Comparisons of short-term and survival outcomes of laparoscopy-assisted versus open total gastrectomy for gastric cancer patients

// Xin-Zu Chen 1, 2, * , Shao-Yong Wang 1, 3, * , Yin-Su Wang 4 , Zi-Han Jiang 4 , Wei-Han Zhang 1, 2 , Kai Liu 1, 2 , Kun Yang 1, 2 , Xiao-Long Chen 1, 2 , Lin-Yong Zhao 1, 2 , Meng Qiu 5 , Hong-Feng Gou 5 , Zong-Guang Zhou 1, 6 and Jian-Kun Hu 1, 2 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China 2 Institute of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China 3 Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang, China 4 Faculty of Medicine, West China Medical School, Sichuan University, Chengdu, China 5 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China 6 Institute of Digestive Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China * These authors equally contributed to this work and are co-first authors Correspondence to: Jian-Kun Hu, email: hujkwch@126.com Keywords: gastric cancer, laparoscopy, gastrectomy, survival, surgical oncology Received: November 14, 2016 Accepted: March 30, 2017 Published: April 10, 2017 ABSTRACT Objectives: The safety and surgical oncology of laparoscopy-assisted total gastrectomy (LATG) remain inconclusive and challenging. This study aimed to compare the short-term and long-term outcomes between LATG and open total gastrectomy (OTG) procedures. Results: In the all-included analyses, there were 69 patients in the LATG group and 268 in the OTG group. LATG was as safe as OTG without increasing postoperative morbidity and mortality. Stage imbalance might introduce differences in the numbers of harvested lymph nodes in LATG (34.4 ± 12.0) and OTG (40.9 ± 16.9), whereas 95.7% of patients underwent D2/D2+ dissection during the LATG procedure. After a median 31 months of follow-up, the overall survival outcomes were comparable between the LATG and OTG procedures (HR = 1.16, 95% CI 0.68–1.97). Sensitivity analysis found comparable node retrieval and stage-specific or treatment-specific overall survival. Materials and Methods: A retrospective case-control study was conducted among gastric cancer patients who underwent either LATG or OTG with curative intention between June 2006 and December 2015. Data retrieval was based on the Surgical Gastric Cancer Patient Registry in the West China Hospital. The primary outcome was overall survival. The secondary outcomes were postoperative complication incidence and severity, operation duration, blood loss, number of harvested lymph nodes, and postoperative hospital stay. Matched pairwise case-control comparisons were performed as a sensitivity analysis. Conclusions: LATG by experienced surgeons possibly has comparable short-term surgical outcomes and long-term survival outcomes compared with OTG for gastric cancer patients. However, high-quality RCTs are necessary before confirmative judgment and recommendation as an optional treatment in general practice.