Comparison Surgical Outcomes between Laparoscopic and Conventional Distal Gastrectomy for Early Gastric Cancer in Obese Patients

ABSTRACT

PURPOSE: In this study, we explored the safety of laparoscopic gastrectomy in obese gastric cancer patients compared with conventional open gastrectomy based on early surgical outcomes. METHODS: A total of 462 patients who underwent curative gastrectomy for early gastric adenocarcinoma from January 2000 to December 2014 were enrolled. Two obesity cohorts were defined according to a body mass index (BMI) of ≥25 kg/m² versus ≥30 kg/m². Those cohorts were further divided into the laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) groups, and clinicopathologic characteristics were compared with early surgical results. RESULTS: There were no significant differences in clinicopathologic characteristics between the LDG and ODG groups in the BMI ≥25 or BMI ≥30 cohorts. For the overall complication rate, fewer complications were observed in the LDG than ODG group in both cohorts. Among the overall complications, significant differences were observed in the minor complication rates (Clavien-Dindo I or II), but no significant difference was observed in the rate of Clavien-Dindo III or higher complications. For risk factor analysis of postoperative complications, open distal gastrectomy, age >60 years, and BMI ≥30 were independent risk factors for postoperative morbidity among all obese patients. CONCLUSION: LDG may be a better procedure to improve surgical outcomes in patients with obesity undergoing surgery for early gastric cancer in terms of less excessive blood loss, shorter operation time, and lower complication rates.