Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan
Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan.
Anticancer Res. 2023 May;43(5):2203-2209. doi: 10.21873/anticanres.16383.
BACKGROUND/AIM: The impact of laparoscopic gastrectomy (LG), a standard gastric cancer (GC) management strategy, in advanced GC cases involving doublet adjuvant chemotherapy remains unclear. This study was aimed at comparing short- and long-term LG and open gastrectomy (OG) results.
Patients who underwent gastrectomy with D2 lymph node dissection for stage II/III GC between 2013 and 2020 were retrospectively analyzed. Patients were divided into two groups: patients undergoing LG (n=96, LG-group) and OG (n=148, OG-group). The primary outcome was relapse-free survival (RFS).
Compared with the OG group, the LG group was associated with a longer operation time (373 vs. 314 min, p<0.001), less blood loss (50 vs. 448 ml, p<0.001), fewer grade 3-4 complications (5.2 vs. 17.1%, p=0.005), and a shorter hospital stay (12 vs. 15 days, p<0.001). More lymph nodes were dissected in the LG group (49 vs. 40, p<0.001). The intergroup difference in prognosis was insignificant [5-year RFS: 60.4% (LG) vs. 63.1% (OG), p=0.825]. The LG group more frequently received doublet adjuvant chemotherapy (46.8 vs. 12.7%, p<0.001) and started treatments within 6 weeks after surgery (71.1% vs. 38.9%, p=0.017), and the completion rate of doublet AC was significantly higher in the LG group (85.4% vs. 58.8%, p=0.027). Compared to OG, LG for stage III GC tended to be associated with improved prognosis (HR=0.61, 95%CI=0.33-1.09, p=0.096).
LG for advanced GC may facilitate doublet regimens due to favorable postoperative outcomes and its intervention may contribute to survival benefits.
背景/目的：腹腔镜胃切除术（LG）作为一种标准的胃癌（GC）管理策略，在涉及双联辅助化疗的晚期 GC 病例中的影响仍不清楚。本研究旨在比较 LG 和开腹胃切除术（OG）的短期和长期结果。
回顾性分析了 2013 年至 2020 年间接受 D2 淋巴结清扫术治疗 II/III 期 GC 的患者。患者分为两组：接受 LG（n=96，LG 组）和 OG（n=148，OG 组）的患者。主要结局是无复发生存（RFS）。
与 OG 组相比，LG 组的手术时间更长（373 分钟 vs. 314 分钟，p<0.001），出血量更少（50 毫升 vs. 448 毫升，p<0.001），III/IV 级并发症更少（5.2% vs. 17.1%，p=0.005），住院时间更短（12 天 vs. 15 天，p<0.001）。LG 组的淋巴结清扫数量更多（49 个 vs. 40 个，p<0.001）。两组间预后差异无统计学意义[5 年 RFS：60.4%（LG）vs. 63.1%（OG），p=0.825]。LG 组更常接受双联辅助化疗（46.8% vs. 12.7%，p<0.001），且在术后 6 周内开始治疗（71.1% vs. 38.9%，p=0.017），LG 组双联 AC 完成率明显更高（85.4% vs. 58.8%，p=0.027）。与 OG 相比，LG 治疗 III 期 GC 可能与改善的预后相关（HR=0.61，95%CI=0.33-1.09，p=0.096）。
LG 治疗晚期 GC 可能由于术后结果有利而促进双联方案，其干预可能有助于生存获益。
