Comparison of short- and long-term outcomes between laparoscopic and open gastrectomy for locally advanced gastric cancer following neoadjuvant chemotherapy: a propensity score matching analysis.

Autor: Zhong H; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Liu X; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Tian Y; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Cao S; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Li Z; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Liu G; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Sun Y; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Zhang X; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Han Z; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Meng C; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Jia Z; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Wang Q; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China., Zhou Y; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China. zhouyanbing@qduhospital.cn.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Aug; Vol. 37 (8), pp. 5902-5915. Date of Electronic Publication: 2023 Apr 18.
DOI: 10.1007/s00464-023-10052-7
Abstrakt: Background: This study was performed to evaluate the safety and efficacy of laparoscopic gastrectomy (LG) in patients with locally advanced gastric cancer (LAGC) who received neoadjuvant chemotherapy (NACT).
Methods: We retrospectively analyzed patients who underwent gastrectomy for LAGC (cT2-4aN+M0) after NACT from January 2015 to December 2019. The patients were divided into a LG group and an open gastrectomy (OG) group. The short- and long-term outcomes in both groups were examined following propensity score matching.
Results: We retrospectively reviewed 288 patients with LAGC who underwent gastrectomy following NACT. Of these 288 patients, 218 were enrolled; after 1:1 propensity score matching, each group comprised 81 patients. The LG group had significantly lower estimated blood loss than the OG group [80 (50-110) vs. 280 (210-320) mL, P < 0.001) but a longer operation time [205 (186.5-222.5) vs. 182 (170-190) min, P < 0.001], a lower postoperative complication rate (24.7% vs. 42.0%, P = 0.002), and a shorter postoperative hospitalization period [8 (7-10) vs. 10 (8-11.5) days, P = 0.001]. Subgroup analysis revealed that patients who underwent laparoscopic distal gastrectomy had a lower rate of postoperative complications than patients in the OG group (18.8% vs. 38.6%, P = 0.034); however, such a pattern was not seen in patients who underwent total gastrectomy (32.3% vs. 45.9%, P = 0.251). The 3-year matched cohort analysis showed no significant difference in overall survival or recurrence-free survival (log-rank P = 0.816 and P = 0.726, respectively) (71.3% and 65.0% in OG vs. 69.1% and 61.7% in LG, respectively).
Conclusion: In the short term, LG following NACT is safer and more effective than OG. However, the long-term results are comparable.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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