Short and long-term outcomes between laparoscopic and open total gastrectomy for advanced gastric cancer after neoadjuvant chemotherapy  

作　　者：Hao Cui Ke-Cheng Zhang Bo Cao Huan Deng Gui-Bin Liu Li-Qiang Song Rui-Yang Zhao Yi Liu Lin Chen Bo Wei 

机构地区：[1]School of Medicine,Nankai University,Tianjin 300071,China [2]Department of General Surgery and Institute of General Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China [3]Medical School,Chinese PLA General Hospital,Beijing 100853,China

出　　处：《World Journal of Gastrointestinal Surgery》2022年第5期452-469,共18页世界胃肠外科杂志（英文版）（电子版）

基　　金：Supported by National Basic Research Program of China (973 Program),No. 2019YFB1311505;National Natural Science Foundation of China,No. 81773135 and No. 82073192

摘　　要：BACKGROUND Neoadjuvant chemotherapy(NACT)combined with surgery is regarded as an effective treatment for advanced gastric cancer(AGC).Laparoscopic surgery represents the mainstream of minimally invasive surgery.Currently,surgeons focus more on surgical safety and oncological outcomes of laparoscopic gastrectomy after NACT.Thus,we sought to evaluate short-and long-term outcomes between laparoscopic total gastrectomy(LTG)and open total gastrectomy(OTG)after NACT.AIM To compare the short and long-term outcomes between LTG and OTG for AGC after NACT.METHODS We retrospectively collected the clinicopathological data of 136 patients who accepted gastrectomy after NACT from June 2012 to June 2019,including 61 patients who underwent LTG and 75 who underwent OTG.Clinicopathological characteristics between the LTG and OTG groups showed no significant difference.SPSS 26.0,R software,and GraphPad PRISM 8.0 were used to perform statistical analyses.RESULTS Of the 136 patients included,eight acquired pathological complete response,and the objective response rate was 47.8%(65/136).The LTG group had longer operation time(P=0.015),less blood loss(P=0.003),shorter days to first flatus(P<0.001),and shorter postoperative hospitalization days(P<0.001).LTG spent more surgical cost than OTG(P<0.001),while total hospitalized cost of LTG was less than OTG(P<0.001).21(28.0%)patients in the OTG group and 14(23.0%)in the LTG group had 30-d postoperative complications,but there was no significant difference between the two groups(P=0.503).The 3-year overall survival(OS)rate was 60.6%and 64.6%in the LTG and OTG groups,respectively[hazard ratio(HR)=0.859,95%confidence interval(CI):0.522-1.412,P=0.546],while the 3-year disease-free survival(DFS)rate was 54.5%and 51.8%in the LTG and OTG group,respectively(HR=0.947,95%CI:0.582-1.539,P=0.823).Multivariate cox analysis showed that body mass index and pTNM stage were independent risk factors for OS while vascular invasion and pTNM stage were independent risk factors for DFS(P<0.05).CONCLUSION After N

关 键 词：Neoadjuvant chemotherapy Gastric cancer LAPAROSCOPE Total gastrectomy MORBIDITY SURVIVAL 

分 类 号：R735.2[医药卫生—肿瘤]