. 2022 Nov;25(6):1105-1116.

doi: 10.1007/s10120-022-01321-w. Epub 2022 Jul 21.

Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population-on behalf of the Italian Research Group for Gastric Cancer

Pietro Maria Lombardi^{1

2}, D Bernasconi^{3

4}, G L Baiocchi^{5

6}, M Berselli⁷, A Biondi^{8

9}, C Castoro^{10

11}, M Catarci¹², M Degiuli^{13

14}, U Fumagalli Romario¹⁵, S Giacopuzzi¹⁶, F Marchesi¹⁷, D Marrelli¹⁸, M Mazzola¹⁹, S Molfino²⁰, S Olmi²¹, S Rausei²², F Rosa²³, R Rosati^{24

25}, F Roviello¹⁸, S Santi²⁶, L Solaini²⁷, F Staderini²⁸, J Viganò²⁹, G Ferrari¹⁹; Italian Research Group for Gastric Cancer (GIRCG)

Collaborators, Affiliations

Collaborators

Italian Research Group for Gastric Cancer (GIRCG):
A Agnes, S Alfieri, M Alloggio, M Bencivenga, M Benedetti, A Bottari, F Cianchi, E Cocozza, G Dalmonte, P De Martini, S De Pascale, M Desio, G Emiliani, G Ercolani, F Galli, I Garosio, A Giani, M Gualtierotti, L Marano, P Morgagni, A Peri, F Puccetti, R Reddavid, M Uccelli

Affiliations

¹ Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy. pietrom.lombardi@gmail.com.
² IRCCS Humanitas Research Hospital, Unit of Foregut Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy. pietrom.lombardi@gmail.com.
³ Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
⁴ Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁵ General Surgery, ASST Cremona, Cremona, Italy.
⁶ Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁷ Unit of General Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy.
⁸ Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli n. 8, 00168, Rome, Italy.
⁹ Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy.
¹⁰ IRCCS Humanitas Research Hospital, Unit of Foregut Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
¹¹ Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.
¹² General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Rome, Italy.
¹³ Department of Oncology, University of Torino, Turin, Italy.
¹⁴ Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, TO, Italy.
¹⁵ Digestive Surgery, European Institute of Oncology, IRCCS, 20141, Milan, Italy.
¹⁶ Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy.
¹⁷ Unit of General Surgery, Parma University Hospital, Parma, Italy.
¹⁸ Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
¹⁹ Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
²⁰ Department of Clinical and Experimental Sciences, University of Brescia and Third Division of General Surgery, Brescia Civili Hospital, Brescia, Italy.
²¹ Head of General and Oncologic Surgery. Center for Minimal Invasive and Laparoscopic Surgery, Policlinico San Marco, Senior Research Vita-Salute University San Raffaele Milan (UNISR), Zingonia, Italy.
²² Department of Surgery, ASST Valle Olona, Gallarate, Italy.
²³ Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy.
²⁵ Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132, Milan, Italy.
²⁶ Division of Esophageal Surgery Regional Referral Center "Mauro Rossi" for Diagnosis and Treatment of Diseases of Esophagus, Azienda Ospedaliero-Universitaria Pisana (AOUP), Via Paradisa 2, 56010, Pisa, Italy.
²⁷ Department of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy.
²⁸ Digestive Surgery Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital of Florence, Florence, Italy.
²⁹ General Surgery. Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

PMID: 35864239
DOI: 10.1007/s10120-022-01321-w

Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population-on behalf of the Italian Research Group for Gastric Cancer

Pietro Maria Lombardi et al. Gastric Cancer. 2022 Nov.

. 2022 Nov;25(6):1105-1116.

doi: 10.1007/s10120-022-01321-w. Epub 2022 Jul 21.

