Laparoscopic Radical Gastrectomy for Gastric Cancer: Long-Term Outcome and Critical Analysis of 10-Year Experience in a Teaching Center

Abstract

Background: Laparoscopic surgical approaches for gastric cancer are increasing, yet limited evidence between the learning curve and long-term outcomes. To analyze survival in GC patients at a single center over 10 years and characterize the relationship between the learning curve and prognosis. Methods: This retrospective cohort study studied 3674 patients who underwent laparoscopic radical gastrectomy for gastric cancer. Cusum and Cox regression were used to assess the association between the surgeon’s experience and the 3 years overall survival (OS). Results: The 3-year OS of all patients was 71.8%. This increase of 3-year OS was associated with laparoscopic cases (r=0.638, p=0.047). Analysis of the CUSUM curve showed a significant change in the 3-year OS of 1400 cases. Further propensity score matching of patients during and after the learning curve (<1400 and ≥1400 cases) showed a significant difference in the 3-year OS between the two groups (68.5% vs. 72.3%, p=0.045). Cox regression analysis verified that in ≥1400 cases, prior laparoscopic surgery (p=0.045), textbook outcome (TO) and the number of retrieved lymph nodes (LNs) were the independent protective factor. The LN non-compliance rate was an independent risk factor. In contrast, the rate of TO and the median number of retrieved LNs were significantly higher after the learning curve (≥1400 cases). Furthermore, the rates of LN non-compliance were significantly lower (p<0.05). Conclusions: Increasing laparoscopic surgical experience is associated with surgical quality and prognostic improvement in patients with gastric cancer. But improvements in outcome accrued slowly over a long period. Funding: The study was sponsored by the Scientific and Technological Innovation Joint Capital Projects of Fujian Province (2017Y9011,2019Y9098). The Second Batch of Special Support Funds for Fujian Province Innovation and Entrepreneurship Talents (2016B013). Declaration of Interest: None to declare. Ethical Approval: The study was approved by IRB of our institute, Fujian Medical University.