Abstract
BackgroundLaparoscopic surgery has been widely accepted to treat early-stage gastric cancer. However, it is still controversial to perform laparoscopic gastrectomy plus D2 lymphadenectomy for locally advanced gastric cancer. We performed the present study to compare the long-term outcomes of patients after laparoscopic or open gastrectomy plus D2 lymphadenectomy.MethodsThe clinicopathological data of 182 gastric cancer patients receiving gastrectomy plus D2 lymphadenectomy between January 2011 and December 2015 at Shenzhen Traditional Chinese Medicine Hospital were retrospectively retrieved. The overall survival (OS) and disease-free survival (DFS) of these 182 patients were compared. Then, the prognostic significance of positive lymph node ratio (LNR) was assessed.ResultsAs a whole, OS (P = 0.789) and DFS (P = 0.672) of patients receiving laparoscopic gastrectomy plus D2 lymphadenectomy were not significantly different from those of patients receiving open surgery. For stage I patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.573) and DFS (P = 0.157). Similarly, for stage II patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.567) and DFS (P = 0.830). For stage III patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.773) and DFS (P = 0.404). Laparoscopic or open gastrectomy plus D2 lymphadenectomy was not proven by Cox regression analysis to be an independent prognostic factor for OS and DFS. High LNR was significantly associated with worse OS (P < 0.001) and DFS (P < 0.001). Surgical type did not significantly affect prognosis of patients with low LNR or survival of patients with high LNR.ConclusionsFor patients with gastric cancer, laparoscopic gastrectomy plus D2 lymphadenectomy was not inferior to open surgery in terms of long-term outcomes. LNR is a useful prognostic marker for GC patients.
Highlights
Laparoscopic surgery has been widely accepted to treat early-stage gastric cancer
For patients with early-stage gastric cancer (GC), laparoscopic gastrectomy has become the preferred choice given its similar long-term oncological outcomes and significantly better short-term outcomes [3,4,5,6]. It was reported by the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) group that laparoscopic gastrectomy was related with much better short-term outcomes such as less blood loss, less severe postoperative pain, faster recovery, and much shorter hospital stay and similar long-term oncological outcomes [7]
Baseline clinicopathological characteristics From January 2011 and December 2015, a total of 328 GC patients underwent an operation at Shenzhen Traditional Chinese Medicine Hospital
Summary
Laparoscopic surgery has been widely accepted to treat early-stage gastric cancer. For patients with early-stage GC, laparoscopic gastrectomy has become the preferred choice given its similar long-term oncological outcomes and significantly better short-term outcomes [3,4,5,6]. It was reported by the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) group that laparoscopic gastrectomy was related with much better short-term outcomes such as less blood loss, less severe postoperative pain, faster recovery, and much shorter hospital stay and similar long-term oncological outcomes [7]. As far as we are concerned, in most guidelines and multicenter clinical trial, laparoscopic gastrectomy is recommended as the treatment of choice for early-stage GC
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