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, Hao, Liu, Xiaodong, Tian, Yulong, Cao, Shougen, Li, Zequn, Liu, Gan, Sun, Yuqi, Zhang, Xingqi, Han, Zhenlong, Meng, Cheng, Jia, Zhuoyu, Wang, Qingrui, Zhou, Yanbing
Zdroj: Surgical Endoscopy; August 2023, Vol. 37 Issue: 8 p5902-5915, 14p
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. Graphic abstract:
Databáze: Supplemental Index
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