Deniz Kütük, Mehmet Ali Koç, Atıl Çakmak, Akın Fırat Kocaay
{"title":"Comparison of laparoscopic and open total gastrectomy with D2 lymphadenectomy for gastric cancer: a propensity score matched study.","authors":"Deniz Kütük, Mehmet Ali Koç, Atıl Çakmak, Akın Fırat Kocaay","doi":"10.1186/s12893-025-03044-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic total gastrectomy (LTG) is increasingly performed for gastric cancer, yet concerns remain regarding its oncologic adequacy compared to open total gastrectomy (OTG), especially outside of randomized clinical trials. Real-world data comparing both techniques are still limited.</p><p><strong>Methods: </strong>This retrospective cohort study included patients who underwent total gastrectomy with D2 lymphadenectomy for gastric cancer between January 2016 and December 2021 at a single tertiary center. Patients were grouped as LTG or OTG. Propensity score matching (1:1) was used to adjust for baseline variables. Long-term clinical outcomes and survival data were compared. Complications were graded using the Clavien-Dindo classification. Kaplan-Meier analysis was used to evaluate disease-free survival (DFS) and overall survival (OS).</p><p><strong>Results: </strong>After propensity score matching (24 LTG vs. 24 OTG), the LTG group demonstrated a significantly shorter hospital stay (6.79 ± 0.66 vs. 7.33 ± 0.64 days; p = 0.006), with comparable operative times (3.5 ± 0.42 vs. 3.5 ± 0.49 h; p = 1.000) and complication rates (16.7% vs. 20.8%; p = 0.71), all classified as Clavien-Dindo Grade I-II. Oncologic outcomes showed equivalent lymph node yield. Oncologic outcomes were equivalent, including lymph node yield (35.12 ± 9.32 vs. 36.46 ± 10.19; p = 0.639). Survival analysis revealed no significant differences: median overall survival was 6 years (95% CI: 3.87-8.12) for LTG vs. 4 years (2.16-5.83) for OTG (p = 0.541), and disease-free survival was 6 years (4.53-7.46) vs. 4 years (1.72-6.27) (p = 0.443), with a median follow-up of 28.4 months.</p><p><strong>Conclusion: </strong>Laparoscopic total gastrectomy is a safe and effective alternative to open surgery when performed by experienced surgeons. These findings support the feasibility of LTG in real-life clinical settings and complement existing evidence from randomized trials.</p><p><strong>Trial registration: </strong>retrospectively registered.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"298"},"PeriodicalIF":1.6000,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12893-025-03044-y","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Laparoscopic total gastrectomy (LTG) is increasingly performed for gastric cancer, yet concerns remain regarding its oncologic adequacy compared to open total gastrectomy (OTG), especially outside of randomized clinical trials. Real-world data comparing both techniques are still limited.
Methods: This retrospective cohort study included patients who underwent total gastrectomy with D2 lymphadenectomy for gastric cancer between January 2016 and December 2021 at a single tertiary center. Patients were grouped as LTG or OTG. Propensity score matching (1:1) was used to adjust for baseline variables. Long-term clinical outcomes and survival data were compared. Complications were graded using the Clavien-Dindo classification. Kaplan-Meier analysis was used to evaluate disease-free survival (DFS) and overall survival (OS).
Results: After propensity score matching (24 LTG vs. 24 OTG), the LTG group demonstrated a significantly shorter hospital stay (6.79 ± 0.66 vs. 7.33 ± 0.64 days; p = 0.006), with comparable operative times (3.5 ± 0.42 vs. 3.5 ± 0.49 h; p = 1.000) and complication rates (16.7% vs. 20.8%; p = 0.71), all classified as Clavien-Dindo Grade I-II. Oncologic outcomes showed equivalent lymph node yield. Oncologic outcomes were equivalent, including lymph node yield (35.12 ± 9.32 vs. 36.46 ± 10.19; p = 0.639). Survival analysis revealed no significant differences: median overall survival was 6 years (95% CI: 3.87-8.12) for LTG vs. 4 years (2.16-5.83) for OTG (p = 0.541), and disease-free survival was 6 years (4.53-7.46) vs. 4 years (1.72-6.27) (p = 0.443), with a median follow-up of 28.4 months.
Conclusion: Laparoscopic total gastrectomy is a safe and effective alternative to open surgery when performed by experienced surgeons. These findings support the feasibility of LTG in real-life clinical settings and complement existing evidence from randomized trials.
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