Published online Feb 27, 2022. doi: 10.4240/wjgs.v14.i2.161
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
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).
To compare the long- and short-term outcomes of advanced GC patients who underwent LTG vs OTG following NAT.
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.
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.
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.