Abstract
Comparisons of laparoscopy-assisted gastrectomy (LAG) and open gastrectomy (OG) in the setting of neoadjuvant chemotherapy (NACT) are lacking. A prospectively maintained database of patients with gastric cancer who underwent LAG or OG following NACT from June 2013 to March 2016 was retrospectively reviewed. Perioperative and survival outcomes were compared between the LAG and OG groups. In total, 174 patients were identified from the database. After PSM analysis, 45 patients who underwent OG were one-to-one matched to 45 patients who underwent LAG in the setting of NACT. These two groups had similar outcomes in terms of intra- and postoperative complications and 3-year overall survival. However, the LAG group had a longer operation time (P = 0.031) and lower estimated blood loss (P = 0.001). Moreover, compared with patients in the OG group, those in the LAG group had fewer days until first ambulation (P = 0.028), first flatus (P = 0.015), first liquid diet (P = 0.035), and first soft diet (P = 0.024) and a shorter postoperative hospital stay (P = 0.041). Additionally, despite an equivalent total number of retrieved lymph nodes between the two groups, the OG group had marginally more lymph nodes dissected from the splenic hilum (P = 0.032) and splenic artery area (P = 0.020). The present study indicates that LAG performed by well-qualified surgeons for treatment of locally advanced gastric cancer after preoperative chemotherapy is as acceptable as OG in terms of oncological outcomes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108. https://doi.org/10.3322/caac.21262
Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surgical laparoscopy & endoscopy, vol 4, pp 146–148. https://www.ncbi.nlm.nih.gov/pubmed/8180768. PMID: 8180768
Kim KH, Kim SH, Kim MC (2014) How much progress has been made in minimally invasive surgery for gastric cancer in Korea?: a viewpoint from Korean prospective clinical trials. Medicine (Baltimore) 93:e233. https://doi.org/10.1097/MD.0000000000000233
Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357. https://doi.org/10.1200/JCO.2015.63.7215
Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized trial (KLASS trial). Ann Surg 251:417–420. https://doi.org/10.1097/SLA.0b013e3181cc8f6b
Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173. https://doi.org/10.1007/s00464-004-8808-y
Lan H, Zhu N, Lan Y, Jin K, Teng L (2015) Laparoscopic gastrectomy for gastric cancer in China: an overview. Hepatogastroenterology 62:234–239 https://www.ncbi.nlm.nih.gov/pubmed/25911902. PMID: 25911902
Choi YY, Noh SH, Cheong JH (2015) Evolution of gastric cancer treatment: from the golden age of surgery to an era of precision medicine. Yonsei Med J 56:1177–1185. https://doi.org/10.3349/ymj.2015.56.5.1177
Ajani JA, D’Amico TA, Almhanna K, Bentrem DJ, Besh S, Chao J, Das P, Denlinger C, Fanta P, Fuchs CS, Gerdes H, Glasgow RE, Hayman JA, Hochwald S, Hofstetter WL, Ilson DH, Jaroszewski D, Jasperson K, Keswani RN, Kleinberg LR, Korn WM, Leong S, Lockhart AC, Mulcahy MF, Orringer MB, Posey JA, Poultsides GA, Sasson AR, Scott WJ, Strong VE, Varghese TK Jr, Washington MK, Willett CG, Wright CD, Zelman D, McMillian N, Sundar H, network National comprehensive cancer (2015) Esophageal and esophagogastric junction cancers, version 1.2015. J Natl Compr Cancer Netw 13(2):194–227 https://www.ncbi.nlm.nih.gov/pubmed/25691612. PMID: 25691612
Ahn HS, Jeong SH, Son YG, Lee HJ, Im SA, Bang YJ, Kim HH, Yang HK (2014) Effect of neoadjuvant chemotherapy on postoperative morbidity and mortality in patients with locally advanced gastric cancer. Br J Surg 101(12):1560–1565. https://doi.org/10.1002/bjs.9632
Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (Corean trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15(7):767–774. https://doi.org/10.1016/S1470-2045(14)70205-0
Ghezzi F, Cromi A, Ditto A, Vizza E, Malzoni M, Raspagliesi F, Uccella S, Corrado G, Cosentino F, Gotsch F, Martinelli F, Franchi M (2013) Laparoscopic versus open radical hysterectomy for stage Ib2-Iib cervical cancer in the setting of neoadjuvant chemotherapy: a multi-institutional cohort study. Ann Surg Oncol 20(6):2007–2015. https://doi.org/10.1245/s10434-012-2777-5
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213 https://www.ncbi.nlm.nih.gov/pubmed/15273542. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360123/pdf/20040800s00003p205.pdf. PMID: 15273542
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised Recist guideline (version 1.1). Eur J Cancer 45(2):228–247. https://doi.org/10.1016/j.ejca.2008.10.026
Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112. https://doi.org/10.1007/s10120-011-0041-5
D’Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17:2265–2281 https://www.ncbi.nlm.nih.gov/pubmed/9802183. PMID: 9802183
Kim DJ, Lee JH, Kim W (2015) Comparison of the major postoperative complications between laparoscopic distal and total gastrectomies for gastric cancer using Clavien-Dindo classification. Surg Endosc 29(11):3196–3204. https://doi.org/10.1007/s00464-014-4053-1
Cui M, Li Z, Xing J, Yao Z, Liu M, Chen L, Zhang C, Yang H, Zhang N, Tan F, Jiang B, Di J, Wang Z, Ji J, Su X (2015) A prospective randomized clinical trial comparing D2 dissection in laparoscopic and open gastrectomy for gastric cancer. Med Oncol 32(10):241. https://doi.org/10.1007/s12032-015-0680-1
Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27:286–294. https://doi.org/10.1007/s00464-012-2442-x
Sato H, Shimada M, Kurita N, Iwata T, Nishioka M, Morimoto S, Yoshikawa K, Miyatani T, Goto M, Kashihara H, Takasu C (2012) Comparison of long-term prognosis of laparoscopy-assisted gastrectomy and conventional open gastrectomy with special reference to D2 lymph node dissection. Surg Endosc 26:2240–2246. https://doi.org/10.1007/s00464-012-2167-x
Kim YW, Reim D, Park JY, Eom BW, Kook MC, Ryu KW, Yoon HM (2016) Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer. Surg Endosc 30:1547–1552. https://doi.org/10.1007/s00464-015-4372-x
Ding J, Liao GQ, Liu HL, Liu S, Tang J (2012) Meta-analysis of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer. J Surg Oncol 105:297–303. https://doi.org/10.1002/jso.22098
Zou ZH, Zhao LY, Mou TY, Hu YF, Yu J, Liu H, Chen H, Wu JM, An SL, Li GX (2014) Laparoscopic vs open D2 gastrectomy for locally advanced gastric cancer: a meta-analysis. World J Gastroenterol 20:16750–16764. https://doi.org/10.3748/wjg.v20.i44.16750
Lee JH, Nam BH, Ryu KW, Ryu SY, Park YK, Kim S, Kim YW (2015) Comparison of outcomes after laparoscopy-assisted and open total gastrectomy for early gastric cancer. Br J Surg 102:1500–1505. https://doi.org/10.1002/bjs.9902
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Research activities involving the study of existing data are exempt from the requirement for institutional review board approval.
Competing Interests
The authors declare they have no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Xi, HQ., Zhang, KC., Li, JY. et al. Comparison of Perioperative and Survival Outcomes of Laparoscopic Versus Open Gastrectomy after Preoperative Chemotherapy: a Propensity Score–Matched Analysis. Indian J Surg 82, 42–49 (2020). https://doi.org/10.1007/s12262-019-01880-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-019-01880-w