Journal Article

Laparoscopic Resection for Adenocarcinoma of the Stomach or Gastroesophageal Junction Improves Postoperative Outcomes: a Propensity Score Matching Analysis

Denecke, Christian, Bahra, Marcus, Biebl, Matthias, Knitter, Sebastian, Spenke, Johanna, Chopra, Sascha, Hofmann, Tobias, Pratschke, Johann, Struecker, Benjamin, Heilmann, Ann-Christin, Thuss-Patience, Peter C., Schmelzle, Moritz, Andreou, Andreas

2019

Overview

Background Minimally invasive resection for upper gastrointestinal tumors has been associated with favorable results. However, the role of laparoscopic surgery (LS) in the multimodal treatment of patients with advanced adenocarcinoma of the stomach or gastroesophageal junction needs further investigation. Methods Clinicopathological data of patients who underwent gastrectomy between 2005 and 2017 were assessed. Outcomes of patients undergoing LS were compared with those of patients treated with a conventional open resection (OR) using a 1:1 propensity score matching analysis. Results Curative resection for adenocarcinoma of the stomach or gastroesophageal junction was performed in 417 patients during the study period. Beginning in June 2014, the majority of patients underwent LS ( n  = 72) and they were matched with 72 patients who were treated with an OR. The majority of patients treated with LS (89%) had advanced cancer (UICC stages II and III) and 82% of them received neoadjuvant chemotherapy. LS was significantly associated with a higher number of harvested lymph nodes (26 (9–62) vs. 21 (4–46), P  = .007), a lower 90-day major complication rate (13 vs. 26%, P  = .035), and a lower length of hospital stay (14 vs. 16 days, P  = .001). After a median follow-up time of 32 months, 1-year overall survival rate was higher after LS than after OR (93 vs. 74%, P  = .126); however, results did not reach statistical significance. Conclusion LS for adenocarcinoma of the stomach or gastroesophageal junction is feasible and significantly reduces major postoperative morbidity resulting in a reduced length of hospital stay. Therefore, LS should be preferably considered for the curative treatment of patients with these malignancies.

• Publisher: Springer US,Springer Nature B.V
• Subject: Adenocarcinoma - pathology / Adenocarcinoma - surgery / Adult / Aged / Aged, 80 and over / Antineoplastic Agents - therapeutic use / Esophagogastric Junction - surgery / Female / Gastrectomy - methods / Gastric Bypass - methods / Gastric cancer / Gastroenterology / Gastrointestinal surgery / Humans / Laparoscopy / Laparoscopy - methods / Laparotomy / Length of Stay / Lymph Node Excision - methods / Male / Medicine / Medicine & Public Health / Middle Aged / Neoadjuvant Therapy / Neoplasm Staging / Original Article / Postoperative Complications - epidemiology / Postoperative Period / Propensity Score / Retrospective Studies / Stomach / Stomach Neoplasms - pathology / Stomach Neoplasms - surgery / Surgery / Survival Rate / Treatment Outcome