KEY TAKEAWAYS
- The study aimed to compare long-term outcomes of laparoscopic vs. OTG after NACT in AGC.
- Researchers noticed that LTG with D2 lymphadenectomy offers similar 3-year OS and DFS to OTG in patients with AGC post-NACT.
Yinkui Wang and the team aimed to evaluate and compare the long-term outcomes of laparoscopic total gastrectomy (LTG) vs open total gastrectomy (OTG) in patients with advanced gastric cancer (AGC) who underwent neoadjuvant chemotherapy (NACT).
By analyzing survival rates, including overall survival (OS) and disease-free survival (DFS), the research aimed to determine whether LTG could offer a viable alternative to OTG, particularly in terms of long-term efficacy. The outcomes were assessed over 3 years, focusing on the effectiveness and safety of LTG compared to the traditional open approach.
They performed an inclusive analysis involving patients with AGC who received NACT before surgery. Patients were enrolled into either the LTG or OTG group. To ensure comparability between the 2 groups, propensity score matching (PSM) was conducted using a 1:2 ratio, applying a 0.15 calliper width.
The study compared 3-year OS and DFS between the LTG and OTG groups before and after PSM. Survival rates were calculated using the Kaplan‒Meier method, and differences were evaluated through a log-rank test. Univariate and multivariate Cox proportional hazard analyses were utilized to estimate prognostic factors’ effects on survival and determine the hazard ratio (HR) between LTG and patients with OTG.
About 144 patients completed the follow-up, with 24 in the LTG group and 120 in the OTG group. After an average follow-up of 64.40 months, there were no significant differences observed in the 3-year OS or DFS rates between the two groups, both before (P = 0.453 and P = 0.362, respectively) and after PSM (P = 0.972 and P = 0.884, respectively). Multivariate Cox proportional hazards analysis identified the ypN stage as an independent risk factor for worse OS (P = 0.013).
The study concluded that LTG with D2 lymphadenectomy when performed by an experienced surgical team, provides comparable 3-year OS and DFS outcomes to OTG in patients with AGC following NACT.
This study was funded by the Beijing Municipal Health Commission (DFL20181103, ZYLX201701) and the Beijing Hospitals Authority Innovation Studio of Young Staff Funding Support (202123).
Source: https://pubmed.ncbi.nlm.nih.gov/39215275/
Wang Y, Lei X, Shan F, et al. (2024). “Long-term outcomes of laparoscopic versus open total gastrectomy in patients with advanced gastric cancer after neoadjuvant chemotherapy: a retrospective cohort study. BMC Cancer.” 2024;24(1):1074. Published 2024 Aug 30. doi:10.1186/s12885-024-12669-w
