Laparoscopic versus open surgery for locally advanced and metastatic gastric cancer complicated with bleeding and/or stenosis: short- and long-term outcomes

Abstract

Background Laparoscopic surgery has justified its efficacy in the treatment of early gastric cancer. There are limited data indicating the eligibility of laparoscopic interventions in locally advanced gastric cancer. Publications describing the safety of laparoscopic techniques in the treatment of local and metastatic gastric cancer complicated by bleeding and stenosis are scarce. Methods The study included patients with histologically confirmed locally advanced and disseminated gastric cancer and complicated with bleeding and/or stenosis who underwent gastrectomy with vital indications between February 2012 and August 2018. Surgical and oncologic outcomes after laparoscopic surgery (laparoscopic surgery) and open surgery (OS) were compared. Results In total, 127 patients (LS, n = 52; OS, n = 75) were analyzed. Baseline characteristics were similar between the groups. Forty-four total gastrectomies with resection of the abdominal part of the esophagus, 63 distal subtotal (43 Billroth-I and 20 Billroth-II), and 19 proximal gastrectomies were performed. The median duration of surgery was significantly longer in the LS group, 253 min (interquartile range [IQR], 200–295) versus 210 min (IQR, 165–220) (p < 0.001), while median intraoperative blood loss in the LS group was significantly less, 180 ml (IQR, 146—214) versus 320 ml (IQR, 290–350), (p < 0.001). Early postoperative complications occurred in 35% in the LS group and in 45 % of patients in the OS group (p = 0.227). There was no difference in postoperative mortality rates between the groups (3 [6 %] versus 5 (7 %), p = 1.00). Median intensive care unit stay and median postoperative hospital stay were significantly shorter after laparoscopy, 2 (IQR, 1–2) versus 4 (IQR, 3–4) days, and 8 (IQR, 7–9) versus 10 (IQR, 8–12) days, both p < 0.001. After laparoscopy, patients started adjuvant chemotherapy significantly earlier than those after open surgery, 20 vs. 28 days (p < 0.001). However, overall survival rates were similar between the group. Three-year overall survival was 24% in the LS group and 27% in the OS groups. Conclusions Despite the technical complexity, in patients with complicated locally advanced and metastatic gastric cancer, laparoscopic gastrectomies were associated with longer operation time, reduced intraoperative blood loss, shorter reconvalescence, and similar morbidity, mortality rates and long-term oncologic outcomes compared to conventional open surgery.

A meta‐analysis of the effect of laparoscopic gastric resection on the surgical site wound infection in patients with advanced gastric cancer

“…Based on the examination of titles and abstracts, 183 studies not meeting the inclusion criteria were excluded, resulting in 139 articles. After carefully reading the full texts, 20 articles that met the inclusion criteria were finally selected 12–31 . Table 1 shows the basic characteristics of the included studies.…”

“…After carefully reading the full texts, 20 articles that met the inclusion criteria were finally selected. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]…”

Effects of enhanced recovery after surgery nursing program on the surgical site wound infection and postoperative complications in patients of gastric cancer: A meta‐analysis

“…Currently, surgical treatment remains the most effective method among all clinical approaches, with surgical options for gastric cancer primarily including open radical gastrectomy, laparoscopic‐assisted radical gastrectomy, total laparoscopic radical gastrectomy, and robot‐assisted radical gastrectomy 42–46 . However, evidence suggests that postoperative prognosis remains grim, with complications such as postoperative bleeding, surgical site infections, slow recovery and severe concurrent complications posing significant threats to patient safety 47,48 . In this context, the ERAS concept has emerged, employing a multidisciplinary collaboration in clinical, nutritional, nursing and anaesthetic care to optimize perioperative measures, reduce surgical stress, enhance functional recovery, minimize complications, and shorten hospital stays 49 …”

“…[42][43][44][45][46] However, evidence suggests that postoperative prognosis remains grim, with complications such as postoperative bleeding, surgical site infections, slow recovery and severe concurrent complications posing significant threats to patient safety. 47,48 In this context, the ERAS concept has emerged, employing a multidisciplinary collaboration in clinical, nutritional, nursing and anaesthetic care to optimize perioperative measures, reduce surgical stress, enhance functional recovery, minimize complications, and shorten hospital stays. 49 Surgical site wound infection is a common complication in gastric cancer surgery.…”

New strategy in hemorrhagic gastric cancer: A case report of complete pathological remission after neoadjuvant chemotherapy

“…[ 2 , 3 ] Although endoscopic therapy, interventional therapy and other non-surgical therapies are options for hemostasis, the risk of rebleeding restricts their usage. [ 4 ] Emergency operation is generally performed to remove the hemorrhagic tumor. [ 3 ] However, emergency surgery patients suffer from higher risk of postoperative complications and poorer long-term prognosis.…”