Ann Surg Treat Res.  2024 Apr;106(4):218-224. 10.4174/astr.2024.106.4.218.

Comparison of totally laparoscopic and laparoscopic-assisted approach in gastrectomy with D2 lymphadenectomy for advanced gastric cancer after neoadjuvant chemotherapy: a retrospective comparative study

• Chen Z
• Chen G
• Li Y
• Kou S
• Wang T
• Zhang L
• Cao Y
• Liu L

• KMID: 2554481
• DOI: http://doi.org/10.4174/astr.2024.106.4.218

Abstract

Purpose
Neoadjuvant chemotherapy is strongly recommended for advanced gastric cancer due to good local control and a high rate of R0 dissection with this strategy. Minimally invasive techniques such as laparoscopy-assisted or total laparoscopic approaches is becoming more and more acceptable in the treatment for gastric cancer. However, the safety and efficiency of total laparoscopic D2 gastrectomy (TLG) for advanced gastric cancer after neoadjuvant chemotherapy have not been well evaluated.
Methods
A retrospective study in a single center from 2014 to 2016 was conducted. A total of 65 locally advanced gastric cancers were treated by laparoscopy-assisted gastrectomy (LAG) or TLG. Parameters which include operation time, blood loss, complications, hospital stay, 3-year overall survival, and 3-year disease-free survival were used for comparison.
Results
The time of operation in the TLG group was shorter than in the LAG group (P = 0.013), blood loss was less (P = 0.002) and time to first flatus was shorter (P = 0.039) in the TLG group than that in the LLG group. Intraoperative and postoperative complications were comparable in both groups. No significant difference was found in 3-year overall and disease-free survival.
Conclusion
For patients with locally advanced gastric cancer after neoadjuvant chemotherapy, laparoscopic D2 gastrectomy can be considered as a safe and efficient alternative. A further multicenter prospective randomized controlled study is needed to elucidate the applicability of this technique for advanced gastric cancer.

Keyword

Stomach neoplasms; Laparoscopy; Lymph node excision; Neoadjuvant therapy

Figure

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  Fig. 1 Reconstruction of total laparoscopic D2 gastrectomy. (A) The distal stomach was cut off using an endoscopic linear stapler at least 5 cm from the proximal edge of the tumor. (B) Mesentery and small intestine were cut off by an endoscopic linear stapler 20 cm away from Treitz ligament. (C) Two holes were made at the proximal jejunum and 40 cm from the distal end of intestine, then an endoscopic linear stapler was inserted from the holes, and side-to-side small intestinal anastomosis was performed. (D) The common entry of intestinal anastomosis was closed by continuous barbed suture. (E) A side-to-side gastrojejunostomy was performed with the afferent loop to lesser curvature. (F) The common entry of gastrojejunostomy was closed by continuous barbed suture.

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  Fig. 2 Overall survival curves following total laparoscopic D2 gastrectomy (TLG) and laparoscopic-assisted D2 gastrectomy (LAG) for advanced gastric cancer after neoadjuvant chemotherapy (P = 0.951).

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  Fig. 3 Disease-free survival curves following total laparoscopic D2 gastrectomy (TLG) and laparoscopic-assisted D2 gastrectomy (LAG) for advanced gastric cancer after neoadjuvant chemotherapy (P = 0.906).

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