Short and long-term outcomes between laparoscopic and open total gastrectomy for advanced gastric cancer after neoadjuvant chemotherapy

Abstract

BACKGROUND Neoadjuvant chemotherapy (NACT) combined with surgery is regarded as an effective treatment for advanced gastric cancer (AGC). Laparoscopic surgery represents the mainstream of minimally invasive surgery. Currently, surgeons focus more on surgical safety and oncological outcomes of laparoscopic gastrectomy after NACT. Thus, we sought to evaluate short- and long-term outcomes between laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG) after NACT. AIM To compare the short and long-term outcomes between LTG and OTG for AGC after NACT. METHODS We retrospectively collected the clinicopathological data of 136 patients who accepted gastrectomy after NACT from June 2012 to June 2019, including 61 patients who underwent LTG and 75 who underwent OTG. Clinicopathological characteristics between the LTG and OTG groups showed no significant difference. SPSS 26.0, R software, and GraphPad PRISM 8.0 were used to perform statistical analyses. RESULTS Of the 136 patients included, eight acquired pathological complete response, and the objective response rate was 47.8% (65/136). The LTG group had longer operation time ( P = 0.015), less blood loss ( P = 0.003), shorter days to first flatus ( P < 0.001), and shorter postoperative hospitalization days ( P < 0.001). LTG spent more surgical cost than OTG ( P < 0.001), while total hospitalized cost of LTG was less than OTG ( P < 0.001). 21 (28.0%) patients in the OTG group and 14 (23.0%) in the LTG group had 30-d postoperative complications, but there was no significant difference between the two groups ( P = 0.503). The 3-year overall survival (OS) rate was 60.6% and 64.6% in the LTG and OTG groups, respectively [hazard ratio (HR) = 0.859, 95% confidence interval (CI): 0.522-1.412, P = 0.546], while the 3-year disease-free survival (DFS) rate was 54.5% and 51.8% in the LTG and OTG group, respectively (HR = 0.947, 95%CI: 0.582-1.539, P = 0.823). Multivariate cox analysis showed that body mass index and pTNM stage were independent risk factors for OS while vascular invasion and pTNM stage were independent risk factors for DFS ( P < 0.05). CONCLUSION After NACT, LTG shows comparable 30-d postoperative morbidity as well as 3-year OS and DFS rate to OTG. We recommend that experienced surgeons select LTG other than OTG for proper AGC patients after NACT.

Comparisons of perioperative and long-term outcomes of laparoscopic versus open gastrectomy for advanced gastric cancer after neoadjuvant therapy: an updated pooled analysis of eighteen studies

“…1 , a total of 1576 potential studies were yielded after systematically searching. Through careful title, abstract and full text assessment, 2 RCTs [ 26 , 27 ] and 16 cohort studies [ 28 – 43 ] were ultimately enrolled in this study. As shown in Table 1 , a total of 2096 patients (933 in the LG group and 1163 in the OG group) were included in the present study.…”

“…[ 44 – 46 ]. Nowadays, the application of NAT to AGC patients has rapidly increased owing to its potential oncological benefits [ 5 , 28 , 31 ]. Nevertheless, before applying LG as the standard treatment option for AGC patients receiving NAT, much more evidence is required to confirm the true benefits of LG over OG, thereby aiding surgical decision-making.…”

Laparoscopic versus open distal gastrectomy for advanced gastric cancer in elderly patients: a propensity-score matched analysis

“…In addition, we suspect that the operation time is greatly related to the level of the surgeon’s laparoscopic technique, knowledge of the anatomy of the stomach and surrounding tissues, and surgical experience. The surgeon’s unclear anatomical relationship between the stomach and surrounding tissues may cause unnecessary damage to surrounding blood vessels and organs, which may require more time to deal with intraoperative complications such as vascular bleeding and organ damage [ 21 , 22 ]. However, the operation time of laparoscopic radical distal gastrectomy will be gradually shortened with the continuous development of laparoscopic technology, the improvement of the surgeon’s technical level, and the accumulation of surgical experience [ 23 , 24 ].…”

Postoperative Complications After Neoadjuvant Chemotherapy Versus Upfront Surgery in Gastric Adenocarcinoma: A Population-Based Nationwide Study in Finland

“…Furthermore, a Chinese study in 2022 found no significant difference in the occurrence of Clavien-Dindo grade II or greater complications between open and laparoscopic gastrectomy for patients receiving neoadjuvant therapy for gastric cancer. 26 …”