoscopic assisted total gastrectomy; BMI: Body mass index; ASA-PS: American Society of Anesthesiologists Physical Status Classification.

Table 2 Operative findings in the laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy groups

Variable	LaTSG (n = 44)	LaTG (n = 58)	P value
Operation time (min)	210.0 ± 49.8	208.0 ± 50.0	0.684
Estimated blood loss (mL)	152.3 ± 166.1	188.9 ± 167.8	0.141
Intraoperative blood transfusion	6/47	8/45	0.570
Tumor size	3.4 ± 1.2	4.5 ± 1.8	0.020
No. of retrieved lymph nodes	31.8 ± 10.1	44.0 ± 16.5	0.008
Proximal margin	3.7 ± 1.6	3.9 ± 2.0	0.233
Distal margin	5.0 ± 2.6	6.2 ± 3.2	0.149

LaTSG: Laparoscopic-assisted tailored subtotal gastrectomy; LaTG: Laparoscopic assisted total gastrectomy.

Table 3 Postoperative complications in the laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy groups, n (%)

Complication	LaTSG (n = 47)	LaTG (n = 45)	P value
Anastomotic leakage	0 (0)	3 (6.7)
Anastomotic stricture	0 (0)	1 (2.2)
Anastomotic bleeding	0 (0)	0 (0)
Duodenal stump leakage	1 (2.1)	0 (0)
Intra-abdominal bleeding	0 (0)	0 (0)
Intra-abdominal abscess	1 (2.1)	3 (6.7)
Lymph leak	0 (0)	1 (2.2)
Ileus	0 (0)	0 (0)
Incision	0 (0)	1 (2.2)
Total	2 (4.2)	8 (17.8)	0.048
Mortality	0 (0)	1 (2.2)
Postoperative hospital stay	8.9 ± 5.0	12.0 ± 7.3	0.025
Reflux esophagitis (LA)			0.002
LA –B	2 (4.2)	5 (11.1)
LA-C	0 (0)	5 (11.1)

LaTSG: Laparoscopic-assisted tailored subtotal gastrectomy; LaTG: Laparoscopic assisted total gastrectomy; LA: Los Angeles classification grade (A/B/C/D).

Table 4 Nutritional indexes of laparoscopic-assisted tailored subtotal gastrectomy and laparoscopic assisted total gastrectomy at 1 year postoperatively

Variable	LaTSG (n = 47)	LaTG (n = 45)	P value
ALB (g/L)	45.2 ± 3.7	45.1 ± 7.2	0.005
PALB (g/L)	21.6 ± 4.7	18.5 ± 5.3	0.015
TP (g/L)	71.0 ± 4.2	67.6 ± 4.6	0.002
Fe	15.6 ± 5.7	13.4 ± 6.9	0.194
HGB (g/L)	133 ± 20.7	120.0 ± 20.1	0.007
RBC(10¹²/L)	4.5 ± 0.7	4.0 ± 0.4	0.003
CRP	0.37 ± 0.97	0.05 ± 0.25	0.187

LaTSG: Laparoscopic-assisted tailored subtotal gastrectomy; LaTG: Laparoscopic assisted total gastrectomy; HGB: Hemoglobin; Fe: ferrous iron; ALB: Albumin; PALB: Prealbumin; TP: Total protein; CRP: C-reaction protein.

Table 5 Univariate and multivariate analyses of overall survival for included patients

