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Laparoscopic gastrectomy for early and advanced gastric cancer in a western center: a propensity score-matched analysis

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Abstract

The employment of laparoscopic gastrectomy (LG) in the management of gastric cancer (GC) is increasing. Despite recent results from randomized trials, its effectiveness and oncological results in different scenarios remain controversial, especially in western centers. The aim of this study was to compare the short-term outcomes and survival of LG with open gastrectomy (OG) for GC. We reviewed all GC patients who underwent curative gastrectomy from a prospective database. Propensity score-matched (PSM) analysis including 10 variables was conducted to reduce patient selection bias using a 1:1 case–control match. A total of 530 GC were eligible for inclusion (438 OG and 92 LG). Older age, lower hemoglobin levels, total gastrectomy, larger tumor size, greater depth of tumor invasion and advanced pTNM stage was more frequent in the OG group. After PMS analysis, 92 patients were matched in each group. All variables assigned in the score were well matched. LG group had a slightly higher number of retrieved lymph nodes (42.3 vs 37.6), however, without reaching statistical significance (p = 0.072). No differences were recorded about the frequency of major postoperative complications (POC) and mortality rates between OG and LG groups (12% vs 15.2%, p = 0.519, respectively). In survival analysis, after matching, there was no difference in survival between the two groups. Multivariate analysis showed that only ASA and pN stage were independent factor associated with survival after PSM. In conclusion, laparoscopic gastrectomy was a safe and effective surgical technique for gastric cancer, with short-term and oncological outcomes comparable to open surgery.

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Data availability

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01246-000, Brazil

    Marcus Fernando Kodama Pertille Ramos, Marina Alessandra Pereira, André Roncon Dias, Ulysses Ribeiro Jr, Bruno Zilberstein & Sergio Carlos Nahas

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  1. Marcus Fernando Kodama Pertille Ramos
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  2. Marina Alessandra Pereira
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  3. André Roncon Dias
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  4. Ulysses Ribeiro Jr
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  5. Bruno Zilberstein
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  6. Sergio Carlos Nahas
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Contributions

MFKPR and MAP study design, data retrieval, critical analysis, statistical analysis, draft of the manuscript. ARD data retrieval, review of the manuscript. UR Jr, BZ and SCN critical analysis, review of the manuscript.

Corresponding author

Correspondence to Marcus Fernando Kodama Pertille Ramos.

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The authors declare no conflict of interest.

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The study was approved by the hospital ethics committee and registered online (https://plataformabrasil.saude.gov.br; CAAE: 62915516.2.0000.0065).

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Informed consent was waived by the local Ethics Committee in view of the retrospective nature of the study.

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This study involved human research participants.

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Ramos, M.F.K.P., Pereira, M.A., Dias, A.R. et al. Laparoscopic gastrectomy for early and advanced gastric cancer in a western center: a propensity score-matched analysis. Updates Surg 73, 1867–1877 (2021). https://doi.org/10.1007/s13304-021-01097-1

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