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Long-Term Outcomes of Open Versus Laparoscopic Distal Gastrectomy for T4a Gastric Cancer: A Propensity Score-Matched Cohort Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic gastrectomy for advanced gastric cancer (GC) has been applied more frequently worldwide but is still controversial for patients with serosal invasion (T4a). This study compared short- and long-term outcomes of laparoscopic distal radical gastrectomy (LDG) with open distal gastrectomy (ODG) for T4a GC.

Patients and Methods

We retrospectively studied 472 patients with T4a gastric adenocarcinoma in the lower or middle third of the stomach: 231 underwent LDG and 241 underwent ODG between 2013 and 2020. Short-term outcomes included operative characteristics and complications. Long-term outcomes included overall survival (OS) and disease-free survival (DFS). Propensity score-matched (PSM) analysis was used to adjust for imbalances in baseline characteristics between groups.

Results

The PSM strategy resulted in 294 patients (147 in each group). The LDG group had a significantly longer operating time (mean: 200 vs 190 min, p = 0.001) but reduced blood loss (mean: 50 vs 100 ml, p = 0.001). The LDG group had a higher rate of any postoperative complication (23.1% vs 12.2%, p = 0.021) but most were classified as grades I–II according to Clavien–Dindo classification. Grade III–V complications were similar between groups. Five-year OS was 69% versus 60% (p = 0.109) and 5-year DFS was 58% vs 53% (p = 0.3) in LDG and ODG groups, respectively. For tumor size < 5 cm, LDG was better in reduction of blood loss, postoperative hospital length of stay, and OS.

Conclusions

LDG is feasible and safe for patients with T4a GC and is comparable to ODG regarding short- and long-term outcomes. Furthermore, LDG can be a favorable option for T4a GC smaller than 5 cm.

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Data Availability

The data presented in this study are available on request from the corresponding author.

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Acknowledgement

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Funding

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Authors and Affiliations

  1. Gastro-intestinal Surgery Department, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Vo Duy Long MD, PhD, Tran Quang Dat MD, MSc, Dang Quang Thong MD, MSc, Nguyen Viet Hai MD, MSc, Ho Le Minh Quoc MD, MSc, Doan Thuy Nguyen MD, MSc, Tran Anh Minh MD, MSc & Nguyen Hoang Bac MD, PhD

  2. Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Vo Duy Long MD, PhD, Nguyen Vu Tuan Anh MD, MSc & Nguyen Hoang Bac MD, PhD

  3. Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Nguyen Lam Vuong MD

  4. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Jimmy So MD, PhD

  5. Department of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Masanori Terashima MD, PhD

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Corresponding authors

Correspondence to Vo Duy Long MD, PhD or Nguyen Lam Vuong MD.

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Disclosure

Drs. Vo Duy Long, Tran Quang Dat, Dang Quang Thong, Nguyen Viet Hai, Ho Le Minh Quoc, Doan Thuy Nguyen, Tran Anh Minh, Nguyen Vu Tuan Anh, Nguyen Lam Vuong, Jimmy So, Masanori Terashima, and Nguyen Hoang Bac disclose any potential or actual personal, political or financial conflict of interest in the material, information or techniques described in the paper.

Ethical Approval

This study was conducted according to the guidelines of the Declaration of Helsinki and approved by Institutional Review Board, University Medical Center Ho Chi Minh city. Approval to perform research on human subjects in this study was provided by the Institutional Review Board, University Medical Center Ho Chi Minh city (registration number: 76/GCN-HDDD).

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Long, V.D., Dat, T.Q., Thong, D.Q. et al. Long-Term Outcomes of Open Versus Laparoscopic Distal Gastrectomy for T4a Gastric Cancer: A Propensity Score-Matched Cohort Study. Ann Surg Oncol 30, 2278–2289 (2023). https://doi.org/10.1245/s10434-022-12897-z

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