Variable	Univariate	P value	Multivariate	P value
Variable	HR (95%CI)	P value	HR (95%CI)	P value
Age, yr (≤ 65)	0.831 (0.301-2.293)	0.721	-	-
Sex (female)	0.493 (0.204-1.192)	0.117	-	-
BMI (≤ 25 kg/m²)	0.703 (0.270-1.832)	0.471	-	-
ASA (I/II/III)	1.440 (0.256-8.086)	0.679	-	-
Previous abdominal operation	0.046 (0.000-250.286)	0.482	-	-
Primary site (L/M/LM)	0.981 (0.707-1.360)	0.908	-	-
Tumor size (> 4 cm)	2.607 (1.064-6.390)	0.036	1.180 (0.906-1.538)	0.219
Neoadjuvant chemotherapy (Yes)	1.369 (0.454-4,129)	0.577	-	-
Tumor grade (W/M/P/U)	0.851 (0.578-1.253)	0.415	-	-
Lauren classification (I/D/M)	0.949 (0.513-1.758)	0.869	-	-
pTNM stage (I/II/III)	3.195 (1.518-6.724)	0.002	3.170 (1.461-6.878)	0.004
Lymphovascular invasion (Yes)	2.203 (0.906-5.358)	0.081	-	-
Neural infiltration (Yes)	1.755 (0.715-4.304)	0.219	-	-
Surgical type (LaTSG/LaTG)	2.977 (1.073-8.263)	0.036	2.876 (1.009-8.195)	0.048
Operation time (> 210 min)	1.130 (0.456-2.803)	0.791	-	-
Estimated blood loss (> 200 mL)	1.261 (0.522-3.048)	0.606	-	-
Intraoperative blood transfusion (Yes)	0.933 (0.273-3.192)	0.912	-	-
No. of retrieved lymph nodes (> 30)	1.631 (0.590-4.511)	0.346	-	-
Proximal margin (> 3 cm)	0.876 (0.362-2.120)	0.770	-	-
Distal margin (> 3 cm)	0.500 (0.203-1.121)	0.132	-	-

BMI: Body mass index; ASA: American Society of Anesthesiologists; L: Lesser curve; M: Middle; ML: Middle and low; W: Well differentiated; M: Moderately differentiated; P: Poorly differentiated; U: Undifferentiated; I: Intestinal type; D: Diffuse type; M: Mixed type; LaTSG: Laparoscopic-assisted tailored subtotal gastrectomy; LaTG: Laparoscopic assisted total gastrectomy.

Table 6 Univariate and multivariate analyses of disease free survival for included patients

Variable	Univariate	P value	Multivariate	P value
Variable	HR (95%CI)	P value	HR (95%CI)	P value
Age, yr (≤ 65)	0.505 (0.209-1.221)	0.129	-	-
Sex (female)	0.795 (0.288-2.192)	0.658	-	-
BMI (≤ 25 kg/m²)	0.675 (0.259-1.761)	0.422		-
ASA (I/II/III)	1.864 (0.277-12.523)	0.522	-	-
Previous abdominal operation	0.045 (0.000-188.621)	0.467	-	-
Primary Site (L/M/LM)	0.993 (0.715-1.377)	0.964	-	-
Tumor size, (> 4 cm)	2.535 (1.035-6.208)	0.042	1.740 (0.706- 4.294)	0.229
Neoadjuvant chemotherapy (Yes)	1.338 (0.442-4.051)	0.606	-	-
Tumor grade (W/M/P/U)	0.852 (0.580-1.252)	0.416	-	-
Lauren classification (I/D/M)	0.970 (0.523-1.798)	0.923	-	-
pTNM stage (I/II/III)	3.317 (1.566-7.023)	0.002	3.353 (1.558-7.214)	0.002
Lymphovascular invasion (Yes)	2.209 (0.906-5.383)	0.081	-	-
Neural infiltration (Yes)	1.729 (0.703-4.253)	0.233	-	-
Surgical type (LaTSG/LaTG)	2.859 (1.027-7.958)	0.044	2.776 (0.981-7.854)	0.054
Operation time (> 210 min)	1.115 (0.450-2.761)	0.814	-	-
Estimated blood loss (> 200 mL)	1.273 (0.526-3.080)	0.592	-	-
Intraoperative blood transfusion (Yes)	0.938 (0.274-3.208)	0.919	-	-
No. of retrieved lymph nodes (> 30)	1.643 (0.593-4.553)	0.339	-	-
Proximal margin (> 3 cm)	0.904 (0.373-2.192)	0.823	-	-
Distal margin (> 3 cm)	0.537 (0.219-1.319)	0.175	-	-

BMI: Body mass index; ASA: American Society of Anesthesiologists; L: Lesser curve; M: Middle; ML: Middle and low; W: Well differentiated; M: Moderately differentiated; P: Poorly differentiated; U: Undifferentiated; I: Intestinal type; D: Diffuse type; M: Mixed type; LaTSG: Laparoscopic assisted tailored subtotal gastrectomy; LaTG: Laparoscopic assisted total gastrectomy.

Citation: Liu H, Jin P, Ma FH, Ma S, Xie YB, Li Y, Li WK, Kang WZ, Tian YT. Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer. World J Gastroenterol 2020; 26(43): 6837-6852
URL: https://www.wjgnet.com/1007-9327/full/v26/i43/6837.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i43.6837