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Is All Advanced Gastric Cancer Suitable for Laparoscopy-Assisted Gastrectomy With Extended Lymphadenectomy? A Case–Control Study Using a Propensity Score Method

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

Abstract

Background

The oncologic outcomes of laparoscopy-assisted gastrectomy (LAG) for the treatment of patients with local advanced gastric cancer (AGC) have not been evaluated. This study aimed to validate the oncologic efficacy of LAG for AGC.

Methods

The data from 539 patients who underwent LAG and 539 patients treated with open gastrectomy (OG) were selected using the propensity score-matching method from a database prospectively constructed between 2005 and 2011. The therapeutic value of lymph node (LN) dissection and the long-term surgical outcomes of these matched groups were compared.

Results

The groups were well balanced after the propensity score matched. The LAG and OG groups did not differ significantly in terms of clinicopathologic characteristics. The number of dissected LNs at stations 11 and 12a were significantly higher in the LAG group. However, the therapeutic index at each LN station did not differ significantly between the two groups. Although the overall survival curve at each stage did not differ significantly (P > 0.05), the survival rate increased overall for patients with pT4aN3bM0 in the OG group (P < 0.05). The stratified analysis showed that overall survival was inferior for LAG surgeons with fewer than 40 completed cases. The survival results for surgeons who had performed more than 40 cases were similar to the results from open surgery.

Conclusions

Although LAG yields comparable oncologic outcomes for local AGC, patients with pT4aN3bM0 gastric cancer may not be suitable for laparoscopic surgery, especially for surgeons with limited experience.

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Acknowledgments

We thank Prof. H. Y. Li, the biostatistician who works in Fujian Medical University, and the Follow-up Office established by the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. The study was supported by the National key clinical specialty discipline construction program of China (no. [2012]649). The key project of science and technology plan of Fujian Province, China (no. 2-14Y0025).

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There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China

    Jian-Xian Lin MM, Chang-Ming Huang MD, Chao-Hui Zheng MD, Ping Li MD, Jian-Wei Xie MD, Jia-bin Wang MD, Lu Jun MM, Qi-Yue Chen MM, Long-long Cao MM & Mi Lin MM

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  1. Jian-Xian Lin MM
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Correspondence to Chang-Ming Huang MD.

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Lin, JX., Huang, CM., Zheng, CH. et al. Is All Advanced Gastric Cancer Suitable for Laparoscopy-Assisted Gastrectomy With Extended Lymphadenectomy? A Case–Control Study Using a Propensity Score Method. Ann Surg Oncol 23, 1252–1260 (2016). https://doi.org/10.1245/s10434-015-4994-1

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