title: Totally laparoscopic versus open gastrectomy for gastric cancer: a matched cohort study.
abstract: BACKGROUND
  The role of laparoscopic surgery for the treatment of gastric cancer is still controversial, particularly in terms of oncologic efficacy. The aim of this study was to compare short-term outcomes of laparoscopic and open resection for gastric cancer at a single Western institution.
  
  
  METHODS
  This study was designed as a matched cohort study from a prospective gastric cancer database. Forty-one patients undergoing laparoscopic gastrectomy for gastric cancer between June 2008 and January 2012 were matched with 41 patients undergoing open gastrectomy in the same time period. Patient pairing was done according to age, gender, type of gastrectomy (subtotal or total), and tumor stage via a randomized statistical method. The short-term outcomes and oncologic adequacy of the laparoscopic and open procedures were compared. A D2 lymph node dissection was performed in the majority of patients in both groups.
  
  
  RESULTS
  The two study groups were similar with respect to patient and tumor characteristics. Laparoscopic procedures were associated with a decreased blood loss (118.7 versus 312.4 mL, P<.005), incidence of surgery-unrelated complications (3 versus 9 patients, P<.05), and duration of hospital stay (8.1 versus 11.5 days, P<.05) but increased operative time for both subtotal (223.5 versus 158.2 minutes, P<.001) and total (298.1 versus 185.5 minutes, P<.001) gastrectomies. The mean number of retrieved lymph nodes after D2 dissection was similar: 30.0 for laparoscopic and 29.7 for open patients.
  
  
  CONCLUSIONS
  Within the limitations of a nonrandomized analysis, this study shows that the laparoscopic approach is a safe and oncologically adequate option for the treatment of gastric cancer, which compares favorably with open gastrectomy in short-term outcomes.
authors.affiliation: Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy. fabio.cianchi@unifi.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Cianchi
authors.forename: Etleva
authors.initials: E
authors.lastname: Qirici
authors.forename: Giacomo
authors.initials: G
authors.lastname: Trallori
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macrì
authors.forename: Giampiero
authors.initials: G
authors.lastname: Indennitate
authors.forename: Manuela
authors.initials: M
authors.lastname: Ortolani
authors.forename: Beatrice
authors.initials: B
authors.lastname: Paoli
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Biagini
authors.forename: Andrea
authors.initials: A
authors.lastname: Galli
authors.forename: Luca
authors.initials: L
authors.lastname: Messerini
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mallardi
authors.forename: Benedetta
authors.initials: B
authors.lastname: Badii
authors.forename: Fabio
authors.initials: F
authors.lastname: Staderini
authors.forename: Giuliano
authors.initials: G
authors.lastname: Perigli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*