Department of Gastrointestinal Surgery, Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China.
Central Research Laboratory, Bashkir State Medical University, Ufa, Russia.
Langenbecks Arch Surg. 2021 May;406(3):641-650. doi: 10.1007/s00423-021-02114-y. Epub 2021 Apr 6.
Data about whether laparoscopic gastrectomy (LG) is applicable in serosa-positive (pT4a) gastric cancer patients remain rare. The purpose of this study is to compare the perioperative and long-term outcomes between the laparoscopic and open gastrectomy (OG) in pT4a gastric cancer patients who underwent curative resection.
A total of 1086 consecutive pT4a patients (101 patients with LG and 985 with OG) who underwent curative gastrectomy in a high-volume center between 2006 and 2016 were evaluated. Demographics, surgical, and oncologic outcomes were analyzed. Propensity score matching (PSM) analysis was performed to balance baseline confounders, and COX regression analysis was performed to identify independent prognostic factors.
After PSM adjustment, a well-balanced cohort comprising 101 patients who underwent LG and 201 who underwent OG was analyzed. Operative time (288.7 vs. 234.2 min; P < 0.001) was significantly longer, while estimated blood loss (172.8 vs. 220.7 ml; P < 0.001) was significantly less in the LG group compared with the OG group. There were no significant differences between groups in total number of harvested lymph nodes, postoperative stays, readmission rate, and postoperative complication rate. The 3-year overall survival (OS) rate was not significant different in the LG and OG groups (66.7% vs. 62.8%, P = 0.668), and the subsequent multivariate analysis revealed that the surgical approach was not an independent prognostic factor for OS (HR = 1.123; 95%CI: 0.803-1.570; P = 0.499). In sensitivity analysis including 78 pairs well-matched patients operated by an experienced surgeon, the results were similar to these for the matched entire cohort.
LG can be a safe and feasible approach for pT4a gastric cancer treatment. However, well-designed high-quality RCTs are expected to draw a definitive conclusion on this topic.
关于腹腔镜胃切除术（LG）是否适用于浆膜阳性（pT4a）胃癌患者的数据仍然很少。本研究的目的是比较在接受根治性切除的 pT4a 胃癌患者中，LG 与开腹胃切除术（OG）的围手术期和长期结果。
回顾性分析 2006 年至 2016 年期间在一个大容量中心接受根治性胃切除术的 1086 例连续 pT4a 患者（LG 组 101 例，OG 组 985 例）。分析人口统计学、手术和肿瘤学结果。进行倾向评分匹配（PSM）分析以平衡基线混杂因素，并进行 COX 回归分析以确定独立的预后因素。
PSM 调整后，分析了 101 例接受 LG 治疗和 201 例接受 OG 治疗的匹配良好的队列。LG 组的手术时间（288.7 分钟 vs. 234.2 分钟；P<0.001）明显延长，而估计出血量（172.8 毫升 vs. 220.7 毫升；P<0.001）明显减少。两组间总淋巴结清扫数、术后住院时间、再入院率和术后并发症发生率无显著差异。LG 组和 OG 组 3 年总生存率（OS）率无显著差异（66.7% vs. 62.8%，P=0.668），随后的多因素分析显示手术方式不是 OS 的独立预后因素（HR=1.123；95%CI：0.803-1.570；P=0.499）。在包括 78 对由经验丰富的外科医生进行手术的匹配良好的患者的敏感性分析中，结果与整个匹配队列的结果相似。
LG 可安全有效地治疗 pT4a 胃癌。然而，预计需要进行设计良好的高质量 RCT 来对此主题得出明确结论。
