Could neoadjuvant chemotherapy increase postoperative complication risk of laparoscopic total gastrectomy? A mono-institutional propensity score-matched study in China

Table 1 Baseline characteristics of laparoscopic total gastrectomy after neoadjuvant chemotherapy group and laparoscopic total gastrectomy group before propensity-score matching

Clinical characteristic	NC-LTG group (n = 92)	LTG group (n = 381)	P value
Sex			0.109
Male	68	310
Female	24	71
Age (yr, mean ± SD)	58.87 ± 10.28	59.85 ± 11.40	0.452
BMI (kg/m2, mean ± SD)	23.03 ± 2.97	23.79 ± 3.65	0.065
History of abdominal surgery			0.368
Yes	17	56
No	75	325
ASA grade			0.023
I	10	3
II	72	336
III	10	42
Tumor diameter, cm (median, IQR)	4.00 (3.00-6.37)	5.00 (3.00-6.50)	0.108
pT			0.433
T0-T1	12	63
T2	15	38
T3	52	206
T4	13	74
pN			0.129
N0	36	127
N1	15	54
N2	18	73
N3	23	127
pTNM			0.600
0-I	20	80
II	28	105
III	44	196
Differentiation			0.829
Well/moderate	44	187
Poor/undifferentiated	48	194
Nerve invasion			0.150
Yes	29	151
No	63	230
Vascular invasion			0.220
Yes	28	142
No	64	239

NC-LTG: Laparoscopic total gastrectomy after neoadjuvant chemotherapy; LTG: Laparoscopic total gastrectomy; BMI: Body mass index; ASA: American Society of Anesthesiologists; IQR: Interquartile range; TNM: Tumor-node-metastasis.

Table 2 Baseline characteristics of laparoscopic total gastrectomy after neoadjuvant chemotherapy group and laparoscopic total gastrectomy group after propensity-score matching

Clinical characteristic	NC-LTG group (n = 73)	LTG group (n = 73)	P value
Sex			0.843
Male	57	56
Female	16	17
Age (yr, mean ± SD)	59.56 ± 10.23	58.48 ± 12.35	0.565
BMI (kg/m2, mean ± SD)	23.16 ± 2.75	23.06 ± 3.91	0.860
History of abdominal surgery			1.000
Yes	14	14
No	59	59
ASA grade			0.646
I	6	2
II	61	67
III	6	4
Tumor diameter, cm (median, IQR)	4.5 (3.0-6.0)	4.0 (3.0-6.0)	0.716
pT			0.706
T0-T1	8	14
T2	12	9
T3	42	37
T4	11	13
pN			0.917
N0	26	32
N1	14	5
N2	16	16
N3	17	20
pTNM			0.710
0-I	14	17
II	25	23
III	34	33
Differentiation			0.619
Well/moderate	37	34
Poor/undifferentiated	36	39
Nerve invasion			0.730
Yes	25	27
No	48	46
Vascular invasion			0.210
Yes	26	19
No	47	54

NC-LTG: Laparoscopic total gastrectomy after neoadjuvant chemotherapy; LTG: Laparoscopic total gastrectomy; BMI: Body mass index; ASA: American Society of Anesthesiologists; IQR: Interquartile range; TNM: Tumor-node-metastasis.

Table 3 Surgical indicators in perioperative days between laparoscopic total gastrectomy after neoadjuvant chemotherapy and laparoscopic total gastrectomy group

Variable	NC-LTG group (n = 73)	LTG group (n = 73)	P value
Surgical time, min (mean ± SD)	244.10 ± 48.13	225.74 ± 45.33	0.019
Blood loss, mL (median, IQR)	150 (100-300)	100 (100-200)	0.011
Retrieved lymph nodes, n (mean ± SD)	31.14 ± 11.81	32.21 ± 12.12	0.593
Fist flatus day, d (mean ± SD)	4.25 ± 1.11	4.27 ± 1.10	0.896
R0 resection rate, n (%)	3 (4.1)	3 (4.1)	1.000
Postoperative day, d (median, IQR)	9.0 (7.0-11.0)	8.0 (7.0-11.0)	0.602
Total complication rate, n (%)	15 (20.5)	10 (13.7)	0.272
Clavien-Dindo classification
Grade II
Anastomosis leakage	2	1
Lymphatic leakage	1	2
Abdominal infection	1	0
Ileus	1	0
Anemia	3	1
Pneumonia	1	0
Hypoproteinemia	2	2
Grade III
Deep venous thrombosis	1	0
Anastomosis leakage	0	1
Intestinal leakage	0	1
Seroperitoneum	0	1
Abdominal hemorrhage	0	1
Grade IV
Cerebral infraction	2	0
Grade V
Severe pneumonia	1	0
Severe complication rate, n (%)	4 (5.5)	4 (5.5)	1.000

NC-LTG: Laparoscopic total gastrectomy after neoadjuvant chemotherapy; LTG: Laparoscopic total gastrectomy; IQR: Interquartile range.

