FIGURE 1.
Pathology findings in patients with non-early gastric adenocarcinoma undergoing distal subtotal gastrectomy
| Variable | Unmatched | Propensity score matched | ||||
|---|---|---|---|---|---|---|
| B-I (n = 165) | B-II (n = 167) | p-value | B-I (n = 97) | B-II (n = 97) | p-value | |
| Tumor size, cm, mean (SD) | 4.5 (1.7) | 6.2 (2.4) | 0.001 | 5.1 (1.5) | 5.2 (1.5) | 0.52 |
| pT stage, n (%) | 0.046 | 0.28 | ||||
| T1–T2 | 69 (41.8%) | 49 (29.3%) | 32 (33%) | 31 (32%) | ||
| T3 | 70 (42.4%) | 85 (50.9%) | 44 (45.4%) | 53 (54.6%) | ||
| T4a/T4b | 26 (15.8%) | 33 (19.8%) | 21 (21.6%) | 13 (13.4%) | ||
| pN stage, n (%) | 0.089 | 0.62 | ||||
| N0 | 47 (28.5%) | 55 (32.9%) | 27 (27.8%) | 32 (33%) | ||
| N1 | 31 (18.8%) | 17 (10.2%) | 14 (14.4%) | 10 (10.3%) | ||
| N2 | 38 (23%) | 34 (20.4%) | 25 (25.8%) | 23 (23.7%) | ||
| N3a | 32 (19.4%) | 47 (28.1%) | 19 (19.6%) | 24 (24.7%) | ||
| N3b | 17 (10.3%) | 14 (8.4%) | 12 (12.4%) | 8 (8.2%) | ||
| Disease stage (AJCC), n (%) | 0.1 | 0.95 | ||||
| I B | 29 (17.6%) | 26 (15.6%) | 13 (13.4%) | 15 (15.5%) | ||
| II A | 32 (19.4%) | 26 (15.6%) | 17 (17.5%) | 18 (18.6%) | ||
| II B | 29 (17.6%) | 16 (9.6%) | 16 (16.5%) | 14 (14.4%) | ||
| III A | 33 (20%) | 36 (21.6%) | 24 (24.7%) | 21 (21.6%) | ||
| III B | 25 (15.2%) | 41 (24.6%) | 15 (15.5%) | 20 (20.6%) | ||
| III C | 17 (10.3%) | 22 (13.2%) | 12 (12.4%) | 9 (9.3%) | ||
| Detected lymph nodes, mean (SD) | 27 (12) | 18 (9) | 0.001 | 27 (12) | 19 (10) | 0.001 |
| Positive lymph nodes, mean (SD) | 6 (7) | 6 (7) | 0.98 | 6.4 (8.1) | 5.6 (7.2) | 0.44 |
| Lymph node ratio, mean (SD) | 0.21 (0.25) | 0.28 (0.27) | 0.52 | 0.24 (0.27) | 0.28 (0.27) | 0.27 |
| R0 resection, n (%) | 151 (91.5%) | 120 (71.9%) | 0.001 | 87 (89.7%) | 80 (82.5%) | 0.16 |
| Tumor differentiation, n (%) | 0.018 | 0.51 | ||||
| Well | 30 (18.2%) | 22 (13.2%) | 15 (15.5%) | 15 (15.5%) | ||
| Middle | 44 (26.7%) | 60 (35.9%) | 26 (26.8%) | 33 (34%) | ||
| Poor/non-differentiated | 91 (55.1%) | 85 (50.9%) | 56 (57.7%) | 49 (50.5%) | ||
Long-term oncologic outcomes after distal subtotal gastrectomy with Billroth I vs Billroth II reconstruction for non-early gastric adenocarcinoma*
| Variable | Unmatched | Propensity score matched | ||||
|---|---|---|---|---|---|---|
| B-I (n = 164) | B-II (n = 165) | p-value | B-I (n = 96) | B-II (n = 95) | p-value | |
| Adjuvant chemotherapy, n (%)¶ | 52 (31.7%) | 44 (26.7%) | 0.32 | 36 (37.5%) | 26 (27.4%) | 0.18 |
