A propensity score-matched comparison of laparoscopic distal versus total gastrectomy for middle-third advanced gastric cancer

Wang, Wenjie; Li, Hongtao; Chen, Peng; Yu, Jianping; Zhang, Jiao; Han, Xiaoyan; Su, Lin; Tao, Ruiyu; Xu, Lin; Kong, Yan-Long; Li, Yumin; Liu, Hongbin

doi:10.1016/j.ijsu.2018.11.015

Cited by 9 publications

(12 citation statements)

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“…We evaluated postoperative complications according to the Clavien-Dindo classification system, which is applicable in most parts of the world [ 25 ]. Previous studies have proven that the complication rate of laparoscopic total gastrectomy varies from 9.1 to 34.6% [ 14 , 22 – 24 , 34 , 35 ]. In the current study, the complication rate of the RATG group was not significantly different from that of the LATG group before PSM (23.8% vs. 29.2%, p = 0.268) and after PSM (23.8% vs. 28.6%, p = 0.390).…”

Section: Discussionmentioning

confidence: 99%

“…Since Kitano [ 9 ] reported laparoscopy-assisted distal gastrectomy in 1994 for the first time, laparoscopy-assisted gastrectomy has been widely used for gastric cancer [ 10 – 12 ]. Despite its technical difficulty, laparoscopy-assisted total gastrectomy (LATG) has been shown to be technically feasible and is superior to open total gastrectomy performed by experienced surgeons in terms of its safety and short-term outcomes [ 13 , 14 ]. However, the two-dimensional visualization and limited movement of laparoscopic instruments make it difficult to perform lymphadenectomy precisely.…”

Section: Introductionmentioning

confidence: 99%

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Short-term outcomes of robotic- versus laparoscopic-assisted Total Gastrectomy for advanced gastric Cancer: a propensity score matching study

et al. 2020

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Background: Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had a longer mean operation time (291.14 ± 59.18 vs. 270.34 ± 52.22 min, p = 0.003), less intraoperative bleeding (154.37 ± 89.68 vs. 183.77 ± 95.39 ml, p = 0.004) and more N2 tier RLNs (9.07 ± 5.34 vs. 7.56 ± 4.50, p = 0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90 ± 13.05 vs. 31.91 ± 12.46, p = 0.065). Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p = 0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55 and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p = 0.145), and the ratio of splenectomy were 1.59 and 0.39% (p = 0.253). The mortality rates were 0.8 and 0.4% for the RATG and LATG groups, respectively (p = 1.000). Conclusion: This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short-term outcomes of robotic- versus laparoscopic-assisted Total Gastrectomy for advanced gastric Cancer: a propensity score matching study

et al. 2020

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“…Furthermore, 44 papers met the exclusion criteria and were removed after the third screening. Finally, 12 retrospective studies were included in this present meta-analysis after rigorous literature screening (10,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). The flowchart for the literature selection process is displayed in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Surgical outcomes. Comparisons of the duration of surgery were provided by 4 of the studies included (10,18,19,24). A significantly longer operative time was observed in the TG as compared with that in the DG group (random-effects model; I 2 : 72%; OR,17.95; 95% CI, 5.69-30.20; P=0.004; Fig.…”

Section: Resultsmentioning

confidence: 99%

Surgical and oncological outcomes of distal gastrectomy compared to total gastrectomy for middle‑third gastric cancer: A systematic review and meta‑analysis

Jiang

Yang

et al. 2022

Oncol Lett

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Distal gastrectomy (DG) and total gastrectomy (TG) are the most common types of radical surgery for patients with middle-third gastric cancer (MTGC). However, the indications and benefits of the two procedures still remain controversial. The present meta-analysis aimed to compare the surgical and oncological outcomes of DG and TG in the treatment of MTGC. A rigorous literature review was performed in the databases of PubMed, Embase, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature to retrieve studies published up to February 2022. The Newcastle-Ottawa Scale was used to assess the quality of included studies and a meta-analysis was performed using RevMan 5.3 software. A total of 12 retrospective studies performing comparisons of DG and TG were included in the present meta-analysis. For patients who underwent DG, a lower rate of overall post-operative complications, anastomosis leakage and intro-abdominal infection was determined. No significant difference was observed between DG and TG in the 5-year overall survival when the proximal resection margin ranged from 3 to 5 cm. Although DG was associated with a higher 5-year overall survival rate when compared to TG, there was no significant difference in the stratified analyses by TNM stage. In conclusion, the prognosis of MTGC did not depend on the extent of gastrectomy. With lower complications and acceptable oncological outcomes, DG was a safe and feasible surgical procedure for MTGC when a negative proximal margin was confirmed.

