Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong, People's Republic of China.
Surg Endosc. 2023 Aug;37(8):5902-5915. doi: 10.1007/s00464-023-10052-7. Epub 2023 Apr 18.
BACKGROUND: This study was performed to evaluate the safety and efficacy of laparoscopic gastrectomy (LG) in patients with locally advanced gastric cancer (LAGC) who received neoadjuvant chemotherapy (NACT). METHODS: We retrospectively analyzed patients who underwent gastrectomy for LAGC (cT2-4aN+M0) after NACT from January 2015 to December 2019. The patients were divided into a LG group and an open gastrectomy (OG) group. The short- and long-term outcomes in both groups were examined following propensity score matching. RESULTS: We retrospectively reviewed 288 patients with LAGC who underwent gastrectomy following NACT. Of these 288 patients, 218 were enrolled; after 1:1 propensity score matching, each group comprised 81 patients. The LG group had significantly lower estimated blood loss than the OG group [80 (50-110) vs. 280 (210-320) mL, P < 0.001) but a longer operation time [205 (186.5-222.5) vs. 182 (170-190) min, P < 0.001], a lower postoperative complication rate (24.7% vs. 42.0%, P = 0.002), and a shorter postoperative hospitalization period [8 (7-10) vs. 10 (8-11.5) days, P = 0.001]. Subgroup analysis revealed that patients who underwent laparoscopic distal gastrectomy had a lower rate of postoperative complications than patients in the OG group (18.8% vs. 38.6%, P = 0.034); however, such a pattern was not seen in patients who underwent total gastrectomy (32.3% vs. 45.9%, P = 0.251). The 3-year matched cohort analysis showed no significant difference in overall survival or recurrence-free survival (log-rank P = 0.816 and P = 0.726, respectively) (71.3% and 65.0% in OG vs. 69.1% and 61.7% in LG, respectively). CONCLUSION: In the short term, LG following NACT is safer and more effective than OG. However, the long-term results are comparable.
背景：本研究旨在评估新辅助化疗（NACT）后接受腹腔镜胃切除术（LG）治疗局部进展期胃癌（LAGC）患者的安全性和疗效。
方法：我们回顾性分析了 2015 年 1 月至 2019 年 12 月期间接受 NACT 后行胃切除术治疗 LAGC（cT2-4aN+M0）的患者。患者分为 LG 组和开放胃切除术（OG）组。对两组患者进行倾向性评分匹配后，检查短期和长期结果。
结果：我们回顾性分析了 288 例接受 NACT 后行胃切除术治疗 LAGC 的患者。其中 288 例患者被纳入研究；经过 1：1 倾向评分匹配后，每组各有 81 例患者。LG 组的估计出血量明显低于 OG 组[80（50-110）比 280（210-320）mL，P<0.001]，但手术时间较长[205（186.5-222.5）比 182（170-190）min，P<0.001]，术后并发症发生率较低[24.7%比 42.0%，P=0.002]，术后住院时间较短[8（7-10）比 10（8-11.5）天，P=0.001]。亚组分析显示，行腹腔镜远端胃切除术的患者术后并发症发生率低于 OG 组（18.8%比 38.6%，P=0.034）；但行全胃切除术的患者无此差异（32.3%比 45.9%，P=0.251）。3 年匹配队列分析显示，总生存率和无复发生存率无显著差异（对数秩 P=0.816 和 P=0.726）（OG 组分别为 71.3%和 65.0%，LG 组分别为 69.1%和 61.7%）。
结论：短期内，NACT 后行 LG 比 OG 更安全、更有效。然而，长期结果相当。
World J Clin Cases. 2023-11-16
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