Surgical and oncological efficacy of laparoscopic-assisted total gastrectomy versus open total gastrectomy for gastric cancer by propensity score matching: a retrospective comparative study

Abstract

Purpose: The application of laparoscopic-assisted total gastrectomy (LATG) for resectable gastric cancer (GC) remains controversial compared with open total gastrectomy (OTG), especially for advanced gastric cancer (AGC) patients according to the inconsistent results demonstrated in the previous studies. The aim of this study was to evaluate the short-term and long-term outcomes between LATG and OTG in a population with more than 80% AGC patients by applying propensity score matching (PSM) method.

Methods: The data of 365 clinical stage I-III GC cases who underwent total gastrectomy with D2 lymphadenectomy were retrospectively collected from January 2011 to April 2018 in the Department of Gastrointestinal Surgery IV of Peking University Cancer Hospital. Propensity scores were generated through taking all covariates into consideration and 131 pairs of patients receiving either LATG or OTG were matched. Intraoperative, postoperative, and survival parameters were compared in the matched groups accordingly. Risk factors for postoperative complications and overall survival were further analyzed.

Results: Patient characteristics in the LATG and OTG groups were well balanced after PSM. LATG showed advantages with respect to shorter time to ambulation, first flatus, and first whole liquid diet intake. No significant differences were found between the two groups with regard to postoperative complications as well as overall survival in terms of different pathological stage. Older age was found as an independent risk factor for postoperative complications, and pathological stage for overall survival as well.

Conclusion: LATG appears to have comparable surgical and oncological safety with OTG by experienced surgeons.

Keywords: Gastric cancer; Laparoscopic-assisted total gastrectomy; Oncological efficacy; Open total gastrectomy; Propensity score matching; Surgical safety.

Fig. 1

Study flow diagram. 365 patients were diagnosed with gastric cancer. 345 cases met the inclusion and exclusion criteria. After propensity score matching (PSM), there were 131 cases in each group. LATG laparoscopic-assisted total gastrectomy, OTG open total gastrectomy, BMI body mass index, ASA American Society of Anesthesiologist, NAC neoadjuvant chemotherapy

Fig. 2

Cumulative survival rates of both LATG and OTG groups according to pathological stages (I, II, III). a, b The cumulative survival rates for pathological stage I were similar between LATG and OTG groups both before PSM (P = 0.891) and after PSM (P = 0.299). c, d The cumulative survival rates for pathological stage II were similar between LATG and OTG groups both before PSM (P = 0.587) and after PSM (P = 0.609). e, f The cumulative survival rates for pathological stage III were similar between LATG and OTG groups both before PSM (P = 0.907) and after PSM (P = 0.815). LATG laparoscopic-assisted total gastrectomy, OTG open total gastrectomy, PSM propensity score matching, pTNM pathological TNM stage

Fig. 3

Forest graph of risk factors from multivariate COX analysis of overall survival. In the multivariate analysis, pTNM-III (P = 0.003) was significant risk factors of OS. OS overall survival, HR hazard ratio, CI confidence interval, BMI body mass index, pTNM pathological TNM stage, CEA carcinoembryonic antigen, CA72-4 carbohydrate antigen 72–4