Survival outcomes of laparoscopic versus open total gastrectomy with nodal dissection for gastric cancer in a high-volume Japanese center: A propensity score-matched analysis.

Abstract

To compare the survival outcomes of laparoscopic total gastrectomy (LTG) with those of open total gastrectomy (OTG) in gastric cancer. Using an in-house database, this single-center study reviewed clinical data for patients who underwent surgery for gastric adenocarcinoma in 2008-2018. The patients were divided into an LTG group and an OTG group. Data for 638 patients were screened. After exclusions, 580 patients (LTG, n=212; OTG, n=368) were enrolled. Noting that the OTG group included more advanced tumors, 1:1 propensity score matching was implemented to reduce any selection bias, leaving 326 patients (LTG, n=163; OTG, n=163; pStage I/II/III=147/87/92) for further analysis. The operation time was longer and blood loss was less in the LTG group. The postoperative hospital stay was shorter in the LTG group than in the OTG group (9d vs 10d；P=.040). There was no significant difference in the incidence of grade III or worse postoperative complications (8.9% vs 11.0%). Five-year overall survival was better in the LTG group (84.9% vs 73.5%; P=.0010, log-rank test), but there was no significant difference in overall survival according to pStage (I, 93.0% vs 89.0%; II, 85.8% vs 77.5%; III, 64.1% vs 52.5%). There was a similar trend in relapse-free survival. Distribution of recurrence sites was comparable. LTG may provide survival outcomes similar to those of OTG when performed by an experienced surgical team. Further evidence is required for final conclusions, especially regarding its efficacy for stage II/III.