Long-term oncological outcomes of minimally invasive versus open gastrectomy for cancer

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-02-01 DOI:10.1016/j.amjsurg.2024.116134

Francesco Abboretti , Laura Didisheim , Hugo Teixeira Farinha , Markus Schäfer , Styliani Mantziari

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引用次数: 0

Abstract

Background

Although laparoscopy is widely used in oncologic digestive surgery, many centers are still reluctant to replace open surgery for gastric cancer treatment, especially in advanced disease. The aim of this study was to assess long-term survival and recurrence in patients after laparoscopic (LG) versus open (OG) oncological gastrectomy, in a tertiary reference center.

Methods

All consecutive patients with gastric adenocarcinoma undergoing curative gastrectomy between December 2007 and December 2021 were retrospectively analyzed. Clinico-pathological characteristics, survival and recurrence were compared among LG, OG or converted (CoG) patients. The ×2 test was used for categorical variables and the Mann-Whitney U test for continuous ones. Survival was assessed with the Kaplan-Meier method and log-rank test, as well as a multivariable Cox regression analysis.

Results

Among 156 included patients, 49 (31.4 %) were in the LG group, 93 (59.6 %) in the OG group, and 14 (9 %) in the CoG group. Baseline demographics were similar among the groups. R0 resection rates were 75.5 % in LG, 80.6 % in OG, and 64.3 % in CoG (p = 0.489). Open surgery was associated with a higher mean lymph node yield (28.4 ± 11.6) compared to LG (22.8 ± 9.7) and CoG (26.5 ± 12.3, p = 0.036). Severe postoperative complications were higher in the CoG group (64.3 % CoG versus 29 % OG, 32.7 % LG, p = 0.035). The CoG group had a significantly inferior disease-free survival (p = 0.012 vs OG, p = 0.003 vs LG; 53.3 % OG, 62.7 % LG and 28.1 % CoG) although overall survival was similar (57.1 % OG, 62.7 % LG and 32.7 % CoG, all p > 0.005).

Conclusions

Laparoscopic gastrectomy, while associated with a lower lymph node yield, provides similar overall survival rates compared to open surgery. Conversion to open surgery was associated with higher major postoperative morbidity and inferior disease-free survival.

Abstract Image

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微创与开放式胃切除术治疗癌症的长期肿瘤预后。

背景：虽然腹腔镜在肿瘤消化外科手术中应用广泛，但许多中心仍不愿意取代开放手术治疗胃癌，特别是在晚期疾病中。本研究的目的是在三级参考中心评估腹腔镜（LG）与开放式（OG）肿瘤胃切除术后患者的长期生存率和复发率。方法：回顾性分析2007年12月至2021年12月连续行根治性胃切除术的所有胃腺癌患者。比较LG、OG和转归（CoG）患者的临床病理特征、生存率和复发率。分类变量采用×2检验，连续变量采用Mann-Whitney U检验。生存率评估采用Kaplan-Meier法和log-rank检验，以及多变量Cox回归分析。结果：156例患者中，LG组49例（31.4%），OG组93例（59.6%），CoG组14例（9%）。各组的基线人口统计数据相似。R0切除率LG为75.5%，OG为80.6%，CoG为64.3% （p = 0.489）。开放手术的平均淋巴结清扫率（28.4±11.6）高于LG（22.8±9.7）和CoG（26.5±12.3,p = 0.036）。CoG组术后严重并发症发生率较高（CoG组64.3%，OG组29%，LG组32.7%,p = 0.035）。CoG组无病生存期明显低于OG组（p = 0.012, p = 0.003）；53.3% OG， 62.7% LG和28.1% CoG)，尽管总生存率相似（57.1% OG， 62.7% LG和32.7% CoG，均p < 0.05）。结论：腹腔镜胃切除术，虽然与较低的淋巴结率相关，但与开放手术相比，提供了相似的总生存率。转为开放手术与较高的术后主要发病率和较差的无病生存率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.