Minimally invasive surgery is feasible after preoperative chemotherapy for stage IV gastric cancer

Annals of Gastroenterological Surgery

卷:4

Hidenori Takahashi¹  Yoshiyuki Fujiwara¹  Hisashi Hara¹  Masahiko Yano¹  Masayuki Ohue¹  Kazuyoshi Yamamoto¹  Keijiro Sugimura¹  Takeshi Omori¹  Naoki Shinno¹  Hiroshi Miyata¹ 

[1] Department of Gastroenterological Surgery Osaka International Cancer Institute Osaka Japan;

关键词: conversion surgery;    gastric cancer;    laparoscopic;    minimally invasive surgery;    robotic;   

DOI  :  10.1002/ags3.12343

来源: DOAJ

【 摘 要 】

Abstract Aim To elucidate the safety and feasibility of minimally invasive surgery (MIS) as conversion surgery after chemotherapy for stage IV gastric cancer, we compared the background characteristics and clinical courses of patients who underwent open conversion surgery (open group) versus MIS (MIS group). Methods We included 94 consecutive patients with stage IV gastric cancer who received chemotherapy followed by conversion surgery gastric resection from January 2011 to October 2019 at the Osaka International Cancer Institute in this analysis. Results The open group included more patients who had macroscopic peritoneal metastasis and required splenectomy. However, other background characteristics, including preoperative chemotherapy duration, were comparable. The MIS group had significantly longer operative time (266 vs 339 minutes, P = .0039) and less operative blood loss (520 vs 10 mL, P < .0001). The incidence of postoperative complication of Clavien‐Dindo grade II or higher was non‐significantly lower (24.5% vs 9.8%, P = .058) and length of postoperative hospital stay was significantly shorter in the MIS group (12 vs 8 days, P < .0001). Even though the open group included more patients with more advanced (ypT4a or higher, or N3) disease, the MIS group had better recurrence free survival and overall survival (OS). Multivariate analysis revealed that N status (hazard ratio [HR], 4.39; 95% confidence interval [CI], 2.18‐12.26; P < .0001) and T status (2.11; 1.05‐4.36; P = .036) were independent prognostic factors for OS. MIS was not a negative prognostic factor for OS (HR, 0.44; 95% CI, 0.15‐1.10; P = .081). Conclusion MIS can be safely performed as conversion surgery following chemotherapy for stage IV gastric cancer.

【 授权许可】

Unknown