Sugimura Keijiro, Motoori Masaaki, Kentaro Kishi, Yamamoto Kazuyoshi, Takeno Atsushi, Hara Hisashi, Hamakawa Takuya, Murakami Kohei, Nakahara Yujiro, Masuzawa Toru, Omori Takeshi, Kurokawa Yukinori, Fujitani Kazumasa, Doki Yuichiro
Department of Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
Department of Surgery, Osaka General Medical Center, Osaka, Japan.
Surg Endosc. 2025 Apr;39(4):2304-2315. doi: 10.1007/s00464-025-11595-7. Epub 2025 Feb 13.
We investigated the safety and efficacy of laparoscopic gastrectomy (LG) in patients with locally advanced gastric cancer who underwent neoadjuvant chemotherapy (NAC).
This study included 247 consecutive patients with advanced gastric cancer who underwent NAC followed by gastrectomy between 2007 and 2017 at one of six institutions. The patients were divided into the open gastrectomy (OG) and LG groups. The short- and long-term outcomes in both groups were investigated after propensity score matching.
After propensity score matching, 72 pairs of patients were selected. The baseline characteristics were not significantly different after matching. Compared with the OG group, the LG group had a significantly longer operative time (360 vs. 305 min, P = 0.002) and less intraoperative blood loss (271 vs. 652 mL, P < 0.001). The LG group had more harvested lymph nodes than the OG group (57.4 vs. 45.1, P < 0.001). The frequency of Clavien-Dindo grade ≥ 2 postoperative complications was not significantly different (26% vs. 22%, P = 0.698). The interval between surgery and postoperative chemotherapy was significantly shorter in the LG group (48.7 vs. 68.6 days, P = 0.048). The 5-year overall survival rates in the OG and LG groups were 54.4% and 53.5%, respectively. The overall survival was similar between the two groups (P = 0.773). No significant differences were observed between the two groups in terms of the type of recurrence, including lymph node, hematogenous, and peritoneal recurrences (P = 1.000, P = 1.000, and P = 0.686, respectively).
Based on both short- and long-term results, LG is a potential therapeutic option for patients with gastric cancer who undergo NAC.
我们调查了接受新辅助化疗（NAC）的局部晚期胃癌患者行腹腔镜胃切除术（LG）的安全性和疗效。
本研究纳入了2007年至2017年期间在六家机构之一接受NAC后行胃切除术的247例连续性晚期胃癌患者。患者被分为开腹胃切除术（OG）组和LG组。在倾向评分匹配后，对两组的短期和长期结局进行了调查。
倾向评分匹配后，选择了72对患者。匹配后基线特征无显著差异。与OG组相比，LG组手术时间显著更长（360 vs. 305分钟，P = 0.002），术中出血量更少（271 vs. 652毫升，P < 0.001）。LG组切除的淋巴结比OG组更多（57.4 vs. 45.1，P < 0.001）。Clavien-Dindo≥2级术后并发症的发生率无显著差异（26% vs. 22%，P = 0.698）。LG组手术与术后化疗之间的间隔显著更短（48.7 vs. 68.6天，P = 0.048）。OG组和LG组的5年总生存率分别为54.4%和53.5%。两组的总生存率相似（P = 0.773）。两组在复发类型方面未观察到显著差异，包括淋巴结复发、血行转移和腹膜复发（分别为P = 1.000、P = 1.000和P = 0.686）。
基于短期和长期结果，LG是接受NAC的胃癌患者的一种潜在治疗选择。
