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. 2021 Apr;12(2):237-248.
doi: 10.21037/jgo-20-374.

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

Yinkui Wang  1 , Xiaokang Lei  1 , Zining Liu  1 , Fei Shan  1 , Xiangji Ying  1 , Ziyu Li  1 , Jiafu Ji  1
Affiliations

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

Yinkui Wang et al. J Gastrointest Oncol. 2021 Apr.

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.

Keywords: Gastric cancer (GC); neoadjuvant chemotherapy (NACT); safety; laparoscopic technique.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo-20-374). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart showing patient enrolment and PSM matching process. PSM, propensity score matching.
Figure 2
Figure 2
The pre-matching and post-matching information are presented: (A) Love plot demonstrating the value of standardized difference for each covariate included in the propensity score before and after matching. The value of azure dots (after matching) did not exceed the absolute value of 0.15 (shown as dashed line), suggesting a well-balanced distribution for all of the covariates after matching. (B) Propensity score distribution in the LTG and OTG groups before PSM application and after matching. LTG, laparoscopic total gastrectomy; OTG, open total gastrectomy; PSM, propensity score matching.
See this image and copyright information in PMC

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