Comparison of Surgical and Oncological Outcomes of Laparoscopic and Open Gastrectomy for Pathologically Serosa-Invasive (pT4a) Advanced Gastric Cancer-Retrospective Propensity Score-Matched Analysis

Kuwabara, Shirou; Kobayashi, Kazuo; Sudo, Natsuru; Omori, Ai; Matsuya, Naoki; Utsumi, Shiori

doi:10.1089/lap.2023.0074

Cited by 1 publication

(1 citation statement)

References 33 publications

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“…The same trend was observed in terms of reported survival rates, for example, at 5 years after surgery, Long et al [40] reported an OS rate of 69% in the LG group and 60% in the OG group. Kuwabara and colleagues [ 37 ] reported a 5-year DFS rate showing a 12.2% advantage of LG compared with OG (51.3% vs. 39.1%). Nevertheless, none of the differences were statistically significant, which may be caused by insufficient statistical power due to the limited sample size of the individual studies.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open gastrectomy for nonmetastatic T4a gastric cancer: a meta-analysis of reconstructed individual participant data from propensity score-matched studies

Pang,

Yan,

Zhao

et al. 2024

World J Surg Onc

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Background The applicability of laparoscopy to nonmetastatic T4a patients with gastric cancer remains unclear due to the lack of high-quality evidence. The purpose of this study was to compare the survival rates of laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for these patients through a meta-analysis of reconstructed individual participant data from propensity score-matched studies. Methods PubMed, Embase, Web of Science, Cochrane library and CNKI were examined for relevant studies without language restrictions through July 25, 2023. Individual participant data on overall survival (OS) and disease-free survival (DFS) were extracted from the published Kaplan-Meier survival curves. One-stage and two-stage meta-analyses were performed. In addition, data regarding surgical outcomes and recurrence patterns were also collected, which were meta-analyzed using traditional aggregated data. Results Six studies comprising 1860 patients were included for analysis. In the one-stage meta-analyses, the results demonstrated that LG was associated with a significantly better DFS (Random-effects model: P = 0.027; Restricted mean survival time [RMST] up to 5 years: P = 0.033) and a comparable OS (Random-effects model: P = 0.135; RMST up to 5 years: P = 0.053) than OG for T4a gastric cancer patients. Two-stage meta-analyses resulted in similar results, with a 13% reduced hazard of cancer-related death (P = 0.04) and 10% reduced hazard of overall mortality (P = 0.11) in the LG group. For secondary outcomes, the pooled results showed an association of LG with less estimated blood loss, faster postoperative recovery and more retrieved lymph nodes. Conclusion Laparoscopic surgery for patients with nonmetastatic T4a disease is associated with a potential survival benefit and improved surgical outcomes.

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Section: Discussionmentioning

confidence: 99%