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Oncological outcomes of laparoscopic versus open radical total gastrectomy for upper-middle gastric cancer after neoadjuvant chemotherapy: a study of real-world data

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Abstract

Background

Laparoscopic technique has been increasingly used in gastrectomy, but the safety and feasibility of the laparoscopic total gastrectomy (LTG) for advanced proximal gastric cancer (PGC) after neoadjuvant chemotherapy (NAC) is unclear.

Methods

A retrospective analysis of 146 patients who received NAC followed by radical total gastrectomy at Fujian Medical University Union Hospital from January 2008 to December 2018 was performed. The primary endpoints were long-term outcomes.

Results

The patients were divided into two groups: 89 were in the LTG group and 57 were in the open total gastrectomy (OTG) group. The LTG group had a significantly shorter operative time (median 173 min vs. 215 min, p < 0.001), less intraoperative bleeding (62 ml vs. 135 ml, p < 0.001), higher total lymph node (LN) dissections (36 vs 31, p = 0.043), and higher total chemotherapy cycle completion rate (≥ 8 cycles) (37.1% vs. 19.7%, p = 0.027) than OTG. The 3-year overall survival (OS) of the LTG group was significantly higher than that of the OTG group (60.7% vs. 35%, p = 0.0013). Survival with inverse probability weighting(IPW) correction for Lauren type, ypTNM stage, NAC schemes and the times at which the surgery was performed showed that there was no significant difference in OS between the two groups (p = 0.463). Postoperative complications (25.8% vs. 33.3%, p = 0.215) and recurrence-free survival (RFS) (p = 0.561) between the LTG and OTG groups were also comparable.

Conclusion

In experienced gastric cancer surgery centers, LTG is recommended as the preferred option for such patients who performed NAC, owing to its long-term survival is not inferior to OTG, and it offers less intraoperative bleeding, better chemotherapy tolerance than conventional open surgery.

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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.

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Funding

Fujian Province Medical "Creating Double High" Construction Funding Support (Fujian Health Medical Administration NO.[2021]76). Funder: Huang Chang-ming.

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Author notes

  1. Hua-Long Zheng, Li-li Shen and Bin-bin Xu contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 **nquan Road, Fuzhou, 350001, Fujian, China

    Hua-Long Zheng, Li-li Shen, Bin-bin Xu, Qi-Yue Chen, Jun Lu, Zhen Xue,  Jia-Lin, Jian-Wei **e, ** Li, Chang-Ming Huang & Chao-Hui Zheng

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Hua-Long Zheng, Li-li Shen, Bin-bin Xu, Qi-Yue Chen, Jun Lu, Zhen Xue,  Jia-Lin, Jian-Wei **e, ** Li, Chang-Ming Huang & Chao-Hui Zheng

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Hua-Long Zheng, Li-li Shen, Bin-bin Xu, Qi-Yue Chen, Jun Lu, Zhen Xue,  Jia-Lin, Jian-Wei **e, ** Li, Chang-Ming Huang & Chao-Hui Zheng

  4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China

    Hua-Long Zheng, Li-li Shen, Bin-bin Xu, Qi-Yue Chen, Jun Lu, Zhen Xue,  Jia-Lin, Jian-Wei **e, ** Li, Chang-Ming Huang & Chao-Hui Zheng

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Contributions

LS, HLZ and BX contributed equally to this work and should be considered first coauthors. CHZ had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: LS, CHZ. Acquisition, analysis, or interpretation of data: JL, LS, QYC, ZX, BX, PL, JL. Drafting of the manuscript: LS, HLZ, BX. Critical revision of the manuscript for important intellectual content: HLZ, CHZ, LS, JWX, CMH. Statistical analysis: LS. Administrative, technical, or material support: CHZ. Supervision: CHZ.

Corresponding author

Correspondence to Chao-Hui Zheng.

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Disclosures

Drs. Hua-Long Zheng, Li–li Shen, Bin-bin Xu, Qi-Yue Chen, Jun Lu, Zhen Xue, Jia-Lin, Jian-Wei **e, ** Li, Chang-Ming Huang, Chao-Hui Zheng have no conflicts of interest to disclose.

Informed consent

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 versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Consent for publication

This article doesn’t report an individual participant's data in any form.

Validity and feasibility of the statistics

The validity and feasibility of statistics have been evaluated by a biostatistician, Wu FQ.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 23 KB)

Supplementary file2 (JPG 27 KB)—eFig. 1 Cut-off of LN dissections through restricted cubic spline

464_2023_10084_MOESM3_ESM.jpg

Supplementary file3 (JPG 1194 KB)—eFig. 2 Comparison of LN dissections between laparoscopic total gastrectomy (LTG) group and open total gastrectomy (OTG) group. A Comparison of mean No. of lymph node dissection in each station between the two groups. B, C Comparison of mean No. of lymph node dissection in each station between the two groups according to RECIST standard. B CR/PR subgroup. C PD/SD subgroup. D, E Comparison of mean No. of lymph node dissection in each station between the two groups according to ypTNM stage. D stage I. E stage II/III

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Zheng, HL., Shen, Ll., Xu, Bb. et al. Oncological outcomes of laparoscopic versus open radical total gastrectomy for upper-middle gastric cancer after neoadjuvant chemotherapy: a study of real-world data. Surg Endosc 37, 6288–6297 (2023). https://doi.org/10.1007/s00464-023-10084-z

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