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Comparison of long-term oncologic outcomes laparoscopy-assisted gastrectomy and open gastrectomy for gastric cancer

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Abstract

Purpose

Laparoscopy-assisted gastrectomy (LAG) is proven by considerable studies as a safe procedure for early gastric cancer (EGC), but its long-term oncologic outcomes in advanced gastric cancer (AGC) have not been well-described. This study aimed at verifying the non-inferiority of LAG in the treatment of EGC and comparing the oncological feasibility of LAG and open gastrectomy (OG) for AGC.

Methods

A total of 209 consecutive patients who underwent LAG or OG with D2 lymph node dissection between December 2008 and November 2012 were included. The survival rate was estimated with the Kaplan–Meier method and the risk factors affecting the survival and recurrence were evaluated with Cox regression models. Subgroup analysis was performed in AGC patients receiving both distal and total gastrectomy.

Results

Of 209 patients, 194 (92.8%; mean age, 62.7 years; 56 [28.9%] women) eligible patients were finally enrolled in this study. No significant differences in the number of lymph nodes retrieved and postoperative complications were observed between patients receiving LAG and OG. During a mean follow-up of 58.3 ± 38.1 months (range 0–121 months), the 5-year overall survival and disease-free survival rates were 56.1% and 53.0% for LAG, and 57.7% and 50.9% for OG. In the subgroup analysis for AGC, laparoscopy-assisted distal gastrectomy and total gastrectomy did not result in inferior long-term outcomes, and recurrence was found in 49 patients (31.2%). Age more than 65 years and the advanced tumor stage were independent risk factors of survival.

Conclusion

LAG is a feasible and safe treatment for gastric cancer, with good oncologic results.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

LAG:

Laparoscopy-assisted gastrectomy

LADG:

Laparoscopy-assisted distal gastrectomy

RCT:

Randomized clinical trials

EGC:

Early gastric cancer

AGC:

Advanced gastric cancer

OG:

Open gastrectomy

LATG:

Laparoscopic-assisted total gastrectomy

DFS:

Disease-free survival

OS:

Overall survival

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Author notes

  1. Xin-Yu Mao and Hua Zhu contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210011, Jiangsu, China

    Xin-Yu Mao, Hua Zhu, Wei Wei, Xin-Lei Xu & Bao-Lin Wang

  2. Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China

    Wei-Zhi Wang

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  1. Xin-Yu Mao
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Contributions

XM was the major contributor in the acquisition of data, analysis and interpretation of data, and drafting of the manuscript. HZ and WW contributed to the analysis and interpretation of data. BW was the major contributor of the study conception and design and critical revision of the manuscript. WW and XX were substantially involved in the acquisition of data. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Wei-Zhi Wang or Bao-Lin Wang.

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The authors declare that they have no competing interests.

Ethics approval

All the conduction of our investigation complied with the Declaration of Helsinki and the ethical standards of national research committee, and with the clinical research ethics committee of The Second Affiliated Hospital of Nanjing Medical University.

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Informed consent for operation was obtained from all patients.

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Online resource 1

(DOCX 16 kb).

Online resource 2

Comparison of OS ad DFS for LAG and OG group according to tumor, node, metastasis classification staging system. a Overall survival for pathologic stage I; b Disease-free survival for pathologic stage I; c Overall survival for pathologic stage II; d Disease-free survival for pathologic stage II; e Overall survival for pathologic stage III; f Disease-free survival for pathologic stage III (TIF 1752 kb).

High resolution image (PNG 325 kb).

Online resource 3

Comparison of OS ad DFS for LAG and OG group for EGC and AGC. a Overall survival for EGC; b Disease-free survival for EGC; c Overall survival for AGC; d Disease-free survival for AGC (TIF 1355 kb).

High resolution image (PNG 227 kb).

Online resource 4

Data (XLSX 58 kb).

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Mao, XY., Zhu, H., Wei, W. et al. Comparison of long-term oncologic outcomes laparoscopy-assisted gastrectomy and open gastrectomy for gastric cancer. Langenbecks Arch Surg 406, 437–447 (2021). https://doi.org/10.1007/s00423-020-01996-8

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