Survival outcomes after laparoscopic gastric cancer surgery: The need for stage-specific insights

Abstract

Gastric cancer remains one of the leading causes of cancer-related mortality worldwide. Advances in surgical techniques, especially laparoscopic surgery, have revolutionized the management of gastric cancer by reducing perioperative morbidity and enabling faster recovery. However, medium- to long-term survival remains understudied, and identifying factors that influence outcomes is essential for improving care. Gan et al’s study analyzes the 3-year survival outcomes and prognosis in patients with primary gastric cancer undergoing laparoscopic surgery. The study identifies the important variables associated with survival, including age, tumor node metastasis stage, tumor characteristics, surgical factors, and postoperative complications. While the study provides important data for clinical practice, further research is warranted to refine risk stratification and explore the role of emerging therapies.

Key Words: Primary gastric cancer; Laparoscopic surgery; Risk stratification; Survival factors; Personalized care; Adjuvant therapy; Multidisciplinary care

Core Tip: Identifying key factors that influence survival after laparoscopic surgery for primary gastric cancer is crucial for optimizing patient outcomes. Moving forward, adopting a more individualized, multidisciplinary approach, risk stratification, and the integration of emerging therapies may further enhance survival and quality of life in these patients.

TO THE EDITOR

Gastric cancer remains a major global health concern and is one of the leading causes of cancer-related mortality worldwide. In China alone, gastric cancer accounts for approximately 260400 deaths annually[1]. Surgical resection continues to be the mainstay of curative treatment[2], and in recent years, laparoscopic surgery has become increasingly prominent due to its minimally invasive nature, reduced intraoperative trauma, faster postoperative recovery, and noninferiority to open distal gastrectomy[3,4].

Despite these advancements, primary gastric cancer retains a risk of postoperative recurrence following laparoscopic surgery[2]. Therefore, identifying clinical and pathological factors that influence survival is essential for optimizing treatment strategies. Gan et al[2] recent retrospective study provides important insights into 3-year survival outcomes of patients undergoing laparoscopic surgery for primary gastric cancer, identifying prognostic variables such as tumor node metastasis (TNM) stage, tumor size, depth of invasion, lymph node metastasis, and postoperative complications.

In this letter, we aim to discuss the strengths of their findings, offer additional perspectives on risk stratification and individualized care, and suggest areas for future research to further outcome improvement for patients with gastric cancer.

Insights into improving survival after laparoscopic gastrectomy

Gan et al[2] study provides valuable insights into the factors influencing 3-year survival in patients with primary gastric cancer undergoing laparoscopic surgery. The reported overall survival rate of 73% after 3 years[2] highlights the progress made with minimally invasive techniques, though there remains room for improvement. The identification of key variables (TNM stage, tumor size, depth of invasion, etc.) provides clinicians with valuable information for optimizing patient outcomes.

A noteworthy point is the inclusion of intraoperative variables in their analysis. The finding that surgical duration and the range of gastrectomy were associated with survival outcomes[2] may aid surgeons in choosing the appropriate maneuvers and better controlling surgical complications. Additionally, the role of postoperative complications emphasizes the need for enhanced recovery protocols.

The inclusion of postoperative carcinoembryonic antigen (CEA) levels as a survival factor is of great clinical relevance. Elevated CEA levels post-surgery are associated with poorer outcomes[5,6], suggesting that serial monitoring could inform risk stratification and prompt early intervention. Furthermore, the inclusion of emerging therapies, such as immune checkpoint inhibitors and targeted therapies, in the study’s discussion reflects the current shift toward personalized treatment strategies[2].

However, the study has some limitations. It did not discuss how the small sample size and single-hospital design might affect the generalizability of the findings. Future research should address these issues by involving larger, multi-center groups and extending the follow-up period to better assess the durability of the benefits observed.

One potential area for further exploration is the stratification of results by TNM stage. Given that more than 55% of patients in the non-survival group were classified as stage III[2], stage-specific analyses could better inform individualized treatment approaches. Additionally, while the study highlighted postoperative CEA levels, integrating preoperative CEA trends could enhance risk stratification.

CONCLUSION

Gan et al[2] have provided a comprehensive and clinically relevant analysis that will aid in refining treatment strategies for gastric cancer. We encourage further research to improve long-term outcomes. For example, a randomized controlled trial comparing laparoscopic vs open gastrectomy in different stages would greatly help future guidelines. To validate the findings and refine intervention strategies, larger, multi-center studies with extended follow-up periods are necessary. Moving forward, multidisciplinary care pathways should aim to integrate these prognostic markers with emerging systemic therapies, such as immunotherapy, and regular CEA monitoring (with intervals of 3-6 months during the first 2-3 years post-surgery). These efforts will ultimately help optimize survival and quality of life for patients undergoing surgery for gastric cancer.