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Laparoscopic versus open total gastrectomy for T4a gastric cancer: a propensity score-matched analysis of long-term outcomes

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Abstract

Evidence of implementation of laparoscopic total gastrectomy (LTG) for surgical T4a stage (sT4a) gastric cancer (GC) remains inadequate. This study aimed to compare short- and long-term outcomes of LTG versus open total gastrectomy (OTG) for sT4a GC. This retrospective cohort study was conducted using data from patients with sT4a GC underwent total gastrectomy from 2014 to 2020. Short-term outcomes included operative characteristics and postoperative complications. Long-term oncological outcomes focused on 3-, and 5-year overall survival (OS) and disease-free survival (DFS). Propensity score matching (PSM) was applied to reduce potential biases in baseline characteristics between groups. There was a total of 161 patients, in which 96 underwent LTG and 65 underwent OTG. After PSM, both groups consisted of 51 patients each, with balanced baseline characteristics. There were no significant differences between the two groups regarding blood loss, length of proximal resected margin, postoperative hospital stays, and overall and major postoperative complications. Most of the complications were classified as minor according to the Clavien–Dindo classification. Operating time was significantly longer in the LTG group (mean: 257 min vs. 231 min, p = 0.006). LTG was superior to OTG groups in time to flatus (mean: 3.0 days vs 3.9 days, p < 0.001). Five-year OS and DFS rates were similar between the two groups (44% and 33% vs. 43% and 28% in the LTG and OTG groups, respectively). Our findings indicate that LTG is a feasible and safe technique, exhibiting comparable long-term oncological outcomes to OTG for sT4a GC. LTG may be an acceptable alternative to OTG for the treatment of sT4a GC.

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Data availability

The data presented in this study are available on request from the corresponding author.

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Authors and Affiliations

  1. Department of Gastro-Intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam

    Vo Duy Long, Doan Thuy Nguyen, Dang Quang Thong, Tran Quang Dat, Nguyen Viet Hai & Nguyen Hoang Bac

  2. Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Vo Duy Long & Nguyen Hoang Bac

  3. Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Nguyen Lam Vuong

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Conflict of interest

Drs. Vo Duy Long, Doan Thuy Nguyen, Dang Quang Thong, Tran Quang Dat, Nguyen Viet Hai, Nguyen Lam Vuong, and Nguyen Hoang Bac disclose any potential or actual personal, political, or financial conflict of interest in the material, information or techniques described in the paper.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by Institutional Review Board, University Medical Center at Ho Chi Minh city. Approval to perform research on human subjects in this study was provided by the Institutional Review Board, University Medical Center Ho Chi Minh city.

Research involving human participants

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional and National) and with the Helsinki Declaration of 1964 and later version. Approval to perform research on human subjects in this study was provided by the Institutional Review Board, University Medical Center Ho Chi Minh city (with number: 1118/HĐĐĐ-ĐHYD).

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Long, V.D., Nguyen, D.T., Thong, D.Q. et al. Laparoscopic versus open total gastrectomy for T4a gastric cancer: a propensity score-matched analysis of long-term outcomes. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01910-7

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