Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2023; 11(32): 7795-7805
Published online Nov 16, 2023. doi: 10.12998/wjcc.v11.i32.7795
Efficacy and safety of laparoscopic vs open gastrectomy after neoadjuvant therapy for locally advanced gastric cancer
Chang-Da Yu, Ke Zhang
Chang-Da Yu, Ke Zhang, Department of General Surgery, Jiujiang First People’s Hospital, Jiujiang 332000, Jiangxi Province, China
Author contributions: Yu CD and Zhang K contributed to the data collection; Yu CD and Zhang K contributed to the data collection; Yu CD and Zhang K contributed to the formal analysis; Yu CD and Zhang K participated in the survey; Yu CD and Zhang K contributed to these methods; Yu CD guided the research; Yu CD and Zhang K jointly validated this study; Zhang K contributed to the visualization of this study; Yu CD drafted the first draft; and Yu CD and Zhang K jointly reviewed and edited the manuscript.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of Jiujiang First People’s Hospital.
Clinical trial registration statement: This study was registered at the Clinical Trial Registration Center Testing Center. The registration identification number is (researchregistry9243).
Informed consent statement: All study participants or their legal guardians provided written informed consent before study enrollment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
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: Chang-Da Yu, MSc, Associate Chief Physician, Department of General Surgery, Jiujiang First People’s Hospital, No. 48 Taling South Road, Jiujiang 332000, Jiangxi Province, China. ycd136359835661123@163.com
Received: September 21, 2023
Peer-review started: September 21, 2023
First decision: October 9, 2023
Revised: October 10, 2023
Accepted: October 30, 2023
Article in press: October 30, 2023
Published online: November 16, 2023
Processing time: 55 Days and 18.4 Hours
Abstract
BACKGROUND

Laparoscopic gastrectomy (LG) is widely accepted as a minimally invasive approach for the treatment of early gastric cancer. However, its role in locally advanced gastric cancer (LAGC) after neoadjuvant therapy (NAT) remains controversial. This study aimed to compare the efficacy and safety of LG vs open gastrectomy (OG) after NAT for the treatment of LAGC.

AIM

To compare the efficacy and safety of LG vs OG after NAT for LAGC.

METHODS

We conducted a prospective study of 76 patients with LAGC who underwent NAT followed by LG (n = 38) or OG (n = 38) between 2021 and 2023. The primary endpoint was overall survival (OS), and the secondary endpoints were disease-free survival (DFS), surgical complications, and quality of life (QOL).

RESULTS

The two groups had comparable baseline characteristics, with a median follow-up period of 24 mo. The 3-year OS rates in the LG and OG groups were 68.4% and 60.5%, respectively (P = 0.42). The 3-year DFS rates in the LG and OG groups were 57.9% and 50.0%, respectively (P = 0.51). The LG group had significantly less blood loss (P < 0.001), a shorter hospital stay (P < 0.001), and a lower incidence of surgical site infection (P = 0.04) than the OG group. There were no significant differences in other surgical complications between the groups, including anastomotic leakage, intra-abdominal abscess, or wound dehiscence. The LG group had significantly better QOL scores than the OG group regarding physical functioning, role functioning, global health status, fatigue, pain, appetite loss, and body image at 6 months postoperatively (P < 0.05).

CONCLUSION

LG after NAT is a viable and safe alternative to OG for the treatment of LAGC, with similar survival outcomes and superior short-term recovery and QOL. LG patients had less blood loss, shorter hospitalizations, and a lower incidence of surgical site infections than OG patients. Moreover, the LG group had better QOL scores in multiple domains 6 mo postoperatively. Therefore, LG should be considered a valid option for patients with LAGC who undergo NAT, particularly for those who prioritize postoperative recovery and QOL.

Keywords: Laparoscopic gastrectomy, Open gastrectomy, Neoadjuvant therapy, Locally advanced gastric cancer, Efficacy, Safety

Core Tip: Laparoscopic gastrectomy (LG) is a viable and safe approach to treating locally advanced gastric cancer (LAGC) following neoadjuvant therapy (NAT). This study aimed to compare the efficacy and safety of LG vs open gastrectomy (OG) after NAT in patients with LAGC. The results demonstrated comparable overall survival and disease-free survival rates between the two groups. Additionally, LG exhibits advantages such as reduced blood loss, a shorter hospital stay, and a lower incidence of surgical site infection than OG. The two groups had similar rates of other surgical complications. Furthermore, LG yielded better quality of life (QOL) scores in terms of physical functioning, role functioning, global health status, fatigue, pain, appetite loss, and body image at 6 months postoperatively. These findings suggest that LG after NAT is a feasible and safe option for LAGC, providing comparable survival outcomes along with improved short-term recovery and QOL compared to OG.