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Page 4 of 9 Yuu et al. Mini-invasive Surg 2019;3:6 I http://dx.doi.org/10.20517/2574-1225.2018.73

Table 2. Surgical and oncological outcomes of the LDG group and ODG group
LDG group (n = 20) ODG group (n = 40) P value
Mode of anastomosis 0.473
Billroth I 12 18
Billroth II 0 2
Roux-en-Y 8 20
LN dissection 0.77
D1 2 9
D1+ 3 5
D2 15 26
Operative time (min) 328 ± 57 243 ± 57 < 0.001
EBL (mL, range) 100 (0-475) 300 (60-2,464) < 0.001
Time to first oral diet (days) 4.9 ± 2.4 8.3 ± 8.1 0.0185
Postoperative stay (days, range) 12 (8-39) 23 (10-514) < 0.001
Postoperative metastasis 3 (15%) 13 (32.5%) 0.0766
EBL: estimated blood loss; LDG: laparoscopic distal gastrectomy; ODG: open distal gastrectomy

group. There was a significant reduction in the estimated blood loss in the LDG group compared with that
in the ODG group (P < 0.001). The time to first oral diet was significantly shorter in the LDG group than in
the ODG group (P = 0.00185).

Postoperative hospital stay was significantly shorter in the LDG group than in the ODG group (P < 0.001).
The clinical pathway was used after gastrectomy in the hospital.

Postoperative complications
Postoperative complications occurred in 8 patients (40.0%) in the LDG group and in 24 patients (60.0%) in
the ODG group (P = 0.176). In terms of abdominal complications, only the rate of paralytic ileus, defined
as bowel obstruction treated by a long nasogastric tube, was significantly lower in the LDG group (P =
0.040). No significant differences were found in the rates of other complications [Table 3]. Pneumonia
occurred in 3 patients in the ODG group, but it did not occur in the LDG group (P = 0.544). Postoperative
complications included all grades of Clavien-Dindo classification. A total of 4 patients (10.0%) in the ODG
group died within 30 days due to postoperative complications: pneumonia in 2, anastomotic leakage in 1,
and remnant stomach necrosis in 1. In the LDG group, only 1 patient died of enteritis due to methicillin-
resistant Staphylococcus aureus on postoperative day 7.

Pathological results
Table 4 describes the pathological findings in the 2 groups. No significant differences were noted in terms
of depth of invasion, nodal catalog, and pathological stage. Stage 4 disease was observed in 1 patient in
the LDG group and in 6 patients in the ODG group. Curative surgery was not performed in 7 patients:
1 patient who had liver metastasis (LDG group), 4 patients who had dissemination (ODG group), and 2
patients who had liver metastases (ODG group). No significant differences were found in terms of tumor
diameter, the mean number of harvested lymph nodes, and the mean number of positive lymph node
metastases between the two groups.

Prognosis
The LDG and ODG groups did not differ significantly in terms of the pathological stage according to the
[12]
Japanese Classification of Gastric Carcinoma . The median follow-up period in the LDG and ODG groups
was 11.7 months (range, 0.3-54.8 months), and the 3-year overall survival was 50.1% and 41.7%, respectively
(P = 0.531) [Figure 1].

DISCUSSION
As life expectancy continues to increase, the number of elderly patients with malignancies and
concomitant comorbidities has increased as well. The proportion of elderly patients among the total gastric