Comparison of Perioperative and Survival Outcomes of Laparoscopic Versus Open Gastrectomy after Preoperative Chemotherapy: a Propensity Score–Matched Analysis

Abstract

Comparisons of laparoscopy-assisted gastrectomy (LAG) and open gastrectomy (OG) in the setting of neoadjuvant chemotherapy (NACT) are lacking. A prospectively maintained database of patients with gastric cancer who underwent LAG or OG following NACT from June 2013 to March 2016 was retrospectively reviewed. Perioperative and survival outcomes were compared between the LAG and OG groups. In total, 174 patients were identified from the database. After PSM analysis, 45 patients who underwent OG were one-to-one matched to 45 patients who underwent LAG in the setting of NACT. These two groups had similar outcomes in terms of intra- and postoperative complications and 3-year overall survival. However, the LAG group had a longer operation time (P = 0.031) and lower estimated blood loss (P = 0.001). Moreover, compared with patients in the OG group, those in the LAG group had fewer days until first ambulation (P = 0.028), first flatus (P = 0.015), first liquid diet (P = 0.035), and first soft diet (P = 0.024) and a shorter postoperative hospital stay (P = 0.041). Additionally, despite an equivalent total number of retrieved lymph nodes between the two groups, the OG group had marginally more lymph nodes dissected from the splenic hilum (P = 0.032) and splenic artery area (P = 0.020). The present study indicates that LAG performed by well-qualified surgeons for treatment of locally advanced gastric cancer after preoperative chemotherapy is as acceptable as OG in terms of oncological outcomes.