Materials and methods
Patients
Surgical procedures
Data collection
Ethics statement
Statistical analysis
Results
Comparisons of clinicopathological characteristics between groups
Variables | Before PSM | After PSM | ||||
---|---|---|---|---|---|---|
Group TL
n = 158 | Group LA
n = 484 |
P
| Group TL
n = 143 | Group LA
n = 143 |
P
| |
Age (year) | 59.0 ± 13.1 | 59.9 ± 11.7 | 0.452 | 60.1 ± 12.7 | 59.4 ± 12.1 | 0.621 |
Gender | 0.238 | 0.899 | ||||
Male | 102 (64.6) | 337 (69.6) | 100 (69.9) | 102 (71.3) | ||
Female | 56 (35.4) | 147 (30.4) | 43 (30.1) | 41 (28.7) | ||
BMI | 22.3 ± 3.2 | 22.5 ± 3.1 | 0.647 | 22.3 ± 3.1 | 22.5 ± 2.8 | 0.602 |
Chalson’s score | 0.517 | 0.712 | ||||
0–1 | 103 (65.2) | 329 (68.0) | 90 (62.9) | 93 (65.0) | ||
≥ 2 | 55 (34.8) | 155 (32.0) | 53 (37.1) | 50 (35.0) | ||
HB | 127.1 ± 21.5 | 132.1 ± 66.4 | 0.362 | 127.2 ± 22.2 | 127.4 ± 26.1 | 0.951 |
History of abdominal operation | 0.056 | 0.125 | ||||
No | 125 (79.1) | 414 (85.5) | 122 (85.3) | 112 (78.3) | ||
Yes | 33 (20.9) | 70 (14.5) | 21 (14.7) | 31 (21.8) | ||
Tumor size(cm) | 3.2 ± 1.9 | 3.5 ± 2.0 | 0.043 | 3.2 ± 1.9 | 3.6 ± 2.0 | 0.053 |
pT | 0.004 | 0.239 | ||||
T1 | 73 (46.2) | 202 (41.7) | 65 (45.4) | 60 (42.0) | ||
T2 | 25 (15.8) | 57 (11.8) | 22 (15.4) | 19 (13.3) | ||
T3 | 46 (29.1) | 120 (24.8) | 42 (29.4) | 38 (26.5) | ||
T4 | 14 (8.9) | 105 (21.7) | 14 (9.8) | 26 (18.2) | ||
pN | 0.129 | 0.068 | ||||
N0 | 78 (49.4) | 247 (51.0) | 72 (50.3) | 75 (52.4) | ||
N1 | 29 (18.4) | 70 (14.5) | 28 (19.6) | 16 (11.2) | ||
N2 | 28 (17.7) | 64 (13.2) | 25 (17.5) | 21 (14.7) | ||
N3 | 23 (14.6) | 103 (21.3) | 18 (12.6) | 31 (21.7) | ||
pTNM | 0.036 | 0.130 | ||||
IA | 54 (34.2) | 173 (35.7) | 48 (33.5) | 53 (37.0) | ||
IB | 23 (14.6) | 47 (9.7) | 23 (16.1) | 11 (7.7) | ||
IIA | 24 (15.2) | 53 (11.0) | 22 (15.4) | 20 (14.0) | ||
IIB | 16 (10.1) | 51 (10.5) | 15 (10.5) | 13 (9.1) | ||
IIIA | 16 (10.1) | 43 (8.9) | 12 (8.4) | 11 (7.7) | ||
IIIB | 20 (12.7) | 61 (12.6) | 18 (12.6) | 20 (14.0) | ||
IIIC | 5 (3.2 %) | 56 (11.6) | 5 (3.5) | 15 (10.5) | ||
With pyloric obstruction | 0.184 | 0.367 | ||||
No | 157 (99.4) | 470 (97.1) | 142 (99.3) | 139 (97.2) | ||
Yes | 1 (0.6) | 14 (2.9) | 1 (0.7) | 4 (2.8) | ||
With hemorrhage | 0.324 | 0.670 | ||||
No | 145 (91.8) | 45 (94.0) | 130 (90.9) | 132 (92.3) | ||
Yes | 13 (8.2) | 29 (6.0) | 13 (9.1) | 11 (7.7) |
Comparisons of surgical outcomes between groups
Variables | Before PSM | After PSM | ||||
---|---|---|---|---|---|---|
Group TL
n = 158 | Group LA
n = 484 |
P
| Group TL
n = 143 | Group LA
n = 143 |
P
| |
No. of retrieved LNs | 35.7 ± 11.4 | 31.9 ± 10.3 | 0.000 | 35.7 ± 11.5 | 31.7 ± 9.6 | 0.002 |
Operation time | 154.4 ± 30.1 | 155.6 ± 46.2 | 0.776 | 154.9 ± 30.3 | 153.9 ± 46.0 | 0.826 |
Blood loss | 51.1 ± 30.9 | 61.6 ± 78.3 | 0.121 | 51.1 ± 31.4 | 63.0 ± 101.2 | 0.195 |
Day of first flatus | 3.9 ± 1.4 | 4.0 ± 1.6 | 0.293 | 3.9 ± 1.5 | 4.1 ± 1.6 | 0.140 |
Day of first fluid diet | 5.1 ± 1.8 | 4.7 ± 1.6 | 0.008 | 5.2 ± 1.9 | 4.9 ± 1.7 | 0.128 |
Day of first semifluid diet | 8.0 ± 2.6 | 7.9 ± 1.9 | 0.589 | 8.0 ± 2.6 | 8.1 ± 2.1 | 0.765 |
Hospital stay | 12.7 ± 7.2 | 11.5 ± 5.4 | 0.038 | 12.8 ± 7.4 | 11.9 ± 6.5 | 0.285 |
Comparisons of postoperative complications between groups
Variables | Before PSM | After PSM | ||||
---|---|---|---|---|---|---|
Group TL
n = 158 | Group LA
n = 484 |
P
| Group TL
n = 143 | Group LA
n = 143 |
P
| |
Complications gradea
| 0.156 | 0.309 | ||||
0 | 134 (84.8 %) | 435 (89.9 %) | 121 (84.6 %) | 129 (90.2 %) | ||
I–II | 14 (8.9 %) | 33 (6.8 %) | 12 (8.4 %) | 9 (6.3 %) | ||
Pulmonary infection | 3 | 8 | 2 | 2 | ||
Celiac infection | 1 | 7 | 1 | 3 | ||
Urinary infection | 2 | 0 | 1 | 0 | ||
Arrhythmia | 0 | 1 | 0 | 1 | ||
Lymphatic leakage | 3 | 4 | 3 | 2 | ||
Lower incomplete gastrointestinal obstruction | 1 | 0 | 1 | 0 | ||
Incision infection | 0 | 3 | 0 | 0 | ||
Anastomotic leakage | 3 | 2 | 3 | 0 | ||
Anastomotic hemorrhage | 0 | 2 | 0 | 0 | ||
Gastric atony | 1 | 6 | 1 | 1 | ||
III–IV | 10 (6.3 %) | 16 (3.3 %) | 10 (7.0 %) | 5 (3.5 %) | ||
Pulmonary infection | 3 | 5 | 3 | 3 | ||
Septicemia | 1 | 0 | 1 | 0 | ||
Inflammatory intestinal obstruction | 1 | 0 | 1 | 0 | ||
Celiac infection | 2 | 1 | 2 | 0 | ||
Incision infection | 0 | 1 | 0 | 0 | ||
Abdominal hemorrhage (not including anastomotic bleeding) | 1 | 2 | 1 | 0 | ||
Anastomotic leakage | 2 | 3 | 2 | 0 | ||
Anastomotic bleeding | 0 | 2 | 0 | 2 | ||
Gastric atony | 0 | 2 | 0 | 0 | ||
Complication rate | 15.2 % | 10.1 % | 0.082 | 15.4 % | 9.8 % | 0.154 |
