title: Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case-control study using propensity score matching method.
abstract: BACKGROUND
  To evaluate the technical feasibility and safety of laparoscopic total gastrectomy (LTG) for gastric carcinoma, this study compared short-term surgical outcomes between LTG and open total gastrectomy (OTG) using the propensity score matching method.
  
  
  METHODS
  After generating propensity scores given the covariates of age, sex, body mass index, comorbidity, American Society of Anesthesiologists (ASA) score, operators, and tumor stage, 122 patients with LTG were matched to 122 OTG patients using the nearest available score matching. Operative outcomes and hospital courses were compared in the matched groups and in the subgroups by the extent of lymph node dissection (LND).
  
  
  RESULTS
  The 2 study groups were well balanced with respect to the baseline characteristics of the propensity score derivation model. In the analysis of overall patients, the LTG group showed significantly longer operating time (289 vs 203 min, p < 0.001), but postoperative outcomes, including hospital stay, morbidity, and mortality, were similar in the 2 groups. In the subgroup with D1 + ß LND (perigastric nodes + Nos. 7, 8a, 9, 11p), the LTG group showed no significant differences in hospital stay, morbidity, and mortality from the OTG group. However, in the subgroup with D2 LND (perigastric nodes + Nos. 7, 8a, 9, 10, 11p, 11d, 12a), the LTG group showed significantly increased morbidity (52.6% vs 21.0%, p = 0.007) and tendency toward increased length of hospital stay and mortality as compared with the OTG group.
  
  
  CONCLUSIONS
  Laparoscopic total gastrectomy is a safe and feasible technique for treatment of upper gastric carcinoma. However, LTG with D2 LND for upper gastric cancer may increase the operative risk and requires considerable experience in laparoscopic surgery.
authors.affiliation: Division of Gastroenterologic Surgery, Department of Surgery, College of Medicine, Chonnam National University, Jeollanam-do, South Korea.
authors.forename: Oh
authors.initials: O
authors.lastname: Jeong
authors.forename: Mi Ran
authors.initials: MR
authors.lastname: Jung
authors.forename: Gwang Yong
authors.initials: GY
authors.lastname: Kim
authors.forename: Han Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Seong Yeop
authors.initials: SY
authors.lastname: Ryu
authors.forename: Young Kyu
authors.initials: YK
authors.lastname: Park
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057216:Propensity Score; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome