The Comparison of the Short and Long-Term Outcomes Between Laparoscopic Total Gastrectomy and Open Total Gastrectomy for Locally Advanced Gastric Cancer After Neoadjuvant Chemotherapy

Abstract BackgroundNeoadjuvant chemotherapy (NACT) combined with surgery is regarded as an effective treatment for advanced gastric cancer. Laparoscopic surgery represents 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.MethodThis is a mono-institutional retrospective study conducted by Chinese PLA general hospital. After screening according to inclusion and exclusion criteria, we collected clinicopathological data of 140 patients who accepted gastrectomy after NACT from June 2012 to June 2019, including 62 patients in LTG group and 78 patients in OTG group. SPSS 26.0 and GraphPad Prism 8.0 were used to perform statistical analysis.ResultClinicopathological characteristics between LTG and OTG group showed no significant difference. In 140 patients, 10 patients acquired pCR while 58 patients presented ORR. Mentioning to perioperative outcomes, we found that LTG group had longer operation time(P=0.013), less blood loss（P=0.003）, shorter first flatus days(P＜0.001) and postoperative days（P＜0.001) . Even though LTG spent more surgical cost than OTG (P＜0.001), total hospitalized cost of LTG was less than OTG(P＜0.001). 21 (26.9%) patients in OTG group and 14 (22.6%) patients in LTG group had 30-day postoperative complication, with no significant difference (P=0.295). Long-term follow up demonstrated that 3-year OS rate was 59.3% and 65.7% in LTG and OTG group (HR: 0.690, 95%CI: 0.413~1.152, P=0.151) while 3-year DFS rate was 51.1% and 53.4% in LTG and OTG group respectively (HR: 0.796,95%CI: 0.488~1.300, P=0.357).ConclusionAfter NACT, LTG showed comparable 30-day postoperative morbidity as well as 3-year OS and DFS rate in comparison with OTG. We recommended experienced surgeons select LTG other than OTG for proper AGC patients after NACT.