Short-term outcomes of laparoscopic versus open total gastrectomy after neoadjuvant chemotherapy: a cohort study using the propensity score matching method

Abstract

Background: Until now, little is known about the benefit of laparoscopic total gastrectomy (LTG) after neoadjuvant chemotherapy (NACT). This study was designed to compare the safety and efficacy of the LTG versus the open total gastrectomy (OTG) approach after NACT treatment in patients with advanced gastric cancer (AGC).Methods: This study involved a cohort of 145 patients with AGC who underwent total gastrectomy after NACT at our centre between April 2013 and August 2018 including 24 cases of LTG and 121 OTG. The baseline characteristics were matched based on 1:2 balanced propensity score-matching method.Results: Sixty-nine marched cases were finally analysed (23 LTG vs. 46 OTG). All patients underwent R0 resection. Compared to the OTG group, the LTG group had a longer surgery duration (P<0.001), but a shorter incision length (P<0.001) and less intravenous patient-controlled analgesia (IV-PCA) time after surgery (P=0.027). No statistical differences were observed in terms of blood loss, retrieved lymph nodes (LNs), resection margin, length of stay, postoperative pain intensity, and complications (P>0.05).Conclusions: LTG had comparable safety and histological findings to OTG after NACT in the perioperative period; however, LTG is less invasive and patients can benefit from less IV-PCA use. Further research is needed to investigate long-term effects.

Meta-Analysis of the Effects of Three-Dimensional Visualized Medical Techniques Hepatectomy for Liver Cancer with and without the Treatment of Sorafenib

“…11 studies [ 18 – 28 ] reported the incidence of postoperative complications, 12 studies [ 18 – 22 , 24 – 30 ] reported the duration of surgery, 4 studies [ 20 – 22 , 25 ] reported the incidence of postoperative liver failure, 10 studies [ 18 – 21 , 24 , 25 , 27 – 30 ] reported the amount of intraoperative bleeding, 5 studies [ 18 , 21 , 22 , 24 , 27 ] reported survival rates, and 4 studies [ 18 , 21 , 24 , 29 ] reported recurrence rates. A total of 1616 patients were included, including 795 patients in the 2D group and 819 patients in the 3D group.…”

“…A total of 10 studies reported intraoperative blood loss [ 18 – 21 , 24 , 25 , 27 – 30 ]. The meta-analysis of random effects model showed that intraoperative blood loss in the 3D group was less than that in the 2D group (SMD = −63.85, 95% CI = −98.66–29.04, P =0.0003), and the difference between the two groups was statistically significant ( Figure 4 ).…”

“…11 studies [18][19][20][21][22][23][24][25][26][27][28] reported the incidence of postoperative complications, 12 studies [18][19][20][21][22][24][25][26][27][28][29][30] reported the duration of surgery, 4 studies [20][21][22]25] reported the incidence of postoperative liver failure, 10 studies [18-21, 24, 25, 27-30] reported the amount of intraoperative bleeding, 5 studies [18,21,22,24,27] reported survival rates, and 4 studies 2…”

“…A total of 11 studies reported postoperative complications [18][19][20][21][22][23][24][25][26][27][28].…”

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

“…STOMACH trial showed no significant difference in the rate of postoperative complications between OTG (42.9%) and LTG (34.0%) in LTG after NACT in Western countries ( P = 0.408). Wang et al [ 30 ] demonstrated that LTG had comparable safety to OTG after NACT in the perioperative period and patients in the LTG group could benefit from less intravenous patient-controlled analgesia (IV-PCA) use[ 30 ]. Back to our study, we found that LTG did not significantly increase or decrease 30-d postoperative complications compared with OTG after NACT (overall morbidity of LTG vs OTG: 23.0% vs 28.0%, P = 0.503; severe morbidity of LTG vs OTG: 3.3% vs 2.7%, P = 1.000), which was similar to the results of the studies mentioned above.…”