Laparoscopy-assisted gastrectomy remains safe and feasible for gastric cancer patients with a history of upper abdominal surgery

Abstract

BACKGROUND

Laparoscopy-assisted radical gastrectomy is a well-established treatment for gastric cancer. However, its safety and feasibility in patients with a history of upper abdominal surgery (UAS) remain controversial.

AIM

To evaluate perioperative outcomes and oncologic radicality in gastric cancer patients with prior UAS undergoing laparoscopic gastrectomy, using a novel adhesion-risk stratification system.

METHODS

This retrospective study included gastric cancer patients with a history of UAS who underwent radical gastrectomy. The primary endpoints were a composite indicator of “difficult surgery” (defined as operative time > 210 minutes or conversion to open surgery) and the achievement of a “textbook outcome” (TO), a composite all-or-none measure of optimal surgical quality. Propensity score matching and inverse probability of treatment weighting were used to adjust for potential confounders.

RESULTS

A total of 179 patients were included (laparoscopic: 83; open: 96). Baseline characteristics were well balanced. Operative time was longer in the laparoscopic group (P < 0.001), with a conversion rate of 9.6%. Both groups achieved 100% R0 resection with comparable lymph node yields (median, 35.0). The laparoscopic group demonstrated significant recovery advantages, including earlier time to first flatus, earlier resumption of oral intake, shorter postoperative hospital stay, and lower pain scores (all P < 0.001). Overall complication rates were similar between groups. Notably, the laparoscopic group achieved a significantly higher TO rate (78.3% vs 52.1%; P < 0.001). A history of high adhesion-risk surgery was not an independent predictor of “difficult surgery” in the laparoscopic cohort (P = 0.261).

CONCLUSION

In gastric cancer patients with prior UAS, laparoscopy-assisted gastrectomy is safe and feasible, offering faster postoperative recovery and higher TO rates without compromising oncologic radicality.

Keywords: Gastric cancer; Laparoscopic surgery; Upper abdominal surgery history; Safety; Adhesion-risk stratification

Core Tip: This study used propensity score matching and inverse probability of treatment weighting to evaluate the safety and feasibility of laparoscopy-assisted gastrectomy in gastric cancer patients with a history of upper abdominal surgery. The results showed that although laparoscopy-assisted gastrectomy required a longer operative time, it was associated with faster postoperative recovery and a shorter hospital stay. Moreover, even among patients at high risk of intra-abdominal adhesions, the laparoscopic approach was not an independent predictor of surgical difficulty. Therefore, laparoscopic surgery should not be considered a contraindication in gastric cancer patients with prior upper abdominal surgery.