Long-term outcomes of laparoscopic versus open gastrectomy for far-advanced gastric cancer after preoperative chemotherapy.

Abstract

e16072 Background: Evidence supporting the implementation of laparoscopic gastrectomy (LG) for far-advanced gastric cancer (GC) including T4b, bulky lymph nodes and limited metastasis after preoperative chemotherapy remains inadequate. This study aimed to compare the long-term outcomes of laparoscopic versus open gastrectomy (OG) in patients with far-advanced GC after preoperative chemotherapy. Methods: This retrospective cohort study was conducted using data from patients with far-advanced GC who underwent either LG or OG and lymphadenectomy after preoperative chemotherapy between January 2018 and June 2024 at the Gastro-intestinal Surgical Department of the University Medical Center, a tertiary hospital in Ho Chi Minh City, Vietnam. Surgical outcomes, postoperative complications, and long-term oncologic outcomes, including overall survival (OS) and progession-free survival (PFS) were compared between the two groups. Results: A total of 70 patients were included in the study, of whom 33 patients underwent LG and other 65 patients underwent OG. There were no significant differences between the two groups in terms of operating time, blood loss, the length of proximal and distal resected margin, the number of retrieved lymph nodes, curability, and overall and major postoperative complications. Most postoperative complications were classified as minor according to the Clavien-Dindo classification. Time to the first flatus, time to tolerance of oral intake, and the length of postoperative hospital stay were also similar between groups. The 3- and 5-year OS rates were comparable between the two groups (51% and 32% vs. 42% and 32% in the LG and OG groups, respectively). The 3- and 5-year PFS rates were also equivalent between the two groups (41% and 38% vs. 41% and 38%, respectively). Conclusions: LG demonstrated comparable long-term oncologic outcomes to OG in patients with far-advanced GC after preoperative chemotherapy. LG may be considered a safe, effective alternative for selected patients.