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. 2022 May 27;14(5):452-469.
doi: 10.4240/wjgs.v14.i5.452.

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

Hao Cui  1 , Ke-Cheng Zhang  2 , Bo Cao  2 , Huan Deng  2 , Gui-Bin Liu  1 , Li-Qiang Song  1 , Rui-Yang Zhao  2 , Yi Liu  2 , Lin Chen  2 , Bo Wei  3
Affiliations

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

Hao Cui et al. World J Gastrointest Surg. .

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.

Keywords: Gastric cancer; Laparoscope; Morbidity; Neoadjuvant chemotherapy; Survival; Total gastrectomy.

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Conflict of interest statement

Conflict-of-interest statement: All authors have completed the ICMJE uniform disclosure form. They declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of patient enrollment. NACT: Neoadjuvant chemotherapy.
Figure 2
Figure 2
Comparisons of laboratorial indexes during the perioperative period. A: Hemoglobin changes between laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG) groups; B: Albumin changes between LTG and OTG groups; C: Neutrophil-to-lymphocyte ratio changes between LTG and OTG groups; D: Platelet-to-lymphocyte ratio changes between LTG and OTG groups. NACT: Neoadjuvant chemotherapy; LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil-to-lymphocyte ratio.
Figure 3
Figure 3
Overall survival and disease-free survival in neoadjuvant chemotherapy-laparoscopic total gastrectomy and neoadjuvant chemotherapy-open total gastrectomy groups. A: Overall survival between the two groups; B: Disease-free survival between the two groups. NACT: Neoadjuvant chemotherapy; LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy.
See this image and copyright information in PMC

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