Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Comparison of Laparoscopic and Open Gastrectomy for Patients With Gastric Cancer Treated With Neoadjuvant Chemotherapy: A Multicenter Retrospective Study Based on the Korean Gastric Cancer Association Nationwide Survey

  • Seul Ki Oh (Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Chang Seok Ko (Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Seong-A Jeong (Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jeong Hwan Yook (Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Moon-Won Yoo (Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Beom Su Kim (Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • In-Seob Lee (Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Chung Sik Gong (Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Sa-Hong Min (Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Na Young Kim (Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • the Information Committee of the Korean Gastric Cancer Association (Korean Gastric Cancer Association)
  • Received : 2023.03.24
  • Accepted : 2023.07.17
  • Published : 2023.07.31
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Abstract

Purpose: Despite scientific evidence regarding laparoscopic gastrectomy (LG) for advanced gastric cancer treatment, its application in patients receiving neoadjuvant chemotherapy remains uncertain. Materials and Methods: We used the 2019 Korean Gastric Cancer Association nationwide survey database to extract data from 489 patients with primary gastric cancer who received neoadjuvant chemotherapy. After propensity score matching analysis, we compared the surgical outcomes of 97 patients who underwent LG and 97 patients who underwent open gastrectomy (OG). We investigated the risk factors for postoperative complications using multivariate analysis. Results: The operative time was significantly shorter in the OG group. Patients in the LG group had significantly less blood loss than those in the OG group. Hospital stay and overall postoperative complications were similar between the two groups. The incidence of Clavien-Dindo grade ≥3 complications in the LG group was comparable with that in the OG group (1.03% vs. 4.12%, P=0.215). No statistically significant difference was observed in the number of harvested lymph nodes between the two groups (38.60 vs. 35.79, P=0.182). Multivariate analysis identified body mass index (odds ratio [OR], 1.824; 95% confidence interval [CI], 1.029-3.234; P=0.040) and extent of resection (OR, 3.154; 95% CI, 1.084-9.174; P=0.035) as independent risk factors for overall postoperative complications. Conclusions: Using a large nationwide multicenter survey database, we demonstrated that LG and OG had comparable short-term outcomes in patients with gastric cancer who received neoadjuvant chemotherapy.

Keywords

Acknowledgement

This research was supported by the nationwide survey project of the Information Committee, funded by the Korean Gastric Cancer Association (grant number: KGCA2022IC17).

References

  1. Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel. Korean practice guideline for gastric cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer 2019;19:1-48. https://doi.org/10.5230/jgc.2019.19.e8
  2. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021;24:1-21. https://doi.org/10.1007/s10120-020-01042-y
  3. Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 2019;393:1948-1957. https://doi.org/10.1016/S0140-6736(18)32557-1
  4. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11-20. https://doi.org/10.1056/NEJMoa055531
  5. Kang YK, Yook JH, Park YK, Lee JS, Kim YW, Kim JY, et al. PRODIGY: a phase III study of neoadjuvant docetaxel, oxaliplatin, and S-1 plus surgery and adjuvant S-1 versus surgery and adjuvant S-1 for resectable advanced gastric cancer. J Clin Oncol 2021;39:2903-2913. https://doi.org/10.1200/JCO.20.02914
  6. Information Committee of the Korean Gastric Cancer Association. Korean Gastric Cancer Association-led nationwide survey on surgically treated gastric cancers in 2019. J Gastric Cancer 2021;21:221-235. https://doi.org/10.5230/jgc.2021.21.e27
  7. Fujisaki M, Mitsumori N, Shinohara T, Takahashi N, Aoki H, Nyumura Y, et al. Short- and long-term outcomes of laparoscopic versus open gastrectomy for locally advanced gastric cancer following neoadjuvant chemotherapy. Surg Endosc 2021;35:1682-1690. https://doi.org/10.1007/s00464-020-07552-1
  8. Li Z, Shan F, Ying X, Zhang Y, e JY, Wang Y, et al. Assessment of laparoscopic distal gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer: a randomized clinical trial. JAMA Surg 2019;154:1093-1101. https://doi.org/10.1001/jamasurg.2019.3473
  9. Wang Y, Lei X, Liu Z, Shan F, Ying X, Li Z, et al. Short-term outcomes of laparoscopic versus open total gastrectomy after neoadjuvant chemotherapy: a cohort study using the propensity score matching method. J Gastrointest Oncol 2021;12:237-248. https://doi.org/10.21037/jgo-20-374
  10. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 2016;34:1350-1357. https://doi.org/10.1200/JCO.2015.63.7215
  11. Yu J, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial. JAMA 2019;321:1983-1992. https://doi.org/10.1001/jama.2019.5359
  12. Lee HJ, Hyung WJ, Yang HK, Han SU, Park YK, An JY, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 2019;270:983-991. https://doi.org/10.1097/SLA.0000000000003217
  13. An JY, Kim KM, Kim YM, Cheong JH, Hyung WJ, Noh SH. Surgical complications in gastric cancer patients preoperatively treated with chemotherapy: their risk factors and clinical relevance. Ann Surg Oncol 2012;19:2452-2458.
  14. Wang N, Zhou A, Jin J, Huang H, Zhang Y, Chen Y, et al. Open vs. laparoscopic surgery for locally advanced gastric cancer after neoadjuvant therapy: Short-term and long-term survival outcomes. Oncol Lett 2020;20:861-867. https://doi.org/10.3892/ol.2020.11626
  15. Li Z, Shan F, Wang Y, Li S, Jia Y, Zhang L, et al. Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer after neoadjuvant chemotherapy: safety and short-term oncologic results. Surg Endosc 2016;30:4265-4271. https://doi.org/10.1007/s00464-015-4739-z
  16. Xi HQ, Zhang KC, Li JY, Gao YH, Liang WQ, Cui JX, et al. Comparison of perioperative and survival outcomes of laparoscopic versus open gastrectomy after preoperative chemotherapy: a propensity score-matched analysis. Indian J Surg 2019;82:42-49.
  17. Amin MB. AJCC Cancer Staging Manual. 8th ed. Chicago (IL): Springer; 2017.
  18. Ko CS, Choi NR, Kim BS, Yook JH, Kim MJ, Kim BS. Totally laparoscopic total gastrectomy using the modified overlap method and conventional open total gastrectomy: a comparative study. World J Gastroenterol 2021;27:2193-2204. https://doi.org/10.3748/wjg.v27.i18.2193
  19. Kanda M. Preoperative predictors of postoperative complications after gastric cancer resection. Surg Today 2020;50:3-11.
  20. Martin AN, Das D, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Morbidity and mortality after gastrectomy: identification of modifiable risk factors. J Gastrointest Surg 2016;20:1554-1564.  https://doi.org/10.1007/s11605-016-3195-y