Surgical and oncological efficacy of laparoscopic-assisted total gastrectomy versus open total gastrectomy for gastric cancer by propensity score matching: a retrospective comparative study

Yingcong Fan,Jiadi Xing,Shijie Li,Xinyu Qi,Ming Cui,Chenghai Zhang,Zaozao Wang,Maoxing Liu,Zhendan Yao,Xiangqian Su,Nan Zhang,Fei Tan,Kai Xu,Hong Yang,Jianhong Yu

doi:10.1007/s00432-020-03503-4

Abstract

PurposeThe application of laparoscopic-assisted total gastrectomy (LATG) for resectable gastric cancer (GC) remains controversial compared with open total gastrectomy (OTG), especially for advanced gastric cancer (AGC) patients according to the inconsistent results demonstrated in the previous studies. The aim of this study was to evaluate the short-term and long-term outcomes between LATG and OTG in a population with more than 80% AGC patients by applying propensity score matching (PSM) method.MethodsThe data of 365 clinical stage I–III GC cases who underwent total gastrectomy with D2 lymphadenectomy were retrospectively collected from January 2011 to April 2018 in the Department of Gastrointestinal Surgery IV of Peking University Cancer Hospital. Propensity scores were generated through taking all covariates into consideration and 131 pairs of patients receiving either LATG or OTG were matched. Intraoperative, postoperative, and survival parameters were compared in the matched groups accordingly. Risk factors for postoperative complications and overall survival were further analyzed.ResultsPatient characteristics in the LATG and OTG groups were well balanced after PSM. LATG showed advantages with respect to shorter time to ambulation, first flatus, and first whole liquid diet intake. No significant differences were found between the two groups with regard to postoperative complications as well as overall survival in terms of different pathological stage. Older age was found as an independent risk factor for postoperative complications, and pathological stage for overall survival as well.ConclusionLATG appears to have comparable surgical and oncological safety with OTG by experienced surgeons.

Highlights

Despite a slight drop of incidence, gastric cancer (GC) remains the fifth most common malignancy and the third main causes of cancer death worldwide (Bray et al 2018)
JCOG1401 and KLASS03 were two singlearm multicenter prospective studies conducted in Japan and Korea which aimed to evaluate the surgical safety of laparoscopic total gastrectomy (LTG) or laparoscopic-assisted total/proximal gastrectomy (LATG/LAPG) for patients with clinical stage I GC (Hyung et al 2019; Kataoka et al 2016)
After propensity score matching (PSM), both laparoscopic-assisted total gastrectomy (LATG) and open total gastrectomy (OTG) groups consisted of 131 patients each, and all the baseline parameters were well balanced between the two groups

Summary

Introduction

Despite a slight drop of incidence, gastric cancer (GC) remains the fifth most common malignancy and the third main causes of cancer death worldwide (Bray et al 2018). Compared with LADG, studies which provide convincing data to prove the feasibility and safety of laparoscopic-assisted total gastrectomy (LATG) remain insufficient. Owing to the difficulty of standard systematic D2 lymphadenectomy and esophagojejunostomy in total gastrectomy (TG), the risk of postoperative complications for advanced gastric cancer (AGC) patients underwent LATG may be even higher, while no RCTs have been launched to evaluate the feasibility and oncological efficacy of LATG for AGC till now. We retrospectively investigated data from 365 patients with a majority of AGC cases who underwent LATG or OTG in the Department of Gastrointestinal Surgery IV of Peking University Cancer Hospital, comprehensively analyzed the data by using propensity score matching (PSM) method, and reported surgical safety as well as oncological efficacy between the two groups, in addition with risk factors for post-operative complications and overall survival

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