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©The Author(s) 2022.
World J Gastrointest Surg. May 27, 2022; 14(5): 452-469
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.452
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.452
Table 1 Baseline characteristics of 136 gastric cancer patients after neoadjuvant chemotherapy (mean ± SD)
Clinical characteristic | LTG group (n = 61) | OTG group (n = 75) | P value |
Gender | 0.821 | ||
Male | 47 | 59 | |
Female | 14 | 16 | |
Age (yr) | 57.56 ± 10.35 | 56.84 ± 11.95 | 0.712 |
BMI (kg/m2) | 22.81 ± 2.67 | 23.67 ± 3.31 | 0.099 |
CCI score, n (%) | 0.982 | ||
0-2 | 43 | 53 | |
> 2 | 18 | 22 | |
History of abdominal surgery | 0.179 | ||
No | 54 | 60 | |
Yes | 7 | 15 | |
Clinical tumor stage | |||
cT | 0.695 | ||
T2 | 1 | 6 | |
T3 | 22 | 23 | |
T4 | 38 | 46 | |
cN | 0.191 | ||
N0 | 7 | 4 | |
N+ | 54 | 71 | |
cTNM | 0.468 | ||
II | 5 | 9 | |
III | 56 | 66 | |
Historical factor | 0.088 | ||
2012-2015 | 22 | 38 | |
2016-2019 | 39 | 37 |
Table 2 Pathological characteristics of 136 gastric cancer patients after neoadjuvant chemotherapy
Pathological characteristic | LTG group (n = 61) | OTG group (n = 75) | P value |
Tumor diameter, cm (median, IQR) | 4.0 (2.5-6.5) | 4.0 (2.0-6.0) | 0.366 |
Site of tumor | 0.244 | ||
Upper 1/3 | 30 | 27 | |
Middle 1/3 | 21 | 29 | |
Diffused | 10 | 19 | |
ypT | 0.751 | ||
T0 | 1 | 7 | |
T1 | 5 | 5 | |
T2 | 10 | 14 | |
T3 | 34 | 30 | |
T4 | 11 | 19 | |
ypN | 0.190 | ||
N0 | 19 | 35 | |
N1 | 14 | 11 | |
N2 | 12 | 11 | |
N3 | 16 | 18 | |
ypTNM | 0.300 | ||
0 | 1 | 7 | |
I | 8 | 17 | |
II | 22 | 16 | |
III | 29 | 34 | |
IV | 1 | 1 | |
Nerve invasion | 0.545 | ||
Yes | 20 | 21 | |
No | 41 | 54 | |
Vascular invasion | 0.982 | ||
Yes | 18 | 22 | |
No | 43 | 53 | |
Differentiation | 0.616 | ||
Well/moderate | 27 | 30 | |
Poor/undifferentiated | 34 | 45 |
Table 3 Neoadjuvant chemotherapy characteristics
Variable | LTG group (n = 61) | OTG group (n = 75) | P value |
Number of cycles of NACT | 0.467 | ||
1-2 | 13 | 12 | |
3-4 | 45 | 59 | |
> 4 | 3 | 4 | |
NACT regimen | 0.143 | ||
SOX | 48 | 65 | |
XELOX | 8 | 9 | |
Other | 5 | 1 | |
Clinical response | 0.659 | ||
CR | 1 | 7 | |
PR | 28 | 29 | |
SD | 28 | 34 | |
PD | 4 | 5 | |
Adverse effects after NACT | 0.535 | ||
Grade 0 | 13 | 17 | |
Grade I | 16 | 21 | |
Grade II | 17 | 23 | |
Grade III | 11 | 12 | |
Grade IV | 4 | 2 | |
Chemotherapy–surgical procedure interval (wk) | 5.07 ± 1.67 | 4.55 ± 1.33 | 0.047 |
Adjuvant therapy | 0.545 | ||
Yes | 52 | 61 | |
No | 9 | 14 |
