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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

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Abstract

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.

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Acknowledgements

The authors are grateful to Prof. Xiaobin Zhou from the Department of Epidemiology and Health Statistics, Qingdao University, for his great technical assistance throughout the experiment’s design and data processing. The authors also thank Angela Morben, DVM, ELS, from Liwen Bianji (Edanz) (www.liwenbianji.cn), for editing the English text of a draft of this manuscript.

Funding

This work was supported by the Shandong Provincial Natural Science Foundation, China (No. ZR2021MH001).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People’s Republic of China

    Hao Zhong, Xiaodong Liu, Yulong Tian, Shougen Cao, Zequn Li, Gan Liu, Yuqi Sun, Xingqi Zhang, Zhenlong Han, Cheng Meng, Zhuoyu Jia, Qingrui Wang & Yanbing Zhou

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  1. Hao Zhong
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  2. Xiaodong Liu
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Contributions

HZ: data acquisition, analysis, and interpretation; manuscript drafting. XL: data acquisition and interpretation. YT: data acquisition and interpretation. SC: data acquisition. ZL: data acquisition. GL: manuscript revision, data interpretation. YS: data acquisition. XZ: data acquisition. ZH: data acquisition. CM: data acquisition. ZJ: data acquisition. QW: data acquisition. YZ: study conception and design, data interpretation, manuscript revision.

Corresponding author

Correspondence to Yanbing Zhou.

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Disclosure

Hao Zhong, Xiaodong Liu, Yulong Tian, Shougen Cao, Zequn Li, Gan Liu, Yuqi Sun, Xingqi Zhang, Zhenlong Han, Cheng Meng, Zhuoyu Jia, Qingrui Wang, and Yanbing Zhou have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was approved by the Affiliated Hospital of Qingdao University ethics review committee (Approval Number QYFYWZLL27017). All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Zhong, H., Liu, X., Tian, Y. et al. 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. Surg Endosc 37, 5902–5915 (2023). https://doi.org/10.1007/s00464-023-10052-7

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