Table 4 Clinical characteristics and surgical indicators in pTNM 0-II patients between laparoscopic total gastrectomy after neoadjuvant chemotherapy and laparoscopic total gastrectomy group

Variable	NC-LTG group (n = 39)	LTG group (n = 40)	P value
Sex			0.560
Male	28	31
Female	11	9
Age (yr, mean ± SD)	59.56 ± 10.67	58.73 ± 12.08	0.745
BMI (kg/m2, mean ± SD)	23.08 ± 2.71	22.20 ± 4.25	0.275
ASA grade			0.508
I	3	1
II	31	38
III	5	1
Surgical time, min (mean ± SD)	249.38 ± 48.62	223.85 ± 50.13	0.024
Blood loss, mL (median, IQR)	100 (100-200)	100 (100-150)	0.067
Retrieved lymph nodes, n (mean ± SD)	30.67 ± 11.53	32.73 ± 13.07	0.461
Fist flatus day, d [(median, IQR)]	4.0 (3.0-5.0)	4.5 (3.0-5.0)	0.741
R0 resection rate, n (%)	2 (5.1)	0 (0)	0.241
Postoperative day, d [(median, IQR)]	9.0 (7.0-10.0)	9.0 (7.0-11.0)	0.724
Total complication rate, n (%)	9 (23.1)	4 (10.0)	0.117
Severe complication rate, n (%)	2 (5.1)	1 (2.5)	0.982

NC-LTG: Laparoscopic total gastrectomy after neoadjuvant chemotherapy; LTG: Laparoscopic total gastrectomy; BMI: Body mass index; ASA: American Society of Anesthesiologists; IQR: Interquartile range.

Table 5 Clinical characteristics and surgical indicators in pTNM III patients between laparoscopic total gastrectomy after neoadjuvant chemotherapy and laparoscopic total gastrectomy group

Variable	NC-LTG group (n = 34)	LTG group (n = 33)	P value
Sex			0.324
Male	29	25
Female	5	8
Age (yr, mean ± SD)	59.56 ± 9.84	58.18 ± 12.85	0.623
BMI (kg/m2, mean ± SD)	23.24 ± 2.85	24.09 ± 3.20	0.250
ASA grade			0.160
I	3	1
II	30	29
III	1	3
Surgical time, min (mean ± SD)	237.44 ± 46.86	228.03 ± 39.39	0.378
Blood loss, mL (median, IQR)	200 (100-500)	100 (100-200)	0.078
Retrieved lymph nodes, n (mean ± SD)	32.09 ± 12.32	31.58 ± 11.04	0.858
Fist flatus day, d [median, (IQR)]	4.0 (3.0-5.0)	4.0 (3.0-5.0)	0.844
R0 resection rate, n (%)	1 (2.9)	3 (9.1)	0.288
Postoperative day, d [median, (IQR)]	9.5 (7.0-11.0)	8.0 (7.0-9.5)	0.321
Total complication rate, n (%)	6 (17.6)	6 (18.2)	0.954
Severe complication rate, n (%)	2 (5.9)	3 (9.1)	0.617

NC-LTG: Laparoscopic total gastrectomy after neoadjuvant chemotherapy; LTG: Laparoscopic total gastrectomy; BMI: Body mass index; ASA: American Society of Anesthesiologists; IQR: Interquartile range.

Table 6 Univariate and multivariate logistic regression analyses for postoperative complications in laparoscopic total gastrectomy patients

Factor	Univariate analysis		P value	Multivariate analysis		P value
	OR	95%CI		OR	95%CI
Sex			0.221			0.076
Male	Ref			Ref
Female	1.807	0.700-4.666		2.601	0.906-7.465
Age			0.215			0.159
< 60	Ref			Ref
≥ 60	0.574	0.239-1.380		0.519	0.208-1.292
BMI (kg/m2)			0.596
< 25	Ref
≥ 25	1.277	0.517-3.152
Neoadjuvant chemotherapy			0.275
No	Ref
Yes	1.629	0.678-3.913
ASA score			0.723
< II	Ref
≥ II	1.474	0.173-12.538
Tumor diameter (cm)			0.208			0.139
< 5	Ref			Ref
≥ 5	1.747	0.733-4.162		2.049	0.793-5.296
Operation time (min)			0.031			0.024
< 240	Ref			Ref
≥ 240	2.726	1.093-6.799		3.021	1.160-7.868
Estimated blood loss (mL)			0.267
≤ 200	Ref
> 200	1.750	0.652-4.699
Vascular invasion			0.539
No	Ref
Yes	1.328	0.537-3.283
Nerve invasion			0.338
No	Ref
Yes	1.533	0.639-3.677

CI: Confidence interval; OR: Odds ratio; BMI: Body mass index; ASA: American Society of Anesthesiologists.