Totally laparoscopic versus open gastrectomy for advanced gastric cancer: a matched retrospective cohort study.

INTRODUCTION: Laparoscopic gastrectomy revolutionised the management of gastric cancer, yet its oncologic equivalency and safety in treating advanced gastric cancer (especially that in smaller centres) has remained controversial because of the extensive lymphadenectomy and learning curve involved. This study aimed to compare outcomes following laparoscopic versus open gastrectomy for advanced gastric cancer at a regional institution in Hong Kong.

METHODS: Fifty-four patients who underwent laparoscopic gastrectomy from January 2009 to March 2017 were compared with 167 patients who underwent open gastrectomy during the same period. All had clinical T2 to T4 lesions and underwent curative-intent surgery. The two groups were matched for age, sex, American Society of Anaesthesiologists class, tumour location, morphology, and clinical stage. The endpoints were perioperative and long-term outcomes including survival and recurrence.

RESULTS: All patients had advanced gastric adenocarcinoma and received D2 lymph node dissection. No between-group differences were demonstrated in overall complications, unplanned readmission or reoperation within 30 days, 30-day mortality, margin clearance, rate of adjuvant therapy, or overall survival. The laparoscopic approach was associated with less blood loss (150 vs 275 mL, P=0.018), shorter operating time (321 vs 365 min, P=0.003), shorter postoperative length of stay (9 vs 11 days, P=0.011), fewer minor complications (13% vs 40%, P<0.001), retrieval of more lymph nodes (37 vs 26, P<0.001), and less disease recurrence (9% vs 28%, P=0.005).

CONCLUSION: Laparoscopic gastrectomy offers a safe and effective therapeutic option and is superior in terms of operative morbidity and potentially superior in terms of oncological outcomes compared with open surgery for advanced, surgically resectable gastric cancer, even in a small regional surgical department.