Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population—on behalf of the Italian Research Group for Gastric Cancer

Lombardi, Pietro Maria; Bernasconi, D.; Baiocchi, Gian Luca; Berselli, M.; Biondi, Alberto; Castoro, Carlo; Catarci, M.; Degiuli, M.; Romario, Uberto Fumagalli; Giacopuzzi, Simone; Marchesi, Federico; Marrelli, Daniele; Mazzola, Michele; Molfino, S.; Olmi, Stefano; Rausei, S.; Rosa, Fausto; Rosati, Riccardo; Roviello, Franco; Santi, S.; Solaini, L.; Staderini, Fabio; Viganò, J.; Ferrari, Giovanni; Agnes, A.; Alfieri, Sergio; Alloggio, M.; Bencivenga, M.; Benedetti, M.; Bottari, Andrea; Cianchi, Fabio; Cocozza, E.; Dalmonte, G.; Martini, Paolo De; Pascale, S. De; Desio, M.; Emiliani, G.; Ercolani, G.; Galli, F.; Garosio, I.; Giani, Alessandro A.; Gualtierotti, Monica; Marano, Luigi; Morgagni, Paolo; Peri, A.; Puccetti, Francesco; Reddavid, R.; Uccelli, Matteo

doi:10.1007/s10120-022-01321-w

Cited by 9 publications

(15 citation statements)

References 53 publications

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“…Even more important, no neoadjuvant chemotherapy is routinely administered in Asia, which was the case for half of the patients in the present study. Recently, the Italian Research Group for Gastric Cancer conducted a multicenter study comparing LG and OG for AGC on a propensity score matched cohort (where 24% of patients received neoadjuvant chemotherapy and 36% underwent total gastrectomy), showing no difference in 3 year OS [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, one important aspect of the multimodal treatment for AGC is the extent to which patients are able to tolerate and complete the preplanned adjuvant chemotherapy. A number of studies have highlighted that the laparoscopic approach may result in higher rates of administration of the intended systemic therapy after gastrectomy [ 14 , 33 , 42 , 43 ]. This is a very important observation, and a potential positive effect of minimally invasive surgery is worth investigating in dedicated future studies.…”

Section: Discussionmentioning

confidence: 99%

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Improved survival after laparoscopic compared to open gastrectomy for advanced gastric cancer: a Swedish population-based cohort study

et al. 2023

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Background Laparoscopic gastrectomy is increasingly used for the treatment of locally advanced gastric cancer but concerns remain whether similar results can be obtained compared to open gastrectomy, especially in Western populations. This study compared the short-term postoperative, oncological and survival outcomes following laparoscopic versus open gastrectomy based on data from the Swedish National Register for Esophageal and Gastric Cancer. Methods Patients who underwent surgery with curative intent for adenocarcinoma of the stomach or gastroesophageal junction Siewert type III from 2015 to 2020 were identified, and 622 patients with cT2-4aN0-3M0 tumors were included. The impact of surgical approach on short-term outcomes was assessed using multivariable logistic regression. Long-term survival was compared using multivariable Cox regression. Results In total, 350 patients underwent open and 272 laparoscopic gastrectomy, of which 12.9% were converted to open surgery. The groups were similar regarding distribution of clinical disease stage (27.6% stage I, 46.0% stage II, and 26.4% stage III). Neoadjuvant chemotherapy was administered to 52.7% of the patients. There was no difference in the rate of postoperative complications, but laparoscopic approach was associated with lower 90 day mortality (1.8 vs 4.9%, p = 0.043). The median number of resected lymph nodes was higher after laparoscopic surgery (32 vs 26, p < 0.001), while no difference was found in the rate of tumor-free resection margins. Better overall survival was observed after laparoscopic gastrectomy (HR 0.63, p < 0.001). Conclusions Laparoscopic gastrectomy can be safely preformed for advanced gastric cancer and is associated with improved overall survival compared to open surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improved survival after laparoscopic compared to open gastrectomy for advanced gastric cancer: a Swedish population-based cohort study

et al. 2023

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“…High referral centers for minimally invasive surgery are aiming to achieve a patienttargeted treatment [123][124][125]. It is supported that laparoscopic gastrectomy offers similar rates of survival when compared to open gastrectomy in both early and advanced gastric cancer [126]. Moreover, while laparoscopic D2 distal gastrectomy has been demonstrated as feasible and safe [123,127,128], laparoscopic total gastrectomy still represents a surgical challenge [123,124,129].…”

