Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2021; 13(5): 429-442
Published online May 27, 2021. doi: 10.4240/wjgs.v13.i5.429
Could neoadjuvant chemotherapy increase postoperative complication risk of laparoscopic total gastrectomy? A mono-institutional propensity score-matched study in China
Hao Cui, Jian-Xin Cui, Yu-Ning Wang, Bo Cao, Huan Deng, Ke-Cheng Zhang, Tian-Yu Xie, Wen-Quan Liang, Yi Liu, Lin Chen, Bo Wei
Hao Cui, Tian-Yu Xie, School of Medicine, Nankai University, Tianjin 300071, China
Jian-Xin Cui, Bo Cao, Huan Deng, Ke-Cheng Zhang, Wen-Quan Liang, Yi Liu, Lin Chen, Bo Wei, Department of General Surgery, Institute of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
Yu-Ning Wang, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Cui H, Cui JX, and Wang YN contributed equally to this work; Cui H, Cui JX, Wang YN, Chen L, and Wei B designed the study; Zhang KC, Cao B, Wang YN, and Deng H collected the data; Liang WQ, Liu Y, and Xie TY analyzed and interpreted the data; Cui H and Cui JX 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; and Health Cultivating Foundation for Capital Citizens, No. Z171100000417023.
Institutional review board statement: The studies involving human participants were reviewed and approved by the Research Ethics Committee of Chinese PLA general hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors 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: All datasets generated for this study are included in the article and available from corresponding authors upon reasonable request.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Wei, MD, PhD, Chief Doctor, Professor, Staff Physician, Department of General Surgery, Institute of General Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. 18431143691@163.com
Received: January 10, 2021
Peer-review started: January 10, 2021
First decision: February 11, 2021
Revised: February 27, 2021
Accepted: April 4, 2021
Article in press: April 4, 2021
Published online: May 27, 2021
Processing time: 130 Days and 20.9 Hours
ARTICLE HIGHLIGHTS
Research background

The potential survival benefit of neoadjuvant chemotherapy (NC) in patients with advanced gastric cancer has been widely recognized.

Research motivation

With the development of minimally invasive surgery, which is represented by laparoscopy, the effect of NC on the safety of laparoscopic gastrectomy remains to be further explored.

Research objectives

To compare the short-term outcomes of laparoscopic total gastrectomy (LTG) after NC (NC-LTG) with LTG alone.

Research methods

A total of 92 patients who underwent NC-LTG and 381 patients who received LTG alone at the Chinese PLA General Hospital between September 2015 and September 2020 were retrospectively included in our study. We used propensity-score matching (PSM) to balance baseline bias. After 1:1 PSM, 73 patients were included in each group with no statistically significant difference in baseline characteristics.

Research results

The NC-LTG group exhibited a longer operation time and increased intraoperative blood loss compared to the LTG group. There were no significant differences in 30-d postoperative morbidity, 30-d severe complication rates, or anastomotic leakage rates. A multivariate analysis showed that an operation time greater than 240 min was an independent risk factor while NC was not an independent risk factor for postoperative complications in LTG.

Research conclusions

Despite a longer operation time and more blood loss after NC-LTG, which indicate surgical difficulty, NC-LTG exhibits acceptable short-term outcomes compared to LTG, illustrating the safety and feasibility of NC-LTG.

Research perspectives

Further research like multi-institutional retrospective study or randomized controlled trial study is needed to confirm our results and provide high-grade evidence for the appropriate application of NC-LTG.