Laparoscopic vs open total gastrectomy for advanced gastric cancer following neoadjuvant therapy: A propensity score matching analysis

Abstract

Background: Laparoscopic total gastrectomy (LTG) has drawn increasing attention over the years. Although LTG has shown surgical benefits compared to open TG (OTG) in early stage gastric cancer (GC), little is known about the surgical and oncological outcomes of LTG for advanced GC following neoadjuvant therapy (NAT).

Aim: To compare the long- and short-term outcomes of advanced GC patients who underwent LTG vs OTG following NAT.

Methods: Advanced GC patients who underwent TG following NAT between April 2011 and May 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences were enrolled and stratified into two groups: LTG and OTG. Propensity score matching analysis was performed at a 1:1 ratio to overcome possible bias.

Results: In total, 185 patients were enrolled (LTG: 78; OTG: 109). Of these, 138 were paired after propensity score matching. After adjustment for propensity score matching, baseline parameters were similar between the two groups. Compared to OTG, LTG was associated with a significantly shorter length of hospital stay (P = 0.012). The rates of R0 resection, lymph node harvest, and postoperative morbidity did not significantly differ between the two groups. Overall survival (OS) outcomes were comparable between the two groups. Pathological T and N stages were found to be independent risk factors for OS.

Conclusion: LTG can be a feasible method for advanced GC patients following NAT, as it appears to be associated with better short- and comparable long-term outcomes compared to OTG.

Keywords: Gastric cancer; Laparoscopic total gastrectomy; Neoadjuvant therapy; Open total gastrectomy; Propensity score matching.

Figure 1

Comparison of cumulative survival rates between laparoscopic total gastrectomy and open total gastrectomy. A: Before propensity score matching (PSM); B: After PSM. There was no statistically significant difference in overall survival between the two groups before (P = 0.111) and after PSM (P = 0.205). LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; OS: Overall survival; PSM: Propensity score matching.

Figure 2

Forest graph of multivariate COX analysis of prognostic factors for overall survival. Pathological T stage and N stage were found as independent risk factors for overall survival. OS: Overall survival; HR: Hazard ratio; CI: Confidence interval; TRG: Tumor regression grading; NAC: Neoadjuvant chemotherapy.