Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2022; 14(5): 452-469
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.452
Short and long-term outcomes between laparoscopic and open total gastrectomy for advanced gastric cancer after neoadjuvant chemotherapy
Hao Cui, Ke-Cheng Zhang, Bo Cao, Huan Deng, Gui-Bin Liu, Li-Qiang Song, Rui-Yang Zhao, Yi Liu, Lin Chen, Bo Wei
Hao Cui, Gui-Bin Liu, Li-Qiang Song, School of Medicine, Nankai University, Tianjin 300071, China
Ke-Cheng Zhang, Bo Cao, Huan Deng, Rui-Yang Zhao, Yi Liu, Lin Chen, Bo Wei, Department of General Surgery and Institute of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Bo Cao, Huan Deng, Rui-Yang Zhao, Medical School, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Cui H, Zhang KC, Cao B, Chen L, and Wei B designed the study; Cao B, Deng H, and Zhao RY collected the data; Liu Y analyzed and interpreted the data; Cui H and Zhang KC prepared the manuscript; all the authors read and approved the final manuscript.
Supported by National Basic Research Program of China (973 Program), No. 2019YFB1311505; National Natural Science Foundation of China, No. 81773135 and No. 82073192.
Institutional review board statement: The study involving human participants was reviewed and approved by the Research Ethics Committee of Chinese PLA General Hospital.
Informed consent statement: The patients and participants provided their written informed consent to participate in this study.
Conflict-of-interest statement: All authors have completed the ICMJE uniform disclosure form. They declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to hospital policy but are available from the corresponding author on reasonable request.
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: Bo Wei, MD, PhD, Chief Doctor, Professor, Staff Physician, Department of General Surgery and Institute of General Surgery, the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. 18431143691@163.com
Received: October 24, 2021
Peer-review started: October 24, 2021
First decision: December 27, 2021
Revised: January 17, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: May 27, 2022
Processing time: 212 Days and 15.9 Hours
Abstract
BACKGROUND

Neoadjuvant chemotherapy (NACT) combined with surgery is regarded as an effective treatment for advanced gastric cancer (AGC). Laparoscopic surgery represents the mainstream of minimally invasive surgery. Currently, surgeons focus more on surgical safety and oncological outcomes of laparoscopic gastrectomy after NACT. Thus, we sought to evaluate short- and long-term outcomes between laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG) after NACT.

AIM

To compare the short and long-term outcomes between LTG and OTG for AGC after NACT.

METHODS

We retrospectively collected the clinicopathological data of 136 patients who accepted gastrectomy after NACT from June 2012 to June 2019, including 61 patients who underwent LTG and 75 who underwent OTG. Clinicopathological characteristics between the LTG and OTG groups showed no significant difference. SPSS 26.0, R software, and GraphPad PRISM 8.0 were used to perform statistical analyses.

RESULTS

Of the 136 patients included, eight acquired pathological complete response, and the objective response rate was 47.8% (65/136). The LTG group had longer operation time (P = 0.015), less blood loss (P = 0.003), shorter days to first flatus (P < 0.001), and shorter postoperative hospitalization days (P < 0.001). LTG spent more surgical cost than OTG (P < 0.001), while total hospitalized cost of LTG was less than OTG (P < 0.001). 21 (28.0%) patients in the OTG group and 14 (23.0%) in the LTG group had 30-d postoperative complications, but there was no significant difference between the two groups (P = 0.503). The 3-year overall survival (OS) rate was 60.6% and 64.6% in the LTG and OTG groups, respectively [hazard ratio (HR) = 0.859, 95% confidence interval (CI): 0.522-1.412, P = 0.546], while the 3-year disease-free survival (DFS) rate was 54.5% and 51.8% in the LTG and OTG group, respectively (HR = 0.947, 95%CI: 0.582-1.539, P = 0.823). Multivariate cox analysis showed that body mass index and pTNM stage were independent risk factors for OS while vascular invasion and pTNM stage were independent risk factors for DFS (P < 0.05).

CONCLUSION

After NACT, LTG shows comparable 30-d postoperative morbidity as well as 3-year OS and DFS rate to OTG. We recommend that experienced surgeons select LTG other than OTG for proper AGC patients after NACT.

Keywords: Neoadjuvant chemotherapy; Gastric cancer; Laparoscope; Total gastrectomy; Morbidity; Survival

Core Tip: Neoadjuvant chemotherapy (NACT), defined as chemotherapy before surgery, is currently a hot research topic of perioperative therapy for advanced gastric cancer. In this study, we focused on the short- and long-term outcomes between laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG) after NACT. We found that the LTG group had longer operation time, less blood loss, shorter time to first flatus, and shorter postoperative hospitalization days. LTG showed comparable 30-d postoperative morbidity as well as 3-year overall survival and disease-free survival rate to OTG. Based on our results, we recommend that experienced surgeons select LTG for proper patients after NACT.