Comparisons of perioperative and survival outcomes of laparoscopic versus open gastrectomy for serosa-positive (pT4a) gastric cancer patients: a propensity score matched analysis

Pang, Hua-Yang; Zhao, Lin-Yong; Zhang, Ziqi; Galiullin, Danil; Chen, Xiao-Long; Li, Kai; Zhang, Weihan; Yang, Kun; Chen, Xin Zu; Hu, Jian-Kun

doi:10.1007/s00423-021-02114-y

Cited by 9 publications

(10 citation statements)

References 32 publications

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“…Total gastrectomy is a highly complex and challenging surgical procedure in GC patients. Its operation time, intraoperative blood loss, and postoperative complications are much higher than other surgical methods [43,44]. However, in our present analysis based on 1049 patients, we found that PD did not show any advantage over ND in patients undergoing total gastrectomy.…”

Section: Discussioncontrasting

confidence: 70%

Prophylactic drainage versus non-drainage following gastric cancer surgery: a meta-analysis of randomized controlled trials and observational studies

Pang

Chen

et al. 2023

Preprint

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Background The role of prophylactic drainage (PD) in gastrectomy for gastric cancer (GC) is not well-established. The purpose of this study is to compare the perioperative outcomes between the PD and non-drainage (ND) in GC patients undergoing gastrectomy. Methods A systematic review of electronic databases including PubMed, Embase, Web of Science, the Cochrane Library and China National Knowledge Infrastructure was performed up to December 2022. All eligible randomized controlled trials (RCTs) and observational studies were included and meta-analyzed separately. The registration number of this protocol is PROSPERO CRD42022371102. Results Overall, 7 RCTs (783 patients) and 14 observational studies (4359 patients) were ultimately included. Data from RCTs indicated that patients in the ND group had a lower total complications rate (OR = 0.68; 95%CI:0.47–0.98; P = 0.04; I2 = 0%), earlier time to soft diet (MD=-0.27; 95%CI: -0.55 to 0.00; P = 0.05; I2 = 0%) and shorter length of hospital stay (MD=-0.98; 95%CI: -1.71 to -0.26; P = 0.007; I2 = 40%). While other outcomes including anastomotic leakage, duodenal stump leakage, pancreatic leakage, intra-abdominal abscess, surgical-site infection, pulmonary infection, need for additional drainage, reoperation rate, readmission rate and mortality were not significantly different between the two groups. Meta-analyses on observational studies showed good agreement with the pooled results from RCTs, with higher statistical power. Conclusion The present meta-analysis suggests that routine use of PD may not be necessary and even harmful in GC patients following gastrectomy. However, well-designed RCTs with risk-stratified randomization are still needed to validate the results of our study.

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Section: Discussioncontrasting

confidence: 70%

Prophylactic drainage versus non-drainage following gastric cancer surgery: a meta-analysis of randomized controlled trials and observational studies

Pang

Chen

et al. 2023

Preprint

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“…2,[14][15][16][17]19 The STOMACH and LOGICA trials were the first Western randomized controlled trials on this subject. 20 However, only one of these studies showed an overall shorter hospital stay in comparison to the outcome of this cohort. 21 All other studies reported similar or overall longer hospital stay in both groups.…”

Section: Discussionmentioning

confidence: 71%

“…While previous studies have found minimally invasive techniques to have shorter hospital stay in comparison to open techniques, this study did not show a significant difference between both groups. A recent pooled analysis of 18 studies comparing MIG with OG for advanced gastric cancer showed a significant difference in hospital stay in favor of MIG 20 . However, only one of these studies showed an overall shorter hospital stay in comparison to the outcome of this cohort 21 .…”

Section: Discussionmentioning

confidence: 98%

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Minimally invasive versus open gastrectomy for gastric cancer. A pooled analysis of two European randomized controlled trials

van der Wielen,

Brenkman,

Seesing

et al. 2024

Journal of Surgical Oncology

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IntroductionMinimally invasive techniques have shown better short term and similar oncological outcomes compared to open techniques in the treatment of gastric cancer in Asian countries. It remains unknown whether these outcomes can be extrapolated to Western countries, where patients often present with advanced gastric cancer.Materials and MethodsA pooled analysis of two Western randomized controlled trials (STOMACH and LOGICA trial) comparing minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in advanced gastric cancer was performed. Postoperative recovery (complications, mortality, hospital stay), oncological outcomes (lymph node yield, radical resection rate, 1‐year survival), and quality of life was assessed.ResultsThree hundred and twenty‐one patients were included from both trials. Of these, 162 patients (50.5%) were allocated to MIG and 159 patients (49.5%) to OG. A significant difference was seen in blood loss in favor of MIG (150 vs. 260 mL, p < 0.001), whereas duration of surgery was in favor of OG (180 vs. 228.5 min, p = 0.005). Postoperative recovery, oncological outcomes and quality of life were similar between both groups.ConclusionMIG showed no difference to OG regarding postoperative recovery, oncological outcomes or quality of life, and is therefore a safe alternative to OG in patients with advanced gastric cancer.

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“…Univariate and multivariate Cox proportional hazards regression models were used to analyze the hazard ratios for a patient’s overall survival. Factors with a P value <0.1 in the univariate analysis as well as those that were clinically significant were entered into the multivariate model using an “Enter” method ( 31 ). A P value less than 0.05 (two-sided) was considered to be statistically significant.…”

Section: Methodsmentioning

confidence: 99%

Impact of Type of Postoperative Complications on Long-Term Survival of Gastric Cancer Patients: Results From a High-Volume Institution in China

et al. 2021

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BackgroundThis study aimed to evaluate the impact of postoperative complication and its etiology on long-term survival for gastric cancer (GC) patients with curative resection.MethodsFrom January 2009 to December 2014, a total of 1,667 GC patients who had undergone curative gastrectomy were analyzed. Patients with severe complications (SCs) (Clavien–Dindo grade III or higher complications or those causing a hospital stay of 15 days or longer) were separated into a “complication group.” Univariate and multivariate analyses were performed to reveal the relationship between postoperative complications and long-term survival. A 2:1 propensity score matching (PSM) was used to balance baseline parameters between the two groups.ResultsSCs were diagnosed in 168 (10.08%) patients, including different etiology: infectious complications (ICs) in 111 (6.66%) and non-infectious complications (NICs) in 71 (4.26%) patients. Multivariate analysis showed that presence of SCs (P=0.001) was an independent prognostic factor for overall survival, and further analysis by complication type demonstrated that the deteriorated overall survival was mainly caused by ICs (P=0.004) rather than NICs (P=0.068). After PSM, patients with SCs (p=0.002) still had a significantly decreased overall survival, and the presence of ICs (P=0.002) rather than NICs (P=0.067) showed a negative impact on long-term survival.ConclusionSerious complications, particularly of an infectious type, may have a negative impact on overall survival of GC patients. However, additional multicenter prospective studies with larger sample size are required to verify this issue.

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Comparisons of perioperative and survival outcomes of laparoscopic versus open gastrectomy for serosa-positive (pT4a) gastric cancer patients: a propensity score matched analysis

Cited by 9 publications

References 32 publications

Prophylactic drainage versus non-drainage following gastric cancer surgery: a meta-analysis of randomized controlled trials and observational studies

Prophylactic drainage versus non-drainage following gastric cancer surgery: a meta-analysis of randomized controlled trials and observational studies

Minimally invasive versus open gastrectomy for gastric cancer. A pooled analysis of two European randomized controlled trials

Impact of Type of Postoperative Complications on Long-Term Survival of Gastric Cancer Patients: Results From a High-Volume Institution in China

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