Short and long-term outcomes between laparoscopic and open total gastrectomy for advanced gastric cancer after neoadjuvant chemotherapy

Table 1 Baseline characteristics of 136 gastric cancer patients after neoadjuvant chemotherapy (mean ± SD)

Clinical characteristic	LTG group (n = 61)	OTG group (n = 75)	P value
Gender			0.821
Male	47	59
Female	14	16
Age (yr)	57.56 ± 10.35	56.84 ± 11.95	0.712
BMI (kg/m2)	22.81 ± 2.67	23.67 ± 3.31	0.099
CCI score, n (%)			0.982
0-2	43	53
> 2	18	22
History of abdominal surgery			0.179
No	54	60
Yes	7	15
Clinical tumor stage
cT			0.695
T2	1	6
T3	22	23
T4	38	46
cN			0.191
N0	7	4
N+	54	71
cTNM			0.468
II	5	9
III	56	66
Historical factor			0.088
2012-2015	22	38
2016-2019	39	37

LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; CCI: Comprehensive complication index; BMI: Body mass index; NACT: Neoadjuvant chemotherapy.

Table 2 Pathological characteristics of 136 gastric cancer patients after neoadjuvant chemotherapy

Pathological characteristic	LTG group (n = 61)	OTG group (n = 75)	P value
Tumor diameter, cm (median, IQR)	4.0 (2.5-6.5)	4.0 (2.0-6.0)	0.366
Site of tumor			0.244
Upper 1/3	30	27
Middle 1/3	21	29
Diffused	10	19
ypT			0.751
T0	1	7
T1	5	5
T2	10	14
T3	34	30
T4	11	19
ypN			0.190
N0	19	35
N1	14	11
N2	12	11
N3	16	18
ypTNM			0.300
0	1	7
I	8	17
II	22	16
III	29	34
IV	1	1
Nerve invasion			0.545
Yes	20	21
No	41	54
Vascular invasion			0.982
Yes	18	22
No	43	53
Differentiation			0.616
Well/moderate	27	30
Poor/undifferentiated	34	45

LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; NACT: Neoadjuvant chemotherapy.

Table 3 Neoadjuvant chemotherapy characteristics

Variable	LTG group (n = 61)	OTG group (n = 75)	P value
Number of cycles of NACT			0.467
1-2	13	12
3-4	45	59
> 4	3	4
NACT regimen			0.143
SOX	48	65
XELOX	8	9
Other	5	1
Clinical response			0.659
CR	1	7
PR	28	29
SD	28	34
PD	4	5
Adverse effects after NACT			0.535
Grade 0	13	17
Grade I	16	21
Grade II	17	23
Grade III	11	12
Grade IV	4	2
Chemotherapy–surgical procedure interval (wk)	5.07 ± 1.67	4.55 ± 1.33	0.047
Adjuvant therapy			0.545
Yes	52	61
No	9	14

LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; NACT: Neoadjuvant chemotherapy; CR: Complete response; PR: Partial response; PD: Progressive disease.

Table 4 Perioperative clinical indexes and postoperative outcomes between laparoscopic total gastrectomy and open total gastrectomy groups after neoadjuvant chemotherapy (mean ± SD)

Variable	LTG group (n = 61)	OTG group (n = 75)	P value
Surgical time, min	255.66 ± 40.10	238.59 ± 40.30	0.015
Blood loss, mL (median, IQR)	150 (100-300)	200 (200-300)	0.003
Blood loss (mL), n (%)			0.003
< 200	31	13
200-400	20	51
> 400	10	11
Retrieved lymph nodes, n	33.38 ± 13.26	34.75 ± 16.69	0.603
No. 10 lymph nodes dissection			0.339
No	41	56
Yes	20	19
Extent of resection			0.471
R0	58	74
R1/R2	3	1
Time to first flatus, d	4.36 ± 1.28	5.41 ± 1.16	0.000
Postoperative stay, d	9.48 ± 3.98	11.89 ± 3.36	0.000
Surgery costs, $	5419.99 ± 1315.39	4162.36 ± 791.93	0.000
Hospitalization costs, $ (median, IQR)	13105.92 (11713.18-14640.53)	14873.96 (13501.66-17131.31)	0.000
Total complication rate (%)	14 (23.0)	21 (28.0)	0.503
Clavien-Dindo classification
Grade II	12	19
Peritoneal infection	2	2
Lymphatic leakage	2	0
Anastomotic leakage	1	0
Pancreatic fistula	1	1
Ileus	1	2
Cardiac failure	1	0
Hypoproteinemia	2	8
Anemia	2	2
Cholecystitis	0	1
Incision infection	0	2
Pneumonia	0	1
Grade IIIa	1	2
Deep venous thrombosis	1	0
Pleural effusion	0	1
Anastomotic leakage	0	1
Grade V	1	0
Septic shock	1	0
Severe complication rate (%)	2 (3.3)	2 (2.7)	1.000

LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; NACT: Neoadjuvant chemotherapy.

Table 5 Clinical characteristics and perioperative indexes in ypTNM 0-II patients after neoadjuvant chemotherapy (mean ± SD)

Variable	LTG group (n = 31)	OTG group (n = 40)	P value
Gender			0.841
Male	25	33
Female	6	7
Age (yr)	59.10 ± 10.51	57.63 ± 11.16	0.574
BMI (kg/m2)	22.58 ± 2.77	23.72 ± 2.93	0.102
CCI score			0.594
0-2	22	26
> 2	9	14
Tumor diameter, cm (median, IQR)	3.00 (2.20-4.50)	2.30 (1.42-4.00)	0.158
Surgical time, min	260.97 ± 37.20	237.93 ± 35.51	0.010
Blood loss, mL (median, IQR)	150 (100-200)	200 (200-300)	0.002
Blood loss (mL), n (%)			0.000
0-200	19	5
200-400	9	31
> 400	3	4
Retrieved lymph nodes, n	34.00 ± 15.11	36.38 ± 17.64	0.552
Time to first flatus, d	4.32 ± 1.28	5.45 ± 1.24	0.000
Postoperative stay, d	8.94 ± 3.63	11.65 ± 3.03	0.001
Surgery costs, $	5641.18 ± 1351.17	4163.48 ± 627.86	0.000
Hospitalization costs, $	13389.70 ± 2254.38	15024.88 ± 23358.95	0.004
Total complication rate (%), C-D classification	5 (16.1)	9 (22.5)	0.503
II	4	8
IIIa	0	1
V	1	0
Severe complication rate (%)	1(3.2)	1 (2.5)	1.000

LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; NACT: Neoadjuvant chemotherapy; CCI: Comprehensive complication index; BMI: Body mass index; C-D classification: Clavien-Dindo classification

Table 6 Clinical characteristics and perioperative index in ypTNM III-IV patients after neoadjuvant chemotherapy (mean ± SD)

Variable	LTG group (n = 30)	OTG group (n = 35)	P value
Gender			0.931
Male	22	26
Female	8	9
Age (yr)	55.97 ± 10.10	55.94 ± 12.90	0.993
BMI (kg/m2)	23.03 ± 2.60	23.63 ± 3.73	0.468
CCI score			0.514
0-2	21	27
> 2	9	8
Tumor diameter, cm	5.5 (3.5-8.0)	5.0 (4.0-8.0)	0.916
Surgical time, min	250.17 ± 42.99	239.34 ± 45.69	0.332
Blood loss, mL (median, IQR)	200 (100-350)	300 (200-400)	0.159
Blood loss (mL), n (%)			0.404
0-200	12	8
200-400	11	20
> 400	7	7
Retrieved lymph nodes, n	32.73 ± 11.24	32.89 ± 15.58	0.965
Time to first flatus, d	4.40 ± 1.30	5.37 ± 1.09	0.002
Postoperative stay, d	10.03 ± 4.30	12.17 ± 3.73	0.036
Surgery costs, $	4793.57 (4032.20-6242.77)	3871.55 (3686.28-4416.86)	0.000
Hospitalization costs, $	13190.05 (12036.98-14591.47)	15263.28 (13162.85-17143.01)	0.000
Total complication rate (%), C-D classification	9 (30.0)	12 (34.3)	0.647
II	8	11
IIIa	1	1
Severe complication rate (%)	1 (3.3)	1 (2.9)	1.000

LTG: Laparoscopic total gastrectomy; OTG: Open total gastrectomy; NACT: Neoadjuvant chemotherapy; CCI: Comprehensive complication index; BMI: Body mass index; C-D classification: Clavien-Dindo classification.

