Abstract
Background: Limited researches focused on the application of laparoscopic gastrectomy (LG) in locally advanced gastric cancer (LAGC) patients following neoadjuvant chemotherapy (NACT). In this study, we aimed at illustrating the surgical and survival outcome of LG in LAGC patients following NACT.Methods: We performed a retrospective study of patients with LAGC who received either LG following NACT or upfront LG at Fujian Provincial Hospital between March 2013 and October 2018. Perioperative parameters, short-term and long-term outcomes were compared. The Kaplan-Meier estimator was used to describe the survival curves, and the differences were examined by the log-rank test.Results: In total, 76 consecutive patients were enrolled into the NACT-LG (41 patients) and LG (35 patients) group, respectively. There was no significant difference between the two groups for baseline characteristics, including age, sex, BMI, Eastern Clinical Oncology Group performance status, tumor size, location, Borrmann type, Lauren type, differentiation, cT stage, and surgical type (all P>0.05). The surgical trauma in terms of incision length and blood loss, and postoperative recovery in terms of first aerofluxus time, first time on liquid diets, drainage duration, and hospital stays were similar between the two groups (all P>0.05). The operation time was significantly longer for NACT-LG than for LG (286.5 vs. 248.9 min, P=0.008). There was no significant difference in surgical morbidity (19.5% vs. 22.9%, P=0.721) between the two groups. No patient died of postoperative complications in the NACT-LG group, and one patient (1/35, 2.9%) died of postoperative complications in the LG group (P=0.461). After NACT, the R0 resection rate was significantly higher (95.1% vs. 77.1%, P=0.049), and metastatic lymph nodes were less for NACT-LG than for LG (1 vs. 8, P=0.001). Compared with the LG group, the NACT-LG group had a significantly better DFS (59.4% vs. 14.4%, P=0.034) and better OS (69.0% vs. 37.4%, P=0.009) at 3 years.Conclusions: NACT does not decrease safety of LG for patients with LAGC and offer higher R0 resection rate and better disease-free and overall survival. For patients with LAGC, LG following NACT should be the priority treatment.
Complete mesogastric excision for locally advanced gastric cancer: short-term outcomes of a randomized clinical trial