Authors

Collaborators

Italian Research Group for Gastric Cancer (GIRCG):
A Agnes, S Alfieri, M Alloggio, M Bencivenga, M Benedetti, A Bottari, F Cianchi, E Cocozza, G Dalmonte, P De Martini, S De Pascale, M Desio, G Emiliani, G Ercolani, F Galli, I Garosio, A Giani, M Gualtierotti, L Marano, P Morgagni, A Peri, F Puccetti, R Reddavid, M Uccelli

Affiliations

¹ Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy. pietrom.lombardi@gmail.com.
² IRCCS Humanitas Research Hospital, Unit of Foregut Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy. pietrom.lombardi@gmail.com.
³ Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
⁴ Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁵ General Surgery, ASST Cremona, Cremona, Italy.
⁶ Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁷ Unit of General Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy.
⁸ Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli n. 8, 00168, Rome, Italy.
⁹ Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy.
¹⁰ IRCCS Humanitas Research Hospital, Unit of Foregut Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
¹¹ Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.
¹² General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Rome, Italy.
¹³ Department of Oncology, University of Torino, Turin, Italy.
¹⁴ Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, TO, Italy.
¹⁵ Digestive Surgery, European Institute of Oncology, IRCCS, 20141, Milan, Italy.
¹⁶ Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy.
¹⁷ Unit of General Surgery, Parma University Hospital, Parma, Italy.
¹⁸ Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
¹⁹ Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
²⁰ Department of Clinical and Experimental Sciences, University of Brescia and Third Division of General Surgery, Brescia Civili Hospital, Brescia, Italy.
²¹ Head of General and Oncologic Surgery. Center for Minimal Invasive and Laparoscopic Surgery, Policlinico San Marco, Senior Research Vita-Salute University San Raffaele Milan (UNISR), Zingonia, Italy.
²² Department of Surgery, ASST Valle Olona, Gallarate, Italy.
²³ Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy.
²⁵ Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132, Milan, Italy.
²⁶ Division of Esophageal Surgery Regional Referral Center "Mauro Rossi" for Diagnosis and Treatment of Diseases of Esophagus, Azienda Ospedaliero-Universitaria Pisana (AOUP), Via Paradisa 2, 56010, Pisa, Italy.
²⁷ Department of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy.
²⁸ Digestive Surgery Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital of Florence, Florence, Italy.
²⁹ General Surgery. Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

PMID: 35864239
DOI: 10.1007/s10120-022-01321-w

Abstract

Background: Oncologic outcomes after laparoscopic gastrectomy for advanced gastric cancer in the West have been poorly investigated. The aim of the present study was to compare survival outcomes in patients undergoing curative-intent laparoscopic and open gastrectomy for advanced gastric cancer in several centres belonging to the Italian Research Group for Gastric Cancer.

Methods: Data of patients operated between 2015 and 2018 were retrospectively analysed. Propensity Score Matching was performed to balance baseline characteristics of patients undergoing laparoscopic and open gastrectomy. The primary endpoint was 3-year overall survival. Secondary endpoints were 3-year disease-free survival and short-term outcomes. Multivariable regression analyses for survival were conducted.

Results: Data were retrieved from 20 centres. Of the 717 patients included, 438 patients were correctly matched, 219 per group. The 3-year overall survival was 73.6% and 68.7% in the laparoscopic and open group, respectively (p = 0.40). When compared with open gastrectomy, laparoscopic gastrectomy showed comparable 3-year disease-free survival (62.8%, vs 58.9%, p = 0.40), higher rate of return to intended oncologic treatment (56.9% vs 40.2%, p = 0.001), similar 30-day morbidity/mortality. Prognostic factors for survival were ASA Score ≥ 3, age-adjusted Charlson Comorbidity Index ≥ 5, lymph node ratio ≥ 0.15, p/ypTNM Stage III and return to intended oncologic treatment.

Conclusions: Laparoscopic gastrectomy for advanced gastric cancer offers similar rates of survival when compared to open gastrectomy, with higher rates of return to intended oncologic treatment. ASA score, age-adjusted Charlson Comorbidity Index, lymph node ratio, return to intended oncologic treatment and p/ypTNM Stage, but not surgical approach, are prognostic factors for survival.

Keywords: Advanced gastric cancer; Gastrectomy; Laparoscopy; Minimally invasive surgery; Survival.

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Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population-on behalf of the Italian Research Group for Gastric Cancer

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Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population-on behalf of the Italian Research Group for Gastric Cancer

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