Abstract
BackgroundThe oncological outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) following neoadjuvant chemotherapy have been investigated in a few studies. Our purpose was to evaluate the oncological outcomes of LG and OG after neoadjuvant chemotherapy in patients with locally advanced gastric cancer (GC) and to determine the advantages, preferences, and ease of use of the two techniques after chemotherapy.MethodsWe conducted a retrospective chart review of all patients who underwent either OG (n = 43) or LG (n = 41). The neoadjuvant treatment regimen consisted of capecitabine plus oxaliplatin for three cycles, which was then repeated 6 to 12 weeks after the operation for four cycles.ResultsThe hospital stay time and intraoperative blood loss in the LG group were significantly lower than those in the OG group. The mortality rate and the 3-year survival rate for patients in the LG group were comparable to those of patients in the OG group (4.6% vs. 9.7% and 68.3% vs. 58.1%, respectively). Similar trends were observed regarding the 3-year recurrence rate and metastasis. The mean survival time was 52.9 months (95% confidence interval [CI], 44.2–61.6) in the OG group compared with 43.3 (95% CI, 36.6–49.8) in the LG group. Likewise, the mean disease-free survival was 56.1 months (95% CI, 46.36–65.8) in the LG group compared with 50.9 months (95% CI, 44.6–57.2) in the OG group.ConclusionLG is a feasible and safe alternative to OG for patients with locally advanced GC receiving neoadjuvant chemotherapy.
Highlights
Gastric cancer (GC), which affects > 950,000 patients annually, is the fifth most prevalent cancer and the third most common cause of cancer-related death worldwide [1,2,3]
In terms of intraoperative characteristics, intraoperative blood loss was significantly lower in the laparoscopic gastrectomy (LG) group than in the open gastrectomy (OG) group (70.5 ± 28.1 mL vs. 157.2 ± 17.6 mL, respectively; P = 0.012)
Despite the great advances in this technique and its impact on oncological outcomes, LG has some issues, such as decreased intraoperative lung compliance owing to the establishment of artificial pneumoperitoneum as well as the relatively long operative time required for this procedure [40]
Summary
Gastric cancer (GC), which affects > 950,000 patients annually, is the fifth most prevalent cancer and the third most common cause of cancer-related death worldwide [1,2,3]. Laparoscopic gastrectomy (LG) is one of the standard procedures for early GC and has proven its feasibility in locally advanced GC [6,7,8]. Many systematic reviews have proven the feasibility of LG compared with open gastrectomy (OG) in patients with GC [12, 14,15,16,17]. The oncological outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) following neoadjuvant chemotherapy have been investigated in a few studies. Our purpose was to evaluate the oncological outcomes of LG and OG after neoadjuvant chemotherapy in patients with locally advanced gastric cancer (GC) and to determine the advantages, preferences, and ease of use of the two techniques after chemotherapy
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