| Recurrence, n (%)¶ | 34 (20.7%) | 60 (36.4%) | 0.002 | 21 (21.9%) | 34 (35.8%) | 0.054 |
| Recurrence type, n (%)¶ | ||||||
| Local | 4 (2.4%) | 16 (9.7%) | 0.006 | 3 (3.1%) | 11 (11.6%) | 0.022 |
| Distant metastases | 12 (7.3%) | 25 (15.2%) | 0.025 | 8 (8.3%) | 12 (12.6%) | 0.3 |
| Peritoneal carcinomatosis | 18 (11%) | 19 (11.5%) | 0.88 | 10 (10.4%) | 11 (11.6%) | 0.65 |
| Overall survival, months, median | 45 (35.4–54.6) | 29 (24.3–33.7) | 0.036 | 45 (30.9–59.1) | 29 (24.9–33.1) | 0.22 |
| 3-year | 59% | 41.1% | 57% | 38.4% | ||
| 5-year | 34.6% | 28.7% | 32.9% | 28.4% | ||
Uni- and multivariable analysis of prognostic factors for tumor recurrence following distal subtotal gastrectomy for non-early gastric adenocarcinoma (Propensity score matching [PSM] cohort)
| Variable | Univariable | Multivariable | ||
|---|---|---|---|---|
| Odds ratio (95% CI) | p-value | Odds ratio (95% CI) | p-value | |
| Age, years | 0.99 (0.96–1.01) | 0.33 | ||
| Gender (female) | 1.34 (0.71–2.51) | 0.37 | ||
| BMI, kg/m2 | 0.99 (0.93–1.07) | 0.89 | ||
| Comorbidity | 0.74 (0.38–1.46) | 0.39 | ||
| ASA score (III–IV) | 0.86 (0.31–2.4) | 0.78 | ||
| CEA, ng/mL | 1.0 (0.99–1.02) | 0.59 | ||
| Ca 19-9, U/mL | 1.0 (0.99–1.001) | 0.93 | ||
| Extended gastrectomy | 0.99 (0.19–5.26) | 0.99 | ||
| B-II reconstruction (vs. B-I) | 1.99 (1.05–3.78) | 0.035 | ———————————— | — |
| Operative time | 1.012 (1.001–1.024) | 0.038 | ———————————— | — |
| Estimated blood loss | 1.001 (0.99–1.01) | 0.65 | ||
| Red blood cell transfusion | 0.26 (0.06–1.18) | 0.082 | ||
| Severe complications | 2.06 (0.53–7.96) | 0.29 | ||
| Relaparotomy | 2.59 (0.62–10.74) | 0.19 | ||
| Tumor size | 1.13 (0.92–1.38) | 0.25 | ||
| pT stage | ||||
| T1–T2 | reference | reference | ||
| T3 | 3.86 (1.76–8.48) | 0.001 | 3.13 (1.36–7.19) | 0.007 |
| T4a/T4b | 1.04 (0.32–3.35) | 0.95 | 0.64 (0.14–2.86) | 0.56 |
| pN stage | ||||
| N0 | Reference | ———————————— | — | |
| N1 | 1.82 (0.57–5.82) | 0.32 | ———————————— | — |
| N2 | 2.31 (0.89–5.95) | 0.08 | ———————————— | — |
| N3a | 4.31 (1.69–10.94) | 0.002 | ———————————— | — |
| N3b | 3.18 (0.98–10.26) | 0.05 | ———————————— | — |
| Detected lymph nodes | 0.96 (0.94–0.99) | 0.022 | 0.96 (0.93–1.01) | 0.06 |
| Lymph node ratio | 1.05 (1.01–1.09) | 0.025 | 1.01 (1.0–1.03) | 0.043 |
| R0 resection | 3.2 (1.36–7.55) | 0.008 | 2.41 (0.85–6.84) | 0.1 |
| Tumor differentiation | ||||
| Well | reference | |||
| Middle | 1.18 (0.59–2.37) | 0.65 | ||
| Poor | 0.63 (0.25–1.59) | 0.33 | ||
