Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2451-2460
Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2451
Survival prognostic analysis of laparoscopic D2 radical resection for locally advanced gastric cancer: A multicenter cohort study
Xiu-Ming Sun, Kui Liu, Wen Wu, Chao Meng
Xiu-Ming Sun, Chao Meng, Department of Pain Management, Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Kui Liu, Department of Hepatobiliary Surgery, Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Wen Wu, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
Author contributions: Sun XM wrote the manuscript; Liu K and Wu W collected the data; and Meng C guided the study. All authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Naval Medical University.
Informed consent statement: Informed consent was obtained from the patients and their families for this study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The data of this study can be provided upon reasonable request and can only be shared after the application is submitted and approved by the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: Chao Meng, MD, Doctor, Department of Pain Management, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao, Qingdao 266000, Shandong Province, China. mengchao1119@126.com
Received: January 27, 2024
Revised: June 7, 2024
Accepted: June 25, 2024
Published online: August 27, 2024
Processing time: 202 Days and 8.9 Hours
Abstract
BACKGROUND

With the development of minimally invasive surgical techniques, the use of laparoscopic D2 radical surgery for the treatment of locally advanced gastric cancer (GC) has gradually increased. However, the effect of this procedure on survival and prognosis remains controversial. This study evaluated the survival and prognosis of patients receiving laparoscopic D2 radical resection for the treatment of locally advanced GC to provide more reliable clinical evidence, guide clinical decision-making, optimize treatment strategies, and improve the survival rate and quality of life of patients.

AIM

To investigate the survival prognosis and influencing factors of laparoscopic D2 radical resection for locally advanced GC patients.

METHODS

A retrospective cohort study was performed. Clinicopathological data from 652 patients with locally advanced GC in our hospitals from December 2013 to December 2023 were collected. There were 442 males and 210 females. The mean age was 57 ± 12 years. All patients underwent a laparoscopic D2 radical operation for distal GC. The patients were followed up in the outpatient department and by telephone to determine their tumor recurrence, metastasis, and survival. The follow-up period ended in December 2023. Normally distributed data are expressed as the mean ± SD, and normally distributed data are expressed as M (Q1, Q3) or M (range). Statistical data are expressed as absolute numbers or percentages; the χ2 test was used for comparisons between groups, and the Mann-Whitney U nonparametric test was used for comparisons of rank data. The life table method was used to calculate the survival rate, the Kaplan-Meier method was used to construct survival curves, the log rank test was used for survival analysis, and the Cox risk regression model was used for univariate and multifactor analysis.

RESULTS

The median overall survival (OS) time for the 652 patients was 81 months, with a 10-year OS rate of 46.1%. Patients with TNM stages II and III had 10-year OS rates of 59.6% and 37.5%, respectively, which were significantly different (P < 0.05). Univariate analysis indicated that factors such as age, maximum tumor diameter, tumor differentiation grade (low to undifferentiated), pathological TNM stage, pathological T stage, pathological N stage (N2, N3), and postoperative chemotherapy significantly influenced the 10-year OS rate for patients with locally advanced GC following laparoscopic D2 radical resection for distal stomach cancer [hazard ratio (HR): 1.45, 1.64, 1.45, 1.64, 1.37, 2.05, 1.30, 1.68, 3.08, and 0.56 with confidence intervals (CIs) of 1.15-1.84, 1.32-2.03, 1.05-1.77, 1.62-2.59, 1.05-1.61, 1.17-2.42, 2.15-4.41, and 0.44-0.70, respectively; P < 0.05]. Multifactor analysis revealed that a tumor diameter greater than 4 cm, low tumor differentiation, and pathological TNM stage III were independent risk factors for the 10-year OS rate in these patients (HR: 1.48, 1.44, 1.81 with a 95%CI: 1.19-1.84). Additionally, postoperative chemotherapy emerged as an independent protective factor for the 10-year OS rate (HR: 0.57, 95%CI: 0.45-0.73; P < 0.05).

CONCLUSION

A maximum tumor diameter exceeding 4 cm, low tumor differentiation, and pathological TNM stage III were identified as independent risk factors for the 10-year OS rate in patients with locally advanced GC following laparoscopic D2 radical resection for distal GC. Conversely, postoperative chemotherapy was found to be an independent protective factor for the 10-year OS rate in these patients.

Keywords: Gastric neoplasms; Chinese Laparoscopic Gastrointestinal Surgery Study Group; Laparoscopic surgery; Locally advanced gastric cancer; D2 lymph node dissection

Core Tip: Data from multicenter patients with locally advanced gastric cancer (GC) were collected to compare the differences in survival and prognosis between laparoscopic D2 radical surgery and traditional open surgery. The contents of the study included postoperative survival rate, postoperative complication rate, postoperative recovery and quality of life. By comparing and analyzing the efficacy and safety of the two surgical methods, this study aimed to evaluate the actual effect of laparoscopic D2 radical surgery in the treatment of locally advanced GC, provide evidence for the selection of clinical surgical methods, and promote the application of minimally invasive surgical techniques in the treatment of GC.