Table 7 Univariate and multivariate analyses for overall survival

Factor	Univariate analysis		P value	Multivariate analysis		P value
	HR	95%CI		HR	95%CI
Sex			0.127
Male	1.000
Female	1.541	0.885-2.684
Age			0.647
< 65	1.000
≥ 65	1.129	0.671-1.900
BMI (kg/m2)			0.091			0.049
< 25	1.000			1.000
≥ 25	0.601	0.333-1.086		0.547	0.300-0.998
Surgical approach			0.549
Laparoscopy	1.000
Open	1.164	0.708-1.914
CCI score			0.438
0-2	1.000
≥ 2	1.225	0.733-2.049
pTNM stage			0.000			0.006
0-II	1.000			1.000
III-IV	2.632	1.569-4.413		2.224	1.258-3.930
Tumor diameter (cm)			0.039			0.153
≤ 3	1.000			1.000
> 3	1.838	1.031-3.277		1.577	0.844-2.945
Operation time (min)			0.483
≤ 240	1.000
> 240	1.192	0.730-1.948
Estimated blood loss (mL)			0.074			0.588
≤ 200	1.000			1.000
> 200	1.559	0.958-2.536		1.154	0.688-1.935
Vascular invasion			0.008			0.062
No	1.000			1.000
Yes	1.987	1.200-3.289		1.712	0.974-3.010
Nerve invasion			0.079			0.567
No	1.000			1.000
Yes	1.580	0.949-2.632		0.838	0.456-1.537
Differentiation			0.261
Well/moderate	1.000
Poor/undifferentiated	1.335	0.806-2.212
Complications			0.662
No	1.000
Yes	1.131	0.651-1.968
Historical factor			0.861
2012-2015	1.000
2016-2019	0.957	0.587-1.560

HR: Hazard ratio; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progressive disease; CCI: Comprehensive complication index; BMI: Body mass index.

Table 8 Univariate and multivariate analyses for disease-free survival

Factor	Univariate analysis		P value	Multivariate analysis		P value
	HR	95%CI		HR	95%CI
Sex			0.259
Male	1.000
Female	0.851	0.642-1.127
Age			0.267
< 65	1.000
≥ 65	1.326	0.806-2.181
BMI (kg/m2)			0.706
< 25	1.000
≥ 25	0.706	0.403-1.237
Surgical approach			0.825
Laparoscopy	1.000
Open	0.947	0.582-1.539
CCI score			0.707
0-2	1.000
≥ 2	1.104	0.660-1.847
pTNM stage			0.000			0.022
0-II	1.000			1.000
III-IV	2.418	1.471-3.973		1.854	1.095-3.140
Tumor diameter (cm)			0.022			0.200
≤ 3	1.000			1.000
> 3	1.954	1.100-3.470		1.484	0.812-2.710
Operation time (min)			0.710
≤ 240	1.000
> 240	1.095	0.679-1.765
Estimated blood loss (mL)			0.024			0.204
≤ 200	1.000			1.000
> 200	1.730	1.075-2.785		1.379	0.840-2.263
Vascular invasion			0.001			0.020
No	1.000			1.000
Yes	2.245	1.378-3.659		1.824	1.101-3.022
Nerve invasion			0.203
No	1.000
Yes	1.387	0.838-2.295
Differentiation			0.283
Well/moderate	1.000
Poor/undifferentiated	1.311	0.800-2.148
Complications			0.751
No	1.000
Yes	1.093	0.631-1.894
Historical factor			0.691
2012-2015	1.000
2016-2019	1.102	0.683-1.779

HR: Hazard ratio; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progressive disease; CCI: Comprehensive complication index; BMI: Body mass index.