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“…Distal gastrectomy was recommended for patients with lower third AGC when the proximal margin distance can be ensured. The choice of total gastrectomy or distal gastrectomy for the middle third of AGC has not yet been decided [43,44]. For patients with AGC who cannot ensure the proximal margin distance and need total gastrectomy, perioperative chemotherapy can be considered to reduce the tumor stage, strive for partial gastrectomy, improve the completion rate of chemotherapy, improve the overall treatment effect and improve the life quality of patients [9,25,[45][46][47].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Prognostic Impact of the Completion of Adjuvant Chemotherapy with Oxaliplatin Plus Oral Fluorouracil for AGC After D2 Gastrectomy

Pan

Huang

et al. 2021

Preprint

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Background: To analyze the risk factors and prognostic impact of the completion of adjuvant chemotherapy with oxaliplatin plus oral fluorouracil for advanced gastric cancer (AGC) after D2 gastrectomy.Methods: A total of 234 patients with AGC who underwent D2 gastrectomy and received oxaliplatin plus oral fluorouracil adjuvant chemotherapy between January 1, 2012 to January 1, 2021 in the First Affiliated Hospital of Xiamen University were identified (203 cases with SOX regime;31 cases with XELOX regime) and their clinicopathological information was retrospectively analyzed. The tolerability and safety of oxaliplatin plus oral fluorouracil therapy were analyzed. Patients were divided into high completion group (n = 135) and low completion group (n = 99) according to whether they had completed 6 cycles of adjuvant combined chemotherapy. Relevant risk factors and the prognostic impact of the completion rates of chemotherapy were analyzed.Results: 99 patients have completed more than 6 cycles of adjuvant chemotherapy with oxaliplatin plus oral fluorouracil and the chemotherapy completion rate was 42.31%. Chemotherapy completion was correlated with age ( P = 0.000) and the extent of gastric resection ( P = 0.039). Age was independent risk factor of chemotherapy completion ( OR ,2.487; 95%CI ,1.449-4.268; P = 0.001). As of January 1,2021, 124 patients were followed up for more than three years, the three-year survival rate (86.9% vs 68.8%; P = 0.02) were significantly different between two groups, and the differences of pN stage, pTNM stage and nerve invasion were also statistically significant ( P < 0.05, respectively). Cox regression analysis showed that pN3 stage ( HR ,2.645; 95%CI ,1.138-6.146 ; P = 0.024) was independent prognostic factor about poor survival.Conclusions: Oxaliplatin plus fluorouracil oral adjuvant chemotherapy was safe and tolerable. Advanced age and total gastrectomy were risk factors for chemotherapy completion. The key to improve the prognosis of patients with AGC after D2 gastrectomy was to improve the completion rate of adjuvant chemotherapy.

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A propensity score-matched comparison of laparoscopic distal versus total gastrectomy for middle-third advanced gastric cancer

Cited by 9 publications

References 44 publications

Short-term outcomes of robotic- versus laparoscopic-assisted Total Gastrectomy for advanced gastric Cancer: a propensity score matching study

Short-term outcomes of robotic- versus laparoscopic-assisted Total Gastrectomy for advanced gastric Cancer: a propensity score matching study

Surgical and oncological outcomes of distal gastrectomy compared to total gastrectomy for middle‑third gastric cancer: A systematic review and meta‑analysis

Risk Factors and Prognostic Impact of the Completion of Adjuvant Chemotherapy with Oxaliplatin Plus Oral Fluorouracil for AGC After D2 Gastrectomy

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