局所進行胃癌に対する術前化学療法後の腹腔鏡下噴門側胃切除術と開腹噴門側胃切除術の比較：短期および長期の転帰
Mingtao Liang1, Jianan Tan2, Shengning Zhou2
1Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China.
Background:
Laparoscopic gastrectomy (LG) represents a technically challenging procedure for locally advanced gastric cancer (LAGC) after neoadjuvant chemotherapy (NAC). The safety and efficacy profiles of LG following NAC remain incompletely defined. This study aimed to compare short- and long-term outcomes between LG and open gastrectomy (OG) in NAC-treated LAGC patients.
Methods:
We retrospectively analyzed consecutive LAGC patients undergoing LG or OG following NAC at our institution (Jan 2010-Dec 2019). Data from the prospectively maintained gastric surgery database were evaluated for demographic characteristics, operative parameters, perioperative morbidity, and oncological outcomes.
Results:
Among 85 patients (46 LG, 39 OG), LG showed reduced blood loss, shorter hospitalization, faster bowel recovery, and earlier oral intake versus OG. Operative time was similar (LG 224 ± 64 min vs. OG 183 ± 52 min, P = 0.212). Complication rates were 19.6% (LG) vs. 25.6% (OG) (P = 0.683). At median 52-month follow-up, recurrence rates were 32.6% vs. 41.0% (P = 0.309). Five-year overall survival (51.8% vs. 56.7%, P = 0.492) and disease-free survival (45.3% vs. 52.4%, P = 0.443) showed no significant differences. The analysis involving multiple variables validated that the type of surgical method was not a standalone prognostic indicator for overall survival (P = 0.116) or disease-free survival (P = 0.108).
Conclusions:
Laparoscopic gastrectomy provides non-inferior technical safety and oncologic outcomes compared to open gastrectomy for LAGC after NAC. Given its benefits of being minimally invasive, such as attenuated surgical trauma and faster postoperative recovery, LG should be considered a standard therapeutic option for appropriately selected patients.
