Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1094-1100
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1094
Feasibility of laparoscopic total gastrectomy in overweight patients: Implications of less impact of overweight on laparoscopic versus open approach
Masatoshi Nakagawa, Kazuyuki Kojima, Mikito Inokuchi, Kenta Kobayashi, Toshiro Tanioka, Keisuke Okuno, Kentaro Gokita
Masatoshi Nakagawa, Kazuyuki Kojima, Mikito Inokuchi, Kenta Kobayashi, Toshiro Tanioka, Keisuke Okuno, Kentaro Gokita, Department of Gastric Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Kazuyuki Kojima, Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Author contributions: Nakagawa M and Kojima K designed research; Inokuchi M, Kobayashi K, Tanioka T, Okuno K and Gokita K collected clinical data from the patients and analyzed them; Nakagawa M wrote the paper.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Tokyo Medical and Dental University (M2017-034).
Informed consent statement: Patients were not required to give informed consent for participation in the study because the analysis used anonymous clinical data obtained after each patient provided written consent agreeing to treatment. For full disclosure, the details of the study are published on the homepage of Tokyo Medical and Dental University.
Conflict-of-interest statement: The authors do not have any financial ties to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Masatoshi Nakagawa, PhD, Doctor, Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. nakagawa.srg1@tmd.ac.jp
Telephone: +81-3-38136111 Fax: +81-3-58030139
Received: August 23, 2018
Peer-review started: August 23, 2018
First decision: October 5, 2018
Revised: October 16, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 26, 2018
Abstract
AIM

To investigate safety and oncological feasibility of laparoscopic total gastrectomy (LTG) in overweight (OW) patients.

METHODS

Patients who underwent total gastrectomy (110 laparoscopic, 211 open) for gastric cancer between January 1999 and July 2016 were included. Propensity score matching selected 152 patients (76 laparoscopic, 76 open), which were subsequently divided into the OW (≥ 25) or non-OW (< 25) group by body mass index. Postoperative outcomes of laparoscopic versus open approaches were compared between OW and non-OW groups.

RESULTS

In the propensity-matched population, baseline characteristics were comparable between the OW and non-OW groups for the laparoscopy and open groups. In the laparoscopy group, operative time was longer (P = 0.01) in the OW group, however, other perioperative results including complication rates were comparable between the non-OW and OW groups. In the open group, number of retrieved lymph nodes were less (P = 0.03) and local complication rate was more frequent (P = 0.03) in the OW group.

CONCLUSION

LTG in OW patients remains technically challenging but can be performed safely. Our findings imply that OW has a lesser effect on the laparoscopic versus open approach to total gastrectomy.

Keywords: Gastric cancer, Laparoscopy, Overweight, Total gastrectomy

Core tip: The feasibility and safety of the laparoscopic approach in overweight (OW) patients and cases of total gastrectomy were already reported, but an assessment of the feasibility and safety of laparoscopic total gastrectomy (LTG) in OW patients has not yet been conducted. In the article we performed two main analyses. One is a comparison of postoperative outcomes after LTG between OW and non-OW patients. The other is that after open total gastrectomy. In order to balance the baseline characteristics between laparoscopy and open groups, we performed propensity score matching. We found out two main results through the analyses. One is LTG in OW patients is feasible and safe although it remains technically challenging (longer operation time). The other is OW has less impact on laparoscopic versus open approach.