Comparison of totally laparoscopic and laparoscopic assisted gastrectomy after neoadjuvant chemotherapy in locally advanced gastric cancer
Menée en Chine à l'aide de données portant sur 139 patients atteints d'un cancer gastrique localement avancé et ayant reçu une chimiothérapie adjuvante, cette étude compare l'efficacité, du point de vue d'un indice de récupération et du taux de complications postopératoires, et la sécurité d'une gastrectomie assistée par laparoscopie et d'une gastrectomie totalement laparoscopique
Résumé en anglais
Background: Neoadjuvant chemotherapy (NACT) and laparoscopic surgery have been increasingly used in the treatment of gastric cancer, however, the feasibility and safety of totally laparoscopic gastrectomy after NACT still remain unknown.
Materials and methods: At the Gastrointestinal cancer center of Peking university cancer hospital and institute in Beijing, clinical and pathological data of patients who has received NACT, followed by radical laparoscopic gastrectomy was retrospectively reviewed between March 2012 and November 2019. Patients were divided into 2 groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed, short-term outcomes (post-operative recovery index and complications) and economic cost were compared between 2 groups.
Result: All of 139 patients underwent laparoscopic gastrectomy. 87 [62.6%] patients had totally laparoscopic gastrectomy (TLG) and 52 [37.4%] patients had laparoscopic-assisted gastrectomy (LAG). Overall complication rate was 28.8% in all patients. TLG group was significantly associated with lower overall complication rate (21.8% VS 40.4%; p = 0.019) and major complication rate (3.4% VS 13.5%; p = 0.001) compared with LAG group. Overall cost was similar (p = 0.077). In subgroup analysis, totally laparoscopic total gastrectomy (TLTG) group showed lower overall postoperative complication rate (19.0% VS 56.5%; p = 0.011), as well as marginal significant differences in major complication (0% VS 21.7%; p = 0.05) than laparoscopic-assisted total gastrectomy (LATG)group. Earlier first liquid diet (4 [3.5–5] VS 6 [4–6.5] day; p = 0.047), earlier first aerofluxus (3 [( Ychou et al., 2011; Kim et al., 2019) 3-43-4 VS 4 [3–4.5] day; p = 0.02) and a shorter hospital stay (9 [( Hyung et al., 2020; Inaki et al., 2015; Li et al., 2019; Liu et al., 2020; van der Wielen et al., 2020) 8-128-12 VS 12 [( Li et al., 2019; Liu et al., 2020; van der Wielen et al., 2020; Woo et al., 2015; Kim et al., 2011; Kim et al., 2011) 10-1510-15 day; p = 0.004) were observed in TLTG group. Overall and major complication rate were similar in totally laparoscopic distal gastrectomy (TLDG) and laparoscopic assisted distal gastrectomy (LADG) group (22.7% VS 27.6%; p = 0.611; 4.5% VS 6.9%; p = 0.639; respectively). Significant differences were found between TLDG and LADG groups regarding time to first liquid diet (4 [( Ychou et al., 2011; Kim et al., 2019; Yu et al., 2019) 3-53-5 VS 6 [3.75–6] day; p = 0.006), time to first aerofluxus (3 [3–3] VS 4 [( Ychou et al., 2011; Kim et al., 2019; Yu et al., 2019; Hu et al., 2016) 3-63-6 day; p < 0.001), time to first defecation (4 [( Kim et al., 2019; Yu et al., 2019) 4-54-5 VS 5 [( Kim et al., 2019; Yu et al., 2019; Hu et al., 2016) 4-64-6 day; p = 0.045), time to remove all drainage (7 [( Hu et al., 2016; Lee et al., 2019; Hyung et al., 2020) 6-86-8 VS 8 [( Hu et al., 2016; Lee et al., 2019; Hyung et al., 2020; Inaki et al., 2015) 6-96-9 day; p = 0.021), white blood cell count on postoperative Day 1 (9.54 ± 2.49 V S 10.91 ± 2.89,10 9/L; p = 0.021)and postoperative hospital stay (9 [( Hyung et al., 2020; Li et al., 2019) 8,108,10 VS 10 [( Inaki et al., 2015; Woo et al., 2015) 9,139,13 day; p = 0.009).
Conclusion: For patients with Locally advanced gastric cancer who received NACT, totally laparoscopic gastrectomy, including TLTG and TLDG, doesn't increase complications and overall cost compared with LAG, and has advantages in gastrointestinal function recovery, incision length and postoperative hospital stay.
