Efficacy and safety of laparoscopic vs open gastrectomy after neoadjuvant therapy for locally advanced gastric cancer

Table 1 Baseline characteristics of the two groups, n (%)

Variable	LG group (n = 38)	OG group (n = 38)	P value
Age (yr)	59.3 ± 9.8	60.5 ± 10.2	0.59
Sex-male	24 (63.2)	26 (68.4)	0.71
Sex-female	14 (36.8)	12 (31.6)
BMI (kg/m)2	23.4 ± 3.2	22.9 ± 2.9	0.48
ECOG PS-0	28 (73.7)	29 (76.3)	0.86
ECOG PS-1	10 (26.3)	9 (23.7)
Comorbidities-yes	14 (36.8)	16 (42.1)	0.67
Comorbidities-no	24 (63.2)	22 (57.9)
Tumor location-upper third	10 (26.3)	12 (31.6)	0.75
Tumor location-middle third	14 (36.8)	13 (34.2)
Tumor location-lower third	14 (36.8)	13 (34.2)
Tumor size (cm)	5.2 ± 1.8	5.4 ± 2.1	0.66
Clinical stage1-II	14 (36.8)	15 (39.5)	0.82
Clinical stage1-III	24 (63.2)
Pathological response-complete2	4 (10.5)	3 (7.9)	0.69
Pathological response-partial2	18 (47.4)	19 (50.0)
Pathological response-stable2	12 (31.6)	11 (28.9)
Pathological response-progressive2	4 (10.5)	5 (13.2)
Type of gastrectomy-total2	20 (52.6)	21 (55.3)	0.88
Type of gastrectomy-subtotal2	18 (47.4)	17 (44.7)

¹According to the 8^th edition of the American Joint Committee on Cancer staging system.

²According to the RECIST version 1.1.

LG: Laparoscopic gastrectomy; OG: Open gastrectomy; BMI: Body mass index; ECOG PS: Eastern Cooperative Oncology Group performance status.

Table 2 Perioperative outcomes of the two groups

Variable	LG group (n = 38)	OG group (n = 38)	P value
Operation time (min)	210 ± 45	220 ± 50	0.28
Blood loss (mL)	100 ± 50	300 ± 100	< 0.001
R0 resection rate (%)	36 (94.7)	35 (92.1)	0.64
Number of harvested lymph nodes1	22 ± 8	23 ± 9	0.57
Proximal margin (cm)2	3.5 ± 1.2	3.6 ± 1.3	0.72
Distal margin (cm)3	4.2 ± 1.4	4.3 ± 1.5	0.79
Hospital stay (days)4	10 ± 3	15 ± 4	< 0.001
Anastomotic leakage-Grade I-IIA5 (%)	2 (5.3)	3 (7.9)	0.67
Anastomotic leakage-Grade IIB-IVB5 (%)	0	1 (2.6)
Intra-abdominal abscess-Grade I-IIA5 (%)	1 (2.6)	2 (5.3)	0.54
Intra-abdominal abscess-Grade IIB-IVB5 (%)	0	1 (2.6)
Wound dehiscence-Grade I-IIA5 (%)	1 (2.6)	2 (5.3)	0.73
Wound dehiscence-Grade IIB-IVB5	0	0
Surgical site infection-Grade I-IIA5 (%)	2 (5.3)	8 (21.1)	0.04
Surgical site infection-Grade IIB-IVB5	0	0
Other complications-Grade I-IIA5 (%)	4 (10.5)	5 (13.2)	0.47
Other complications-Grade IIB-IVB5	0	1 (2.6)

¹Only for patients who underwent D2 lymphadenectomy.

²Only for patients who underwent total gastrectomy.

³Only for patients who underwent subtotal gastrectomy.

⁴From the day of surgery to the day of discharge.

⁵According to the Clavien-dindo classification.

LG: Laparoscopic gastrectomy; OG: Open gastrectomy.