Table 4 Perioperative clinical indexes and postoperative outcomes between laparoscopic total gastrectomy and open total gastrectomy groups after neoadjuvant chemotherapy (mean ± SD)
Variable | LTG group (n = 61) | OTG group (n = 75) | P value |
Surgical time, min | 255.66 ± 40.10 | 238.59 ± 40.30 | 0.015 |
Blood loss, mL (median, IQR) | 150 (100-300) | 200 (200-300) | 0.003 |
Blood loss (mL), n (%) | 0.003 | ||
< 200 | 31 | 13 | |
200-400 | 20 | 51 | |
> 400 | 10 | 11 | |
Retrieved lymph nodes, n | 33.38 ± 13.26 | 34.75 ± 16.69 | 0.603 |
No. 10 lymph nodes dissection | 0.339 | ||
No | 41 | 56 | |
Yes | 20 | 19 | |
Extent of resection | 0.471 | ||
R0 | 58 | 74 | |
R1/R2 | 3 | 1 | |
Time to first flatus, d | 4.36 ± 1.28 | 5.41 ± 1.16 | 0.000 |
Postoperative stay, d | 9.48 ± 3.98 | 11.89 ± 3.36 | 0.000 |
Surgery costs, $ | 5419.99 ± 1315.39 | 4162.36 ± 791.93 | 0.000 |
Hospitalization costs, $ (median, IQR) | 13105.92 (11713.18-14640.53) | 14873.96 (13501.66-17131.31) | 0.000 |
Total complication rate (%) | 14 (23.0) | 21 (28.0) | 0.503 |
Clavien-Dindo classification | |||
Grade II | 12 | 19 | |
Peritoneal infection | 2 | 2 | |
Lymphatic leakage | 2 | 0 | |
Anastomotic leakage | 1 | 0 | |
Pancreatic fistula | 1 | 1 | |
Ileus | 1 | 2 | |
Cardiac failure | 1 | 0 | |
Hypoproteinemia | 2 | 8 | |
Anemia | 2 | 2 | |
Cholecystitis | 0 | 1 | |
Incision infection | 0 | 2 | |
Pneumonia | 0 | 1 | |
Grade IIIa | 1 | 2 | |
Deep venous thrombosis | 1 | 0 | |
Pleural effusion | 0 | 1 | |
Anastomotic leakage | 0 | 1 | |
Grade V | 1 | 0 | |
Septic shock | 1 | 0 | |
Severe complication rate (%) | 2 (3.3) | 2 (2.7) | 1.000 |
Table 5 Clinical characteristics and perioperative indexes in ypTNM 0-II patients after neoadjuvant chemotherapy (mean ± SD)
Variable | LTG group (n = 31) | OTG group (n = 40) | P value |
Gender | 0.841 | ||
Male | 25 | 33 | |
Female | 6 | 7 | |
Age (yr) | 59.10 ± 10.51 | 57.63 ± 11.16 | 0.574 |
BMI (kg/m2) | 22.58 ± 2.77 | 23.72 ± 2.93 | 0.102 |
CCI score | 0.594 | ||
0-2 | 22 | 26 | |
> 2 | 9 | 14 | |
Tumor diameter, cm (median, IQR) | 3.00 (2.20-4.50) | 2.30 (1.42-4.00) | 0.158 |
Surgical time, min | 260.97 ± 37.20 | 237.93 ± 35.51 | 0.010 |
Blood loss, mL (median, IQR) | 150 (100-200) | 200 (200-300) | 0.002 |
Blood loss (mL), n (%) | 0.000 | ||
0-200 | 19 | 5 | |
200-400 | 9 | 31 | |
> 400 | 3 | 4 | |
Retrieved lymph nodes, n | 34.00 ± 15.11 | 36.38 ± 17.64 | 0.552 |
Time to first flatus, d | 4.32 ± 1.28 | 5.45 ± 1.24 | 0.000 |
Postoperative stay, d | 8.94 ± 3.63 | 11.65 ± 3.03 | 0.001 |
