Long- and short-term outcomes of laparoscopic gastrectomy versus open gastrectomy in patients with clinically and pathological locally advanced gastric cancer: a propensity-score matching analysis

BackgroundOne of the most controversial areas in gastrointestinal oncology is the benefit of postoperative chemoradiotherapy (CRT) over chemotherapy (CT) alone after D2 dissection of locally advanced gastric cancer (LAGC). We aimed to identify the LAGC patients who may benefit from adjuvant CRT.MethodsWe analyzed retrospectively 188 patients receiving radical gastrectomy with D2 dissection for LAGC in our hospital. Patients were divided into two balanced groups by using propensity score matching: CRT group (n = 94) received adjuvant CRT, and CT group received adjuvant CT alone.ResultsAt a median follow-up of 27.10 months, 188 patients developed 79 first recurrence events (36 in CRT group and 43 in CT group). Our results showed that adjuvant CRT significantly decreased the risk of developing local regional recurrence (LRR) when compared to CT alone (14.9% vs. 25.5%, p = 0.044), while the estimated 3-year disease-free survival (DFS) was comparable between the CRT and CT groups (59.3% vs. 50.9%, p = 0.239). In the subgroup analysis, a significantly decreased LRR rate was also observed in LAGC patients with N1-3a stage after adjuvant CRT (p = 0.046), but not for N3b. Para-aortic lymph nodes (station No. 16) were the most frequent sites of LRR. After receiving radiotherapy, recurrence of 16 a2 region and 16 b1 region were significantly deceased (p = 0.026 and p = 0.044, respectively). Patients who received irradiation more than 4 months after surgery showed an increased risk of LRR (p = 0.022).ConclusionsThis study showed that adjuvant CRT significantly reduced LRR after D2 dissection of LAGC. Early initiation of adjuvant RT with clinical target volume encompassing a2 and b1 regions of para-aortic lymph nodes is recommended for pN1-3a patients after D2 dissection.

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Long-Term Oncologic Result of Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Propensity Score-Matching Analysis

10.21203/rs.3.rs-111292/v1 ◽

2020 ◽

Author(s):

Si-yuan Wu ◽

Meng-Hsing Ho ◽

Hao-Ming Chang ◽

Kuo-Feng Hsu ◽

Jyh-Cherng Yu ◽

...

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Tumor Size ◽

Laparoscopic Gastrectomy ◽

Laparoscopic Group ◽

Open Gastrectomy ◽

Advanced Stage ◽

Propensity Score Matching Analysis

Abstract Background: Laparoscopic gastrectomy is an acceptable procedure for early-stage gastric cancer; however, most patients are diagnosed at an advanced stage and older age in Taiwan. The feasibility and safety of applying laparoscopic gastrectomy in daily practice remains unclear. This study aimed to examine the short- and long-term outcomes of laparoscopic gastrectomy versus open procedures.Methods: From 2007 to 2015, 192 patients who underwent open gastrectomy and 189 patients who underwent laparoscopic gastrectomy for gastric cancer at a single center were included. Propensity score-matching analysis was used to adjust selection biases associated with age, preoperative hemoglobulin, extent of resection, tumor size, and stage of disease. The demographics, perioperative parameters, postoperative short-term results, and 5-year survival data were analyzed.Results: Open gastrectomy was more frequently performed in the elderly, larger tumor size, advanced stage of disease, and disease requiring total gastrectomy or combined organ resection. After propensity score-matching, 108 patients with laparoscopic gastrectomy were compared to 108 patients with open gastrectomy. The morbidity rates were not different in both groups (25.9%), while hospital stay was shorter in the laparoscopic group (16.0 vs. 18.8 days, p = 0.04). The 5-year overall survival and disease-free survival were superior in the laparoscopic group (p = 0.03 and p = 0.01, respectively); however, the survival differences were not significant in the subgroup analysis by stage. Laparoscopic gastrectomy had fewer recurrences than open gastrectomy. The pattern of recurrence was not different between the groups.Conclusions: Laparoscopic gastrectomy can be safely applied in both early and locally advanced gastric cancer without compromising oncologic outcomes.Trial registration: Retrospective registration.

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