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25-09-2024 | Gastrectomy

Oncological long-term outcomes of laparoscopic versus open gastrectomy for cT3-4 gastric cancer at surgical staging: a propensity-score matched cohort study

Authors: Arrieta G. Manuel, Takahiro Kinoshita, Neda Amini, Eigo Akimoto, Masahiro Yura, Mitsumasa Yoshida, Takumi Habu, Hiromi Nagata, Masaru Komatsu, Junichi Sano, Daiki Terajima

Published in: Surgical Endoscopy

Abstract

Background

The oncological efficacy of laparoscopic surgery for advanced gastric cancer (AGC) has been evaluated by several randomized trials. However, the inclusion of earlier-stage disease was a limitation in previous studies.

Methods

Patients with cT3-4 gastric cancer, determined by surgical staging to minimize migration of earlier stages, treated at a tertiary cancer center from 2009 to 2018 were included. Based on the surgical approach, the patients were divided into two groups: the laparoscopic gastrectomy (LG) and the open gastrectomy (OG) and matched for age, sex, macroscopic appearance (type 4 or non-type 4), body mass index, estimated tumor size, clinical stage T3’T4, clinical N stage, pathologic T stage (T3 or T4), and type of surgery (total or distal gastrectomy).

Results

588 patients (221 LG, 367 OG) were included in the analysis. After 1:1 propensity-score matching, 386 patients (193 LG, 193 OG) were assigned for analysis. In the LG group, operation time was longer with lower blood loss. The incidence of postoperative complications (≥ grade III) did not differ significantly between the groups (OG: 8.3%, vs. LG: 9.3%). Overall survival (OS) was longer in the LG group (5-year OS: 79.3 vs. 73% HR 0.66, 95% CI 0.44–0.99, P = 0.0497). Relapse-free survival (RFS) did not show a statistical difference (5-year RFS: 69.5 vs. 68.7 HR 0.88, 95% CI 0.62–1.26, P = 0.487). Subgroup analysis for OS also demonstrated equivalent outcomes.

Conclusion

LG demonstrates comparable safety and efficacy to OG for advanced gastric cancer at surgical staging, with similar rates of severe complications and long-term oncological outcomes. Further research is needed to validate these findings, particularly for total gastrectomy and for patients from Western populations.

Graphical abstract

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Title: Oncological long-term outcomes of laparoscopic versus open gastrectomy for cT3-4 gastric cancer at surgical staging: a propensity-score matched cohort study
Authors: Arrieta G. Manuel
Takahiro Kinoshita
Neda Amini
Eigo Akimoto
Masahiro Yura
Mitsumasa Yoshida
Takumi Habu
Hiromi Nagata
Masaru Komatsu
Junichi Sano
Daiki Terajima
Publication date: 25-09-2024
Publisher: Springer US
Keywords: Gastrectomy
Gastrectomy
Gastric Cancer
Gastric Cancer
Published in: Surgical Endoscopy
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-024-11287-8

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Oncological long-term outcomes of laparoscopic versus open gastrectomy for cT3-4 gastric cancer at surgical staging: a propensity-score matched cohort study

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

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Abstract

Background

Methods

Results

Conclusion

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Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions