Comparison of complications after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for gastric cancer using the Clavien-Dindo classification

The complication rate after surgery for gastric cancer varies according to the particular definition of morbidity. Complications after gastrectomy should be reported using a standardized method. The present study retrospectively analyzed patient outcomes after open distal gastrectomy (ODG) and laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer using a standardized classification system of the severity of complications (the Clavien-Dindo system). A total of 1,631 patients who underwent curative ODG or LADG for gastric adenocarcinoma between May 2003 and December 2009 were included in the study and any risk factors related to complications were analyzed. Six hundred twenty-nine patients were treated with ODG and 1,002 with LADG. Postoperative complications were less frequent in the LADG group than in the ODG group (25.3% vs. 40.1%, P < 0.001), and fewer major complications (Clavien-Dindo classification a parts per thousand yenIIIa) were observed with LADG than with ODG (2.1% vs. 5.4%, P < 0.001). Multivariate analysis showed that the laparoscopic surgical approach correlated with significantly fewer overall and major complications in patients with stage I disease. Using the Clavien-Dindo system, we observed fewer complications with LADG than with ODG. This shows that the laparoscopic approach for treating gastric cancer is less invasive than the open approach in terms of morbidity. Future studies will be needed to confirm this.