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Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China

BACKGROUND: Given the great technical difficulty and procedural complexity of laparoscopic total gastrectomy (LTG), the technical and oncologic safety of LTG versus open total gastrectomy (OTG) in the field of advanced gastric cancer (AGC) is yet undetermined. OBJECTIVE: This multicenter cohort stud...

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Autores principales: Feng, Xingyu, Chen, Xin, Ye, Zaisheng, Xiong, Wenjun, Yao, Xueqing, Wang, Wei, Wang, Junjiang, Chen, Luchuan, Li, Yong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710448/
https://www.ncbi.nlm.nih.gov/pubmed/34966682
http://dx.doi.org/10.3389/fonc.2021.780398
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author Feng, Xingyu
Chen, Xin
Ye, Zaisheng
Xiong, Wenjun
Yao, Xueqing
Wang, Wei
Wang, Junjiang
Chen, Luchuan
Li, Yong
author_facet Feng, Xingyu
Chen, Xin
Ye, Zaisheng
Xiong, Wenjun
Yao, Xueqing
Wang, Wei
Wang, Junjiang
Chen, Luchuan
Li, Yong
author_sort Feng, Xingyu
collection PubMed
description BACKGROUND: Given the great technical difficulty and procedural complexity of laparoscopic total gastrectomy (LTG), the technical and oncologic safety of LTG versus open total gastrectomy (OTG) in the field of advanced gastric cancer (AGC) is yet undetermined. OBJECTIVE: This multicenter cohort study aimed to compare the surgical and oncological outcomes of LTG with those of OTG in AGC patients. PATIENTS AND METHODS: In total, 588 patients from 3 centers who underwent primary total gastrectomy with D2 lymphadenectomy, by well-trained surgeons with adequate experience, for pathologically confirmed locally AGC (T2N0–3, T3N0–3, or T4N0–3) between January 1, 2011, and December 31, 2015, were identified, and their clinical data were collected from three participating centers. After 1:1 propensity score matching (PSM), 450 cases (LTG, n = 225; OTG, n = 225) were eligible and assessed. RESULTS: No significant difference in the number of retrieved lymph nodes, 5-year disease-free survival (DFS) rates, or 5-year overall survival (OS) rates between both surgical groups were observed. Although LTG had significantly longer surgical time (262 vs. 180 min, p < 0.001), LTG was associated with fewer postoperative complications [relative risk (RR) 0.583, 95% CI 0.353–0.960, p = 0.047), less intraoperative bleeding (120 vs. 200 ml, p < 0.001), longer proximal margin resection (3 vs. 2 cm, p < 0.001), and shorter postoperative hospitalization (11 vs. 13 days, p < 0.001). The mortality rate was comparable in both groups. CONCLUSIONS: LTG was not inferior to OTG in terms of survival outcomes and was associated with shorter surgical and postoperative hospitalization time and fewer postoperative complications, suggesting LTG with D2 lymphadenectomy as an important alternative to OTG for patients with AGC, but to be carried out in highly experienced centers.
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spelling pubmed-87104482021-12-28 Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China Feng, Xingyu Chen, Xin Ye, Zaisheng Xiong, Wenjun Yao, Xueqing Wang, Wei Wang, Junjiang Chen, Luchuan Li, Yong Front Oncol Oncology BACKGROUND: Given the great technical difficulty and procedural complexity of laparoscopic total gastrectomy (LTG), the technical and oncologic safety of LTG versus open total gastrectomy (OTG) in the field of advanced gastric cancer (AGC) is yet undetermined. OBJECTIVE: This multicenter cohort study aimed to compare the surgical and oncological outcomes of LTG with those of OTG in AGC patients. PATIENTS AND METHODS: In total, 588 patients from 3 centers who underwent primary total gastrectomy with D2 lymphadenectomy, by well-trained surgeons with adequate experience, for pathologically confirmed locally AGC (T2N0–3, T3N0–3, or T4N0–3) between January 1, 2011, and December 31, 2015, were identified, and their clinical data were collected from three participating centers. After 1:1 propensity score matching (PSM), 450 cases (LTG, n = 225; OTG, n = 225) were eligible and assessed. RESULTS: No significant difference in the number of retrieved lymph nodes, 5-year disease-free survival (DFS) rates, or 5-year overall survival (OS) rates between both surgical groups were observed. Although LTG had significantly longer surgical time (262 vs. 180 min, p < 0.001), LTG was associated with fewer postoperative complications [relative risk (RR) 0.583, 95% CI 0.353–0.960, p = 0.047), less intraoperative bleeding (120 vs. 200 ml, p < 0.001), longer proximal margin resection (3 vs. 2 cm, p < 0.001), and shorter postoperative hospitalization (11 vs. 13 days, p < 0.001). The mortality rate was comparable in both groups. CONCLUSIONS: LTG was not inferior to OTG in terms of survival outcomes and was associated with shorter surgical and postoperative hospitalization time and fewer postoperative complications, suggesting LTG with D2 lymphadenectomy as an important alternative to OTG for patients with AGC, but to be carried out in highly experienced centers. Frontiers Media S.A. 2021-12-13 /pmc/articles/PMC8710448/ /pubmed/34966682 http://dx.doi.org/10.3389/fonc.2021.780398 Text en Copyright © 2021 Feng, Chen, Ye, Xiong, Yao, Wang, Wang, Chen and Li https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Feng, Xingyu
Chen, Xin
Ye, Zaisheng
Xiong, Wenjun
Yao, Xueqing
Wang, Wei
Wang, Junjiang
Chen, Luchuan
Li, Yong
Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China
title Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China
title_full Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China
title_fullStr Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China
title_full_unstemmed Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China
title_short Laparoscopic Versus Open Total Gastrectomy for Advanced Gastric Cancer: A Multicenter, Propensity Score-Matched Cohort Study in China
title_sort laparoscopic versus open total gastrectomy for advanced gastric cancer: a multicenter, propensity score-matched cohort study in china
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710448/
https://www.ncbi.nlm.nih.gov/pubmed/34966682
http://dx.doi.org/10.3389/fonc.2021.780398
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