Anastomosis-related complications | 6 (3.8 %) | 17 (3.5 %) | 0.867 | 6 (4.2 %) | 3 (2.1 %) | 0.501 |
Anastomotic leakage | 5 (3.2 %) | 5 (1.0 %) | 0.131 | 5 (3.5 %) | 0 (0.0 %) | 0.060 |
Anastomotic hemorrhage | 0 (0.0 %) | 4 (0.8 %) | 0.577 | 0 (0.0 %) | 2 (1.4 %) | 0.498 |
Gastric atony | 1 (0.6 %) | 8 (1.7 %) | 0.577 | 1 (0.7 %) | 1 (0.7 %) | 1.000 |
Anastomotic stricture | 0 | 0 | – | 0 | 0 | – |
Stratification analysis of surgical outcomes between groups
Variables | Early GC | Locally advanced GC | ||||
---|---|---|---|---|---|---|
Group TL
n = 65 | Group LA
n = 60 |
P
| Group TL
n = 78 | Group LA
n = 83 |
P
| |
No. of retrieved LNs | 32.5 ± 11.3 | 29.4 ± 8.2 | 0.088 | 38.2 ± 11.1 | 33.3 ± 10.1 | 0.004 |
Operation time | 153.5 ± 30.7 | 144.4 ± 33.6 | 0.129 | 156.1 ± 30.2 | 160.3 ± 52.0 | 0.544 |
Blood loss | 52.0 ± 27.4 | 51.7 ± 31.0 | 0.955 | 50.4 ± 34.5 | 70.6 ± 128.2 | 0.191 |
Day of first flatus | 3.7 ± 1.0 | 3.9 ± 1.2 | 0.255 | 4.0 ± 1.7 | 4.3 ± 1.8 | 0.323 |
Day of first fluid diet | 4.9 ± 1.0 | 4.6 ± 0.9 | 0.159 | 5.4 ± 2.3 | 5.0 ± 2.1 | 0.237 |
Day of first semifluid diet | 7.5 ± 1.3 | 7.9 ± 1.8 | 0.130 | 8.4 ± 3.3 | 8.2 ± 2.2 | 0.624 |
Hospital stay | 12.17 ± 5.2 | 11.0 ± 3.3 | 0.176 | 13.3 ± 8.8 | 12.5 ± 7.9 | 0.535 |
Operative complication | 7(10.8 %) | 7(11.7 %) | 0.874 | 15(19.2 %) | 7(8.4 %) | 0.046 |
Anastomosis-related complications | 1(1.5 %) | 1(1.7 %) | 1.000 | 5(6.4 %) | 2(2.4 %) | 0.265 |
Anastomotic leakage | 1(1.5 %) | 0(0.0 %) | 1.000 | 4(5.1 %) | 0(0.0 %) | 0.053 |
Anastomotic hemorrhage | 0(0.0 %) | 1(1.7 %) | 0.480 | 0(0.0 %) | 1(1.2 %) | 1.000 |
Gastric atony | 0 | 0 | – | 1(1.3 %) | 1(1.2 %) | 1.000 |
Anastomotic stricture | 0 | 0 | – | 0 | 0 | – |
Risk factors of postoperative complications in locally advanced GC
Variables | Postoperative complications | Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|---|---|
Yes | No |
P
| OR | 95 % CI |
P
| |
BMI | 24.4 ± 3.2 | 22.0 ± 2.9 | 0.000 | 1.278 | 1.087–1.501 | 0.003 |
Digestive tract reconstruction | 0.046 | 2.741 | 0.993–7.562 | 0.052 | ||
TLDG | 15 (19.2 %) | 63 (80.8) | ||||
LADG | 7 (8.4 %) | 76 (91.6 %) | ||||
Chalson’s score | 0.027 | 2.366 | 0.812–6.893 | 0.114 | ||
0–1 | 16 (11.2 %) | 127 (88.8 %) | ||||
≥ 2 | 6 (33.3 %) | 12 (66.7 %) |