Surgery costs, $ | 5641.18 ± 1351.17 | 4163.48 ± 627.86 | 0.000 |
Hospitalization costs, $ | 13389.70 ± 2254.38 | 15024.88 ± 23358.95 | 0.004 |
Total complication rate (%), C-D classification | 5 (16.1) | 9 (22.5) | 0.503 |
II | 4 | 8 | |
IIIa | 0 | 1 | |
V | 1 | 0 | |
Severe complication rate (%) | 1(3.2) | 1 (2.5) | 1.000 |
Table 6 Clinical characteristics and perioperative index in ypTNM III-IV patients after neoadjuvant chemotherapy (mean ± SD)
Variable | LTG group (n = 30) | OTG group (n = 35) | P value |
Gender | 0.931 | ||
Male | 22 | 26 | |
Female | 8 | 9 | |
Age (yr) | 55.97 ± 10.10 | 55.94 ± 12.90 | 0.993 |
BMI (kg/m2) | 23.03 ± 2.60 | 23.63 ± 3.73 | 0.468 |
CCI score | 0.514 | ||
0-2 | 21 | 27 | |
> 2 | 9 | 8 | |
Tumor diameter, cm | 5.5 (3.5-8.0) | 5.0 (4.0-8.0) | 0.916 |
Surgical time, min | 250.17 ± 42.99 | 239.34 ± 45.69 | 0.332 |
Blood loss, mL (median, IQR) | 200 (100-350) | 300 (200-400) | 0.159 |
Blood loss (mL), n (%) | 0.404 | ||
0-200 | 12 | 8 | |
200-400 | 11 | 20 | |
> 400 | 7 | 7 | |
Retrieved lymph nodes, n | 32.73 ± 11.24 | 32.89 ± 15.58 | 0.965 |
Time to first flatus, d | 4.40 ± 1.30 | 5.37 ± 1.09 | 0.002 |
Postoperative stay, d | 10.03 ± 4.30 | 12.17 ± 3.73 | 0.036 |
Surgery costs, $ | 4793.57 (4032.20-6242.77) | 3871.55 (3686.28-4416.86) | 0.000 |
Hospitalization costs, $ | 13190.05 (12036.98-14591.47) | 15263.28 (13162.85-17143.01) | 0.000 |
Total complication rate (%), C-D classification | 9 (30.0) | 12 (34.3) | 0.647 |
II | 8 | 11 | |
IIIa | 1 | 1 | |
Severe complication rate (%) | 1 (3.3) | 1 (2.9) | 1.000 |
Table 7 Univariate and multivariate analyses for overall survival
Factor | Univariate analysis | P value | Multivariate analysis | P value | ||
HR | 95%CI | HR | 95%CI | |||
Sex | 0.127 | |||||
Male | 1.000 | |||||
Female | 1.541 | 0.885-2.684 | ||||
Age | 0.647 | |||||
< 65 | 1.000 | |||||
≥ 65 | 1.129 | 0.671-1.900 | ||||
BMI (kg/m2) | 0.091 | 0.049 | ||||
< 25 | 1.000 | 1.000 | ||||
≥ 25 | 0.601 | 0.333-1.086 | 0.547 | 0.300-0.998 | ||
Surgical approach | 0.549 | |||||
Laparoscopy | 1.000 | |||||
Open | 1.164 | 0.708-1.914 | ||||
CCI score | 0.438 | |||||
0-2 | 1.000 | |||||
≥ 2 | 1.225 | 0.733-2.049 | ||||
pTNM stage | 0.000 | 0.006 | ||||
0-II | 1.000 | 1.000 | ||||
III-IV | 2.632 | 1.569-4.413 | 2.224 | 1.258-3.930 | ||
Tumor diameter (cm) | 0.039 | 0.153 | ||||
≤ 3 | 1.000 | 1.000 | ||||
> 3 | 1.838 | 1.031-3.277 | 1.577 | 0.844-2.945 | ||
Operation time (min) | 0.483 | |||||
≤ 240 | 1.000 | |||||
> 240 | 1.192 | 0.730-1.948 | ||||
Estimated blood loss (mL) | 0.074 | 0.588 | ||||
