Safety And Efficacy Of Laparoscopy And Laparotomy After Neoadjuvant Chemotherapy For Locally Advanced Gastric Cancer

Objective: This study compared postoperative complications and survival of patients who underwent laparoscopic gastrectomy（LAG）after neoadjuvant chemotherapy with patients who underwent open gastrectomy（OG）after neoadjuvant chemotherapy,to evaluate the safety and efficacy of laparoscopic gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer.Methods: A retrospective study was performed on 154 locally advanced gastric cancer patients who received gastrectomy after neoadjuvant chemotherapy in First Hospital of Lanzhou University from January 2017 to December 2020,including 52 patients undergoing laparoscopic gastrectomy and 102 patients undergoing open gastrectomy.First,They were analyzed to patients of two groups of neoadjuvant chemotherapy and baseline data such as patients’ age,gender,tumor stage,preoperative complications,tumor location,and then compared two groups of patients with operation data（eg:excision scope,way,operation time,intraoperative blood loss,postoperative complications,etc.）.Kaplan-meier survival analysis was used to compare median survival time between the two groups..The influencing factors of postoperative complications in all patients were analyzed by Logistic multivariate regression analysis.Kaplan-meier was used for single factor analysis of overall survival（OS）,and the factors that were statistically significant in univariate analysis and might affect OS were included in COX risk regression for multivariate survival analysis.Results: A total of 154 patients enrolled in the study were analyzed.Laparoscopic gastrectomy group 52 patients,open gastrectomy group 102 patients.Neoadjuvant chemotherapy data and baseline data（including age,gender,BMI value,previous surgical history,KPS score,preoperative complications,tissue grade type,Lauren classification,tumor location,tumor length,T stage,N stage,neoadjuvant chemotherapy plan and number of cycles）were not statistically significant between 2groups（P≥0.05）.In the comparison of surgical data between the two groups,there were statistically significant in resection scope,surgical incision length and surgical time,with P values of 0.033,0.014 and 0.012,respectively.There were no significant differences in surgical anastomosis,intraoperative blood loss and postoperative hospital stay between the two groups（P≥0.05）.Postoperative complications（P=0.635）and death in hospital（P=0.550）in 2 groups were not statistically significant.The median OS of patients in the two groups was statistically significant（P=0.038）.The median OS was 57 months in the laparoscopic gastrectomy group and49 months in the open gastrectomy group.In univariate analysis of influencing factors of postoperative complications,BMI and N stage were the influencing factors of postoperative complications,with P values of 0.040 and < 0.001,respectively.In multivariate analysis,no independent risk factors for postoperative complications were found.In univariate analysis of influencing factors of OS,N stage（P=0.013）,surgical method（P=0.038）and postoperative complications（P=0.017）in TNM stage were statistically significant.In the multi-factor analysis of influencing factors of OS,N stage（P=0.015）,surgical method（P=0.013）and postoperative complications（P=0.002）were statistically significant and were independent predictors of OS.Conclusions: Laparoscopic gastrectomy after neoadjuvant chemotherapy is as safe as open gastrectomy.Patients in the laparoscopic gastrectomy group had a better survival outcome than those in the open gastrectomy group.Lauren classification,N stage,surgical method,and postoperative complications were independent predictors of OS.