Published online Nov 16, 2023. doi: 10.12998/wjcc.v11.i32.7795
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
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.
To compare the efficacy and safety of LG vs OG after NAT for LAGC.
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).
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).
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.
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.