≤ 200 | 1.000 | 1.000 | ||||
> 200 | 1.559 | 0.958-2.536 | 1.154 | 0.688-1.935 | ||
Vascular invasion | 0.008 | 0.062 | ||||
No | 1.000 | 1.000 | ||||
Yes | 1.987 | 1.200-3.289 | 1.712 | 0.974-3.010 | ||
Nerve invasion | 0.079 | 0.567 | ||||
No | 1.000 | 1.000 | ||||
Yes | 1.580 | 0.949-2.632 | 0.838 | 0.456-1.537 | ||
Differentiation | 0.261 | |||||
Well/moderate | 1.000 | |||||
Poor/undifferentiated | 1.335 | 0.806-2.212 | ||||
Complications | 0.662 | |||||
No | 1.000 | |||||
Yes | 1.131 | 0.651-1.968 | ||||
Historical factor | 0.861 | |||||
2012-2015 | 1.000 | |||||
2016-2019 | 0.957 | 0.587-1.560 |
Table 8 Univariate and multivariate analyses for disease-free survival
Factor | Univariate analysis | P value | Multivariate analysis | P value | ||
HR | 95%CI | HR | 95%CI | |||
Sex | 0.259 | |||||
Male | 1.000 | |||||
Female | 0.851 | 0.642-1.127 | ||||
Age | 0.267 | |||||
< 65 | 1.000 | |||||
≥ 65 | 1.326 | 0.806-2.181 | ||||
BMI (kg/m2) | 0.706 | |||||
< 25 | 1.000 | |||||
≥ 25 | 0.706 | 0.403-1.237 | ||||
Surgical approach | 0.825 | |||||
Laparoscopy | 1.000 | |||||
Open | 0.947 | 0.582-1.539 | ||||
CCI score | 0.707 | |||||
0-2 | 1.000 | |||||
≥ 2 | 1.104 | 0.660-1.847 | ||||
pTNM stage | 0.000 | 0.022 | ||||
0-II | 1.000 | 1.000 | ||||
III-IV | 2.418 | 1.471-3.973 | 1.854 | 1.095-3.140 | ||
Tumor diameter (cm) | 0.022 | 0.200 | ||||
≤ 3 | 1.000 | 1.000 | ||||
> 3 | 1.954 | 1.100-3.470 | 1.484 | 0.812-2.710 | ||
Operation time (min) | 0.710 | |||||
≤ 240 | 1.000 | |||||
> 240 | 1.095 | 0.679-1.765 | ||||
Estimated blood loss (mL) | 0.024 | 0.204 | ||||
≤ 200 | 1.000 | 1.000 | ||||
> 200 | 1.730 | 1.075-2.785 | 1.379 | 0.840-2.263 | ||
Vascular invasion | 0.001 | 0.020 | ||||
No | 1.000 | 1.000 | ||||
Yes | 2.245 | 1.378-3.659 | 1.824 | 1.101-3.022 | ||
Nerve invasion | 0.203 | |||||
No | 1.000 | |||||
Yes | 1.387 | 0.838-2.295 | ||||
Differentiation | 0.283 | |||||
Well/moderate | 1.000 | |||||
Poor/undifferentiated | 1.311 | 0.800-2.148 | ||||
Complications | 0.751 | |||||
No | 1.000 | |||||
Yes | 1.093 | 0.631-1.894 | ||||
Historical factor | 0.691 | |||||
2012-2015 | 1.000 | |||||
2016-2019 | 1.102 | 0.683-1.779 |
- Citation: Cui H, Zhang KC, Cao B, Deng H, Liu GB, Song LQ, Zhao RY, Liu Y, Chen L, Wei B. Short and long-term outcomes between laparoscopic and open total gastrectomy for advanced gastric cancer after neoadjuvant chemotherapy. World J Gastrointest Surg 2022; 14(5): 452-469
- URL: https://www.wjgnet.com/1948-9366/full/v14/i5/452.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v14.i5.452