Improved survival after laparoscopic compared to open gastrectomy for advanced gastric cancer : a Swedish population-based cohort study
(2023) In Gastric Cancer 26(3). p.467-477- Abstract
Background: Laparoscopic gastrectomy is increasingly used for the treatment of locally advanced gastric cancer but concerns remain whether similar results can be obtained compared to open gastrectomy, especially in Western populations. This study compared the short-term postoperative, oncological and survival outcomes following laparoscopic versus open gastrectomy based on data from the Swedish National Register for Esophageal and Gastric Cancer. Methods: Patients who underwent surgery with curative intent for adenocarcinoma of the stomach or gastroesophageal junction Siewert type III from 2015 to 2020 were identified, and 622 patients with cT2-4aN0-3M0 tumors were included. The impact of surgical approach on short-term outcomes was... (More)
Background: Laparoscopic gastrectomy is increasingly used for the treatment of locally advanced gastric cancer but concerns remain whether similar results can be obtained compared to open gastrectomy, especially in Western populations. This study compared the short-term postoperative, oncological and survival outcomes following laparoscopic versus open gastrectomy based on data from the Swedish National Register for Esophageal and Gastric Cancer. Methods: Patients who underwent surgery with curative intent for adenocarcinoma of the stomach or gastroesophageal junction Siewert type III from 2015 to 2020 were identified, and 622 patients with cT2-4aN0-3M0 tumors were included. The impact of surgical approach on short-term outcomes was assessed using multivariable logistic regression. Long-term survival was compared using multivariable Cox regression. Results: In total, 350 patients underwent open and 272 laparoscopic gastrectomy, of which 12.9% were converted to open surgery. The groups were similar regarding distribution of clinical disease stage (27.6% stage I, 46.0% stage II, and 26.4% stage III). Neoadjuvant chemotherapy was administered to 52.7% of the patients. There was no difference in the rate of postoperative complications, but laparoscopic approach was associated with lower 90 day mortality (1.8 vs 4.9%, p = 0.043). The median number of resected lymph nodes was higher after laparoscopic surgery (32 vs 26, p < 0.001), while no difference was found in the rate of tumor-free resection margins. Better overall survival was observed after laparoscopic gastrectomy (HR 0.63, p < 0.001). Conclusions: Laparoscopic gastrectomy can be safely preformed for advanced gastric cancer and is associated with improved overall survival compared to open surgery.
(Less)
- author
- Tsekrekos, Andrianos ; Vossen, Laura E. ; Lundell, Lars ; Jeremiasen, Martin LU ; Johnsson, Erik ; Hedberg, Jakob ; Edholm, David ; Klevebro, Fredrik ; Nilsson, Magnus and Rouvelas, Ioannis
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Advanced gastric cancer, Laparoscopic gastrectomy, Minimally invasive surgery, Survival
- in
- Gastric Cancer
- volume
- 26
- issue
- 3
- pages
- 467 - 477
- publisher
- Springer
- external identifiers
-
- pmid:36808262
- scopus:85148358267
- ISSN
- 1436-3291
- DOI
- 10.1007/s10120-023-01371-8
- language
- English
- LU publication?
- yes
- id
- 3d5e018b-1bd6-48fc-b44a-de513144f476
- date added to LUP
- 2023-03-08 08:48:35
- date last changed
- 2024-04-18 08:06:50
@article{3d5e018b-1bd6-48fc-b44a-de513144f476,
abstract = {{<p>Background: Laparoscopic gastrectomy is increasingly used for the treatment of locally advanced gastric cancer but concerns remain whether similar results can be obtained compared to open gastrectomy, especially in Western populations. This study compared the short-term postoperative, oncological and survival outcomes following laparoscopic versus open gastrectomy based on data from the Swedish National Register for Esophageal and Gastric Cancer. Methods: Patients who underwent surgery with curative intent for adenocarcinoma of the stomach or gastroesophageal junction Siewert type III from 2015 to 2020 were identified, and 622 patients with cT2-4aN0-3M0 tumors were included. The impact of surgical approach on short-term outcomes was assessed using multivariable logistic regression. Long-term survival was compared using multivariable Cox regression. Results: In total, 350 patients underwent open and 272 laparoscopic gastrectomy, of which 12.9% were converted to open surgery. The groups were similar regarding distribution of clinical disease stage (27.6% stage I, 46.0% stage II, and 26.4% stage III). Neoadjuvant chemotherapy was administered to 52.7% of the patients. There was no difference in the rate of postoperative complications, but laparoscopic approach was associated with lower 90 day mortality (1.8 vs 4.9%, p = 0.043). The median number of resected lymph nodes was higher after laparoscopic surgery (32 vs 26, p < 0.001), while no difference was found in the rate of tumor-free resection margins. Better overall survival was observed after laparoscopic gastrectomy (HR 0.63, p < 0.001). Conclusions: Laparoscopic gastrectomy can be safely preformed for advanced gastric cancer and is associated with improved overall survival compared to open surgery.</p>}},
author = {{Tsekrekos, Andrianos and Vossen, Laura E. and Lundell, Lars and Jeremiasen, Martin and Johnsson, Erik and Hedberg, Jakob and Edholm, David and Klevebro, Fredrik and Nilsson, Magnus and Rouvelas, Ioannis}},
issn = {{1436-3291}},
keywords = {{Advanced gastric cancer; Laparoscopic gastrectomy; Minimally invasive surgery; Survival}},
language = {{eng}},
number = {{3}},
pages = {{467--477}},
publisher = {{Springer}},
series = {{Gastric Cancer}},
title = {{Improved survival after laparoscopic compared to open gastrectomy for advanced gastric cancer : a Swedish population-based cohort study}},
url = {{http://dx.doi.org/10.1007/s10120-023-01371-8}},
doi = {{10.1007/s10120-023-01371-8}},
volume = {{26}},
year = {{2023}},
}