Hu HT, Ma FH, Xiong JP, Li Y, Jin P, Liu H, Ma S, Kang WZ, Tian YT. Laparoscopic vs open total gastrectomy for advanced gastric cancer following neoadjuvant therapy: A propensity score matching analysis. World J Gastrointest Surg 2022; 14(2): 161-173 [PMID: 35317541 DOI: 10.4240/wjgs.v14.i2.161]
Corresponding Author of This Article
Yan-Tao Tian, MD, Chief Doctor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 100021, Beijing Province, China. tianyantao@cicams.ac.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hai-Tao Hu, Fu-Hai Ma, Jian-Ping Xiong, Yang Li, Peng Jin, Hao Liu, Shuai Ma, Wen-Zhe Kang, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, Beijing Province, China
Author contributions: Hu HT contributed to the design of the study, collected data and drafted the manuscript; Ma FH and Xiong JP performed the data analyses and revised the manuscript; Li Y, Jin P and Liu H helped perform the analysis with constructive discussions; Ma S and Kang WZ contributed to manuscript preparation data for the work; Tian YT conceived the work that led to the submission and approved the final version; and all authors issued final approval for the version to be submitted.
Supported byNational Natural Science Foundation of China, No. 81772642.
Institutional review board statement: This study was approved by the Ethics Committee of the Cancer Hospital of the Chinese Academy of Medical Sciences (No.14-067/857).
Informed consent statement: This study obtained informed consent exemptions approved by the Ethics Committee of the Cancer Hospital of the Chinese Academy of Medical Sciences.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, MD, Chief Doctor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 100021, Beijing Province, China. tianyantao@cicams.ac.cn
Received: July 15, 2021 Peer-review started: July 15, 2021 First decision: November 8, 2021 Revised: December 13, 2021 Accepted: February 10, 2022 Article in press: February 10, 2022 Published online: February 27, 2022 Processing time: 222 Days and 8.6 Hours
Abstract
BACKGROUND
Laparoscopic total gastrectomy (LTG) has drawn increasing attention over the years. Although LTG has shown surgical benefits compared to open TG (OTG) in early stage gastric cancer (GC), little is known about the surgical and oncological outcomes of LTG for advanced GC following neoadjuvant therapy (NAT).
AIM
To compare the long- and short-term outcomes of advanced GC patients who underwent LTG vs OTG following NAT.
METHODS
Advanced GC patients who underwent TG following NAT between April 2011 and May 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences were enrolled and stratified into two groups: LTG and OTG. Propensity score matching analysis was performed at a 1:1 ratio to overcome possible bias.
RESULTS
In total, 185 patients were enrolled (LTG: 78; OTG: 109). Of these, 138 were paired after propensity score matching. After adjustment for propensity score matching, baseline parameters were similar between the two groups. Compared to OTG, LTG was associated with a significantly shorter length of hospital stay (P = 0.012). The rates of R0 resection, lymph node harvest, and postoperative morbidity did not significantly differ between the two groups. Overall survival (OS) outcomes were comparable between the two groups. Pathological T and N stages were found to be independent risk factors for OS.
CONCLUSION
LTG can be a feasible method for advanced GC patients following NAT, as it appears to be associated with better short- and comparable long-term outcomes compared to OTG.
Core Tip: Laparoscopic total gastrectomy (LTG) is known to have better short-term outcomes and prognosis than open TG (OTG) in early gastric cancer (GC). However, its application in advanced GC remains controversial. In this study, we evaluated both long- and short-term outcomes of LTG compared to those of OTG in 185 patients with advanced GC who had received neoadjuvant therapy (NAT). Our results indicate that LTG is associated with better short-term and comparable long-term outcomes compared to the traditional OTG surgery. Therefore, it can be a feasible surgical treatment for advanced GC patients following NAT.
