Abstract
BackgroundFew studies have been designed to evaluate the short- and long-term outcomes of laparoscopy-assisted total gastrectomy (LATG), and a retrospective study of a large patient cohort is valuable before conducting randomized controlled clinical trials.ResultsAmong all patients, age, tumor location, histologic type, pT stage, pN stage and pTNM stage significantly differed between the LATG group and OTG group. After the propensity score matching, the clinicopathological characteristics did not significantly differ between groups. The operation time, estimated blood loss, time to first flatus and the number of retrieved lymph nodes (P < 0.05) were better in the LATG group than the OTG group. Morbidity and mortality were lower in the LATG group than the OTG group (P < 0.05) for pre-matched patients. However, significant intergroup differences in morbidity were not identified after propensity matching. Although overall survival did not significantly differ between groups for the pre-matched patients, the 3-year cumulative survival rates were significantly lower in the LATG group (89.9%) than the OTG group (97.7%) for patients with stage I disease (P = 0.028). After propensity score matching, the analysis of the cumulative survival curve did not show a significant difference for any cancer stage.Materials and MethodsWe prospectively collected data from 1096 patients who underwent total gastrectomy for gastric cancer. Propensity score matching was applied to compare the covariates between the LATG group and the open total gastrectomy (OTG) group. Operative outcomes and long-term outcomes were compared between the two groups.ConclusionsImplementation of LATG for gastric cancer is a safe, reliable and minimally invasive procedure with long-term outcomes similar to those of OTG. Further randomized controlled clinical trials can be conducted to provide valuable evidence of the safety and efficacy of LATG in treating gastric cancer.
Highlights
Since laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) was first reported by Kitano et al [1] in 1994, the use of laparoscopy-assisted gastrectomy (LAG) has gained popularity as a treatment for EGC
Among all patients, age, tumor location, histologic type, pT stage, pN stage and pTNM stage significantly differed between the laparoscopy-assisted total gastrectomy (LATG) group and open total gastrectomy (OTG) group
Morbidity and mortality were lower in the LATG group than the OTG group (P < 0.05) for pre-matched patients
Summary
Since laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) was first reported by Kitano et al [1] in 1994, the use of laparoscopy-assisted gastrectomy (LAG) has gained popularity as a treatment for EGC. Laparoscopic gastrectomy has been a standard approach for EGC due to its minimal invasiveness and similar long-term outcomes compared with conventional open surgery. To the best of our knowledge, few reports have compared the feasibility, safety and long-term outcomes of laparoscopyassisted total gastrectomy (LATG) to those of open total gastrectomy (OTG), and randomized controlled clinical trials comparing these two modalities have not yet been reported. We compared the short-term and longterm outcomes achieved by LATG and OTG to investigate the efficacy of the laparoscopic approach for patients with gastric cancer, and the results can provide new evidence to support the application of LATG prior to conducting randomized controlled clinical trials. Few studies have been designed to evaluate the short- and long-term outcomes of laparoscopy-assisted total gastrectomy (LATG), and a retrospective study of a large patient cohort is valuable before conducting randomized controlled clinical trials
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