Outcomes of Laparoscopic Radical Dissection in Gastric Cancer Patients Based on the Systematic Mesogastric Excision Concept: A Retrospective Study.

Aim: Laparoscopic systematic mesogastric excision (LSME) is an innovative theory and may lead to better outcomes for the treatment of locally advanced gastric cancers (LAGC). The purpose of this study was to compare outcomes after LSME to those after traditional laparoscopic D2 dissection (TLD2) in patients with LAGC.

Methods: From January 2018 to December 2020, 675 patients with LAGC underwent LSME and TLD2 at The First Affiliated Hospital of Bengbu Medical University. Of these, 202 conformed to the inclusion criteria and were included in the study after propensity score matching (PSM). The primary endpoints of this study were 5-year disease-free survival (DFS) and overall survival (OS). The secondary endpoints included surgical outcomes and postoperative complications.

Results: The demographic and pathological characteristics of the patients in both groups were well balanced after PSM. The 5-year DFS rates were 25.2% and 39.2% in the TLD2 group and the LSME group (p = 0.044), respectively. The difference in 5-year overall survival between the two groups was not statistically significant (39.1% in TLD2 vs. 43.2% in LSME, p = 0.370). LSME was associated with less intraoperative blood loss (21.3 ± 9.1 mL in LSME vs. 33.3 ± 11.9 mL in TLD2, p < 0.001), more dissected lymph nodes (LNs) (45.0 ± 16.0 LNs in LSME vs. 40.0 ± 14.0 LNs in TLD2; p = 0.019), and fewer lower limb thromboses (LSME: 6.9% vs. TLD2: 17.8%; p = 0.019). The other postoperative morbidities were similar.

Conclusions: LSME is safe for the treatment of LAGC because it results in fewer postoperative complications. Compared with TLD2, LSME may decrease local recurrence rate and improve 5-year DFS, but there is no significant difference in 5-year OS.