Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study.
OBJECTIVE
The oncologic outcomes of laparoscopy-assisted gastrectomy for the treatment of gastric cancer have not been evaluated. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer in terms of long-term survival, morbidity, and mortality retrospectively.


METHODS
The study group comprised 2,976 patients who were treated with curative intent either by laparoscopic gastrectomy (1,477 patients) or open gastrectomy (1,499 patients) between April 1998 and December 2005. The long-term 5-year actual survival analysis in case-control and case-matched population was conducted using the Kaplan-Meier method. The morbidity and mortality and learning curves were evaluated.


RESULTS
In the case-control study, the overall survival, disease-specific survival, and recurrence-free survival (median follow-up period, 70.8 months) were not statistically different at each cancer stage with the exception of an increased overall survival rate for patients with stage IA cancer treated via laparoscopy (laparoscopic group; 95.3%, open group: 90.3%; P < .001). After matching using a propensity scoring system, the overall survival, disease-specific survival, and recurrence-free survival rates were not statistically different at each stage. The morbidity of the case-matched group was 15.1% in the open group and 12.5% in the laparoscopic group, which also had no statistical significance (P = .184). The mortality rate was also not statistically significant (0.3% in the open group and 0.5% in the laparoscopic group; P = 1.000). The mean learning curve was 42.


CONCLUSIONS
The long-term oncologic outcomes of laparoscopic gastrectomy for patients with gastric cancer were comparable to those of open gastrectomy in a large-scale, multicenter, retrospective clinical study.
Hyung-Ho Kim, Seoul National University College of Medicine, Seoul National University Bundang Hospital; Sang-Uk Han, Ajou University School of Medicine; Gyu Seok Cho, Soonchunhyang University School of Medicine, Gyeonggi-do; Min-Chan Kim, Dong-A University College of Medicine, Busan; Woo Jin Hyung, Yonsei University College of Medicine, Robot and Minimally Invasive Surgery Center, Severance Hospital, Yonsei University Health System, Yonsei; Wook Kim, Yeouido St Mary's Hospital, College of Medicine, the Catholic University of Korea; Hyuk-Joon Lee, Seoul National University College of Medicine, Seoul National University Hospital; Kyo Young Song, Seoul St Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul; Seung Wan Ryu, Keimyung University School of Medicine, Daegu; and Seong Yeob Ryu, Chonnam National University School of Medicine, Gwangju, Korea.
Hyung-Ho
HH
Kim
Sang-Uk
SU
Han
Min-Chan
MC
Kim
Woo Jin
WJ
Hyung
Wook
W
Kim
Hyuk-Joon
HJ
Lee
Seung Wan
SW
Ryu
Gyu Seok
GS
Cho
Kyo Young
KY
Song
Seong Yeob
SY
Ryu
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007723:Korea; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D057216:Propensity Score; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome