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
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

Currently, surgeons focus more on surgical safety and oncological outcomes of laparoscopic gastrectomy after NACT.

Research objectives

We sought to evaluate short- and long-term outcomes between laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG) after NACT.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.