Laparoscopic gastrectomy for stage II and III advanced gastric cancer: long‑term follow‑up data from a Western multicenter retrospective study

Abstract

Introduction There has been an increasing interest for the laparoscopic treatment of early gastric cancer, especially among Eastern surgeons. However, the oncological effectiveness of Laparoscopic Gastrectomy (LG) for Advanced Gastric Cancer (AGC) remains a subject of debate, especially in Western countries where limited reports have been published. The aim of this paper is to retrospectively analyze short- and long-term results of LG for AGC in a real-life Western practice. Materials and methods All consecutive cases of LG with D2 lymphadenectomy for AGC performed from January 2005 to December 2019 at seven different surgical departments were analyzed retrospectively. The primary outcome was diseases-free survival (DFS). Secondary outcomes were overall survival (OS), number of retrieved lymph nodes, postoperative morbidity and conversion rate. Results A total of 366 patients with stage II and III AGC underwent either total or subtotal LG. The mean number of harvested lymph nodes was 25 ± 14. The mean hospital stay was 13 ± 10 days and overall postoperative morbidity rate 27.32%, with severe complications (grade ≥ III) accounting for 9.29%. The median follow-up was 36 ± 16 months during which 90 deaths occurred, all due to disease progression. The DFS and OS probability was equal to 0.85 (95% CI 0.81–0.89) and 0.94 (95% CI 0.92–0.97) at 1 year, 0.62 (95% CI 0.55–0.69) and 0.63 (95% CI 0.56–0.71) at 5 years, respectively. Conclusion Our study has led us to conclude that LG for AGC is feasible and safe in the general practice of Western institutions when performed by trained surgeons.

Impact of neoadjuvant therapy followed by laparoscopic radical gastrectomy with D2 lymph node dissection in Western population: A multi‐institutional propensity score‐matched study

“…We previously presented short and long-term outcomes from the same series of over 300 patients who underwent LG. 31 In We hypothesize that several factors could affect outcomes after NAT as they relate to toxicity, 33 a worse nutritional status, sarcopenia, 34 and neutropenia. 35 However, our findings differ from those of others western 36,37 and eastern [38][39][40][41] studies claiming that the administration of NAT is not associated with a greater risk of postoperative morbidity when compared to the United States.…”

Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer

“…Randomized studies are difficult to run, as most referral centers dedicated to MIG have consolidated experience either in LG or in RG, and different levels of specific expertise are likely to affect monocentric comparisons [29,34]. Actually, both laparoscopic and robotic MIG can be recommended for selected patients at centers with specific technical expertise, as they are associated with fewer morbidity while resulting in long-term outcomes which are equivalent to those of open surgery [3,4,16,21]. Available data from RCT is scarce and most retrospective reports are still biased by some confounding factors.…”

“…The employment of laparoscopic techniques in gastric surgery has diffused and evolved rapidly over the last two decades [1][2][3]. Minimally Invasive Gastrectomy (MIG) is now almost universally accepted as a valid option for the treatment of gastric cancer (GC) as it optimizes postoperative recovery without compromising the adequacy of resection and long-term oncological outcomes [1][2][3][4][5][6].…”

“…The employment of laparoscopic techniques in gastric surgery has diffused and evolved rapidly over the last two decades [1][2][3]. Minimally Invasive Gastrectomy (MIG) is now almost universally accepted as a valid option for the treatment of gastric cancer (GC) as it optimizes postoperative recovery without compromising the adequacy of resection and long-term oncological outcomes [1][2][3][4][5][6]. Recent NCCN guidelines (version 2.2021) for GC treatment indicate that MIG (including both conventional laparoscopic and robotic techniques) may be considered, for early and locally advanced cases, provided specific expertise in minimally invasive foregut procedures and lymphadenectomy are available [1][2][3][5][6][7][8][9].…”

“…The technical difficulties of laparoscopic surgery that are encountered in performing MIG have led some surgical teams to the use of robotic surgery [10,11]. Indeed, robotics has been originally introduced in clinical practice to overcome some of the intrinsic limitations of conventional laparoscopic and to broaden the range of application of minimally invasive surgery, and also in the field of the surgery of the stomach, several experiences have indicated excellent outcomes [3,[5][6][7][8][9]. A recent study by Stewart et al have investigated the adoption of robotic surgery in surgical oncology by analyzing the available data from the National Inpatient Sample (NIS) American database [12].…”