Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.452
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
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.
We sought to evaluate short- and long-term outcomes between laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG) after NACT.
We retrospectively collected the clinicopathological data of 136 patients who accepted gastrectomy after NACT from June 2012 to June 2019, including 61 patients in the LTG group and 75 patients in the OTG group. Clinicopathological characteristics between the LTG and OTG groups showed no significant difference. We compared the perioperative indexes and long-term outcomes between the LTG and OTG groups after NACT. SPSS 26.0, R software, and GraphPad PRISM 8.0 were used to perform statistical analyses.
In this study, we found that LTG had longer operation time, less blood loss, shorter days to first flatus, and shorter postoperative hospitalization days compared with OTG. LTG showed comparable 30-d postoperative morbidity as well as 3-year OS and DFS rate to OTG.
This study suggested that there are no significant disparities between LTG and OTG in postoperative complication rates, 3-year OS rates, and 3-year DFS rates after NACT for AGC patients. LTG performed by experienced surgeons after NACT has several advantages including less blood loss, faster postoperative recovery, and less hospitalized cost, which could be regarded as an alternative surgical approach with its safety, feasibility, and comparable oncological benefits at any ypTNM stage.
We recommend that experienced surgeons could select LTG for proper patients after NACT. Large-scale retrospective or even multi-institutional RCT studies are required to better understand the association between LTG and OTG after NACT.