Section: Benefits and Drawbacks Of Minimally Invasive Approachmentioning

confidence: 99%

“…In Italy, GIRCG recently investigated laparoscopic and open gastrectomy for advanced gastric cancer, a quarter of whom underwent pre-operative chemotherapy, between 2015 and 2018, showing similar 3-year survival outcomes and 30-day morbidity/mortality [126]. The same group designed a propensity score matching analysis aimed at comparing survival outcomes in patients undergoing curative-intent laparoscopic and robotic gastrectomy for advanced gastric cancer.…”

Section: Benefits and Drawbacks Of Minimally Invasive Approachmentioning

confidence: 99%

Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues

Marano

Carbone²,

Poto³

et al. 2023

Current Oncology

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Despite its decreasing incidence, gastric cancer remains an important global healthcare problem due to its overall high prevalence and high mortality rate. Since the MAGIC and FNLCC/FFCD trials, the neoadjuvant chemotherapy has been recommended throughout Europe in gastric cancer. Potential benefits of preoperative treatments include a higher rate of R0 resection achieved by downstaging the primary tumor, a likely effect on micrometastases and isolated tumor cells in the lymph nodes, and, as a result, improved cancer-related survival. Nevertheless, distortion of anatomical planes of dissection, interstitial fibrosis, and sclerotic tissue changes may increase surgical difficulty. The collection of at least twenty-five lymph nodes after neoadjuvant therapy would seem to ensure removal of undetectable node metastasis and reduce the likelihood of locoregional recurrence. It is not what you take but what you leave behind that defines survival. Therefore, para-aortic lymph node dissection is safe and effective after neoadjuvant chemotherapy, in both therapeutic and prophylactic settings. In this review, the efficacy of adequate lymph node dissection, also in a neoadjuvant setting, has been investigated in the key studies conducted to date on the topic.

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“…Minimally invasive gastrectomy (MIG) has several advantages such as smaller surgical incision and faster post-operative recovery [ 9 ]. Most studies also demonstrated the comparable short-term and long-term outcomes between MIG and open gastrectomy (OG) [ 10 , 11 ]. Therefore, MIG is commonly recommended as the standard surgical approach for GC cases.…”

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of minimally invasive gastrectomy after neoadjuvant immunotherapy for locally advanced gastric cancer: a propensity score-matched analysis in China

Cui,

Liang,

Cui

et al. 2023

Gastroenterology Report

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Background The effect of neoadjuvant immunotherapy on minimally invasive gastrectomy (MIG) for locally advanced gastric cancer (LAGC) remains controversial. This study aimed to compare short-term outcomes between MIG after neoadjuvant chemo-immunotherapy (NICT-MIG) and MIG after neoadjuvant chemotherapy alone (NCT-MIG), and determine risk factors for post-operative complications (POCs). Methods This retrospective study included clinicopathologic data from 193 patients who underwent NCT-MIG or NICT-MIG between January 2020 and February 2023 in the Department of General Surgery, Chinese People’s Liberation Army General Hospital First Medical Center (Beijing, China). Propensity score-matched analysis at a ratio of 1:2 was performed to reduce bias from confounding patient-related variables and short-term outcomes were compared between the two groups. Results The baseline characteristics were comparable between 49 patients in the NICT-MIG group and 86 patients in the NCT-MIG group after propensity score matching. Objective and pathologic complete response rates were significantly higher in the NICT-MIG group than in the NCT-MIG group (P < 0.05). The overall incidence of treat-related adverse events, intraoperative bleeding, operation time, number of retrieved lymph nodes, time to the first flatus, post-operative duration of hospitalization, overall morbidity, and severe morbidity were comparable between the NCT-MIG and NICT-MIG groups (P > 0.05). By multivariate logistic analysis, estimated blood loss of >200 mL (P = 0.010) and prognostic nutritional index (PNI) score of <45 (P = 0.003) were independent risk factors for POCs after MIG following neoadjuvant therapy. Conclusions Safety and feasibility of NICT were comparable to those of NCT in patients undergoing MIG for LAGC. Patients with an estimated blood loss of >200 mL or a PNI score of <45 should be carefully evaluated for increased POCs risk.

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Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population—on behalf of the Italian Research Group for Gastric Cancer

Cited by 9 publications

References 53 publications

Improved survival after laparoscopic compared to open gastrectomy for advanced gastric cancer: a Swedish population-based cohort study

Improved survival after laparoscopic compared to open gastrectomy for advanced gastric cancer: a Swedish population-based cohort study

Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues

Safety and feasibility of minimally invasive gastrectomy after neoadjuvant immunotherapy for locally advanced gastric cancer: a propensity score-matched analysis in China

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