Short- and Long-Term Outcomes in Malnourished Patients After Laparoscopic or Open Radical Gastrectomy

The aim of this study was to compare the short- and long-term outcomes of malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy. Preoperative malnutrition is an independent risk factor for postoperative mortality and morbidity in major gastrointestinal surgery. However, whether laparoscopic surgery can improve the short- and long-term outcomes of malnourished gastric cancer patients has not been determined. We reviewed prospectively collected data from 2441 patients with gastric cancer between January 2009 and December 2014 and compared the short- and long-term outcomes in malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy. Nutritional risk factors included weight loss > 10% within 6 months, body mass index < 18.5 kg/m(2), Subjective Global Assessment Grade C, and serum albumin < 3.0 g/dL. Overall, 501 patients (20.52%) were classified as malnourished. Patients with gastric stump carcinoma, neoadjuvant chemotherapy, distant metastases, palliative operation, or the presence of other malignancies were excluded. Finally, a total of 412 patients were analyzed; 304 in the laparoscopic group and 108 in the open group. There were no significant differences between the two groups regarding the clinicopathological characteristics. However, the operation time (181 +/- 53 vs. 253 +/- 81 min), intraoperative blood loss (80 +/- 116 vs. 322 +/- 502 mL), time to first ambulation (2.21 +/- 1.04 vs. 2.55 +/- 1.50 days), liquid diet (4.91 +/- 1.61 vs. 5.72 +/- 2.09 days) and semiliquid diet (7.67 +/- 1.56 vs. 9.53 +/- 2.09 days) as well as the postoperative hospital stay duration (13.00 +/- 6.56 vs. 15.22 +/- 6.87 days) were significantly lower in the laparoscopic group than those in the open group (p < 0.05). The instances of overall complications (laparoscopic vs. open: 18.4 vs. 30.6%, p = 0.008) and pneumonia (laparoscopic vs. open: 10.9 vs. 19.4%, p = 0.023) were significantly lower in the laparoscopic group. With a median follow-up of 31.0 months (range 1.0-88.0), the 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) rates for the entire cohort were 58.9, 54.0 and 63.0%, respectively. Further analysis showed that the OS (57.5 vs. 59.4%, p = 0.560), RFS (51.8 vs. 54.8%, p = 0.441) and CSS (62.8 vs. 63.0%, p = 0.789) between the laparoscopic and open groups, respectively, were no significantly different. Further analysis showed no significant differences in the OS rates of the two groups of patients stratified by tumor stage (p > 0.05). Compared with open radical gastrectomy, laparoscopy would reduce the postoperative complications especially pneumonia and shorten the postoperative hospital stay for patients with preoperative malnutrition without affecting their long-term survival.