| Adjuvant chemotherapy | 1.28 (0.66–2.47) | 0.46 | ||
Perioperative data in patients with non-early gastric adenocarcinoma undergoing distal subtotal gastrectomy
| Variable | Unmatched | Propensity score matched | ||||
|---|---|---|---|---|---|---|
| B-I (n = 165) | B-II (n = 167) | p-value | B-I (n = 97) | B-II (n = 97) | p-value | |
| Age, years, mean (SD) | 60.8 (11.7) | 62.6 (10.9) | 0.16 | 60.9 (10.9) | 63.2 (11.6) | 0.46 |
| Gender (female), n (%) | 74 (44.8%) | 59 (35.3%) | 0.08 | 42 (43.3%) | 43 (44.3%) | 0.26 |
| BMI, kg/m2, mean (SD) | 26.0 (6.5) | 25.5 (5.1) | 0.55 | 26.3 (5.9) | 25.4 (5.5) | 0.31 |
| Comorbidity, n (%) | 129 (78.2%) | 109 (65.3%) | 0.01 | 76 (78.3%) | 63 (64.9%) | 0.04 |
| Cardiovascular disease, n (%) | 88 (53.3%) | 75 (44.9%) | 0.13 | 50 (51.5%) | 46 (47.4%) | 0.58 |
| Diabetes mellitus, n (%) | 18 (10.9%) | 16 (9.6%) | 0.69 | 14 (14.4%) | 7 (7.2%) | 0.13 |
| Number of comorbidities, mean (SD) | 2.3 (1.1) | 3.1 (0.9) | 0.001 | 2.3 (1.1) | 3.0 (0.8) | 0.001 |
| ASA score (III–IV), n (%) | 145 (87.9%) | 145 (86.8%) | 0.77 | 87 (89.7%) | 88 (90.7%) | 0.81 |
| Hemoglobin, g/dL, mean (SD) | 124 (27) | 119 (29) | 0.09 | 122 (28) | 119 (29) | 0.42 |
| Total protein, g/dL, mean (SD) | 72 (8.4) | 72 (5.9) | 0.53 | 70.5 (9.8) | 72.1 (5.8) | 0.15 |
| CEA, ng/mL, median (range) [IQR]* | 1 (0.5–627.2) [1–2] | 1.5 (0.5–188) [1–3] | 0.02 | 1 (0.5–174) [1–2] | 1 (0.5–100) [1–2] | 0.81 |
| Ca 19-9, U/mL, median (range) [IQR]* | 8 (1–1549) [3–21] | 9 (1–999) [3–29] | 0.62 | 8.3 (1–1549) [4–25] | 9 (1–999) [3–30] | 0.7 |
| Location in antrum, n (%) | 160 (97%) | 133 (79.6%) | 0.001 | 93 (95.9%) | 94 (96.9%) | 0.65 |
| Extended gastrectomy, n (%) | 3 (1.8%) | 25 (15%) | 0.001 | 3 (3.1%) | 4 (4.1%) | 0.65 |
| Operative time, min, mean (SD) | 144 (28) | 168 (29) | 0.001 | 143 (27) | 165 (28) | 0.001 |
| Red blood cell transfusion, n (%) | 17 (10.3%) | 13 (7.8%) | 0.42 | 12 (12.4%) | 7 (7.2%) | 0.23 |
| Severe complications, n (%) | 8 (4.8%) | 13 (7.8%) | 0.27 | 5 (5.2%) | 7 (7.2%) | 0.53 |
| Anastomotic leakage, n (%) | 4 (2.4%) | 5 (3%) | 1.0 | 1 (1%) | 2 (2.1%) | 0.56 |
| Relaparotomy, n (%) | 7 (4.2%) | 11 (6.6%) | 0.35 | 4 (4.1%) | 5 (5.2%) | 0.71 |
| 30-day mortality, n (%) | 1 (0.6%) | 2 (1.2%) | 1.0 | 1 (1%) | 2 (2.1%) | 0.56 |
| 90-day mortality, n (%) | 1 (0.6%) | 4 (2.4%) | 0.37 | 1 (1%) | 4 (4.1%) | 0.36 |
| Postoperative days, median (range) | 11 (6–48) [9–13] | 11 (5–72) [9–13] | 0.51 | 10 (6–48) [9–13] | 11 (5–72) [9–14] | 0.47 |