Table 3 Univariate and multivariate analyses of survival outcomes

Variable	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Overall survival
Group
LG	1 (reference)		1 (reference)
OG	1.28 (0.67-2.45)	0.46	1.24 (0.64-2.40)	0.52
Age
≤ 60	1 (reference)		1 (reference)
> 60	1.35 (0.72-2.54)	0.35	1.32 (0.69-2.51)	0.40
Sex
Male	1 (reference)		1 (reference)
Female	0.86 (0.45-1.64)	0.65	0.84 (0.43-1.61)	0.59
BMI
≤ 25	1 (reference)		1 (reference)
> 25	1.12 (0.58-2.16)	0.74	1.09 (0.56-2.13)	0.79
Tumor location
Upper third	1 (reference)		1 (reference)
Middle third	0.97 (0.47-2.01)	0.94	0.95 (0.45-1.98)	0.89
Lower third	0.92 (0.44-1.91)	0.82	0.89 (0.42-1.86)	0.75
Tumor size
≤ 5 cm	1 (reference)		1 (reference)
> 5 cm	1.41 (0.75-2.65)	0.28	1.38 (0.72-2.62)	0.32
Pathological stage1
II	1 (reference)		1 (reference)
III	2.15 (1.12-4.13)	0.02	2.12 (1.09-4.10)	0.03
Pathological response2
Complete	1 (reference)		1 (reference)
Partial	1.22 (0.38-3.94)	0.74	1.18 (0.36-3.86)	0.79
Stable	1.45 (0.45-4.66)	0.54	1.41 (0.43-4.59)	0.57
Progressive	2.67 (0.81-8.80)	0.11	2.61 (0.78-8.68)	0.12
Disease-free survival
Group
LG	1 (reference)		1 (reference)
OG	1.19 (0.64-2.21)	0.58	1.16 (0.62-2.17)	0.64
Age
≤ 60	1 (reference)		1 (reference)
> 60	1.25 (0.68-2.30)	0.47	1.23 (0.66-2.27)	0.51
Sex
Male	1 (reference)		1 (reference)
Female	0.91 (0.49-1.70)	0.77	0.89 (0.47-1.66)	0.71
BMI
≤ 25	1 (reference)		1 (reference)
> 25	1.08 (0.57-2.05)	0.81	1.05 (0.54-2.01)	0.88
Tumor location
Upper third	1 (reference)		1 (reference)
Middle third	0.99 (0.49-2.02)	0.98	0.97 (0.47-1.99)	0.93
Lower third	0.94 (0.46-1.93)	0.87	0.91 (0.44-1.88)	0.80
Tumor size
≤ 5 cm	1 (reference)		1 (reference)
> 5 cm	1.32 (0.72-2.42)	0.37	1.29 (0.69-2.38)	0.42
Pathological stage
II	1 (reference)		1 (reference)
III	2.03 (1.08-3.81)	0.03	2.01 (1.06-3.78)	0.03
Pathological response
Complete	1 (reference)		1 (reference)
Partial	1.18 (0.38-3.67)	0.78	1.15 (0.36-3.59)	0.82
Stable	1.36 (0.43-4.30)	0.60	1.32 (0.41-4.23)	0.64
Progressive	2.49 (0.77-8.07	0.13	2.43 (0.74-7.97)	0.14

¹According to the 8^th edition of the AJCC staging system.

²According to the RECIST version 1.1.

LG: Laparoscopic gastrectomy; OG: Open gastrectomy; BMI: Body mass index; HR: Hazard ratio; CI: Confidence interval.

Table 4 Quality of life scores of the two groups

Period	Variable	LG group (n = 38)	OG group (n = 38)	P value
Baseline	Physical functioning1	83 ± 12	82 ± 13	0.79
	Role Functioning1	80 ± 15	79 ± 16	0.83
	Emotional functioning1	76 ± 14	75 ± 15	0.88
	Cognitive functioning1	78 ± 13	77 ± 14	0.81
	Social functioning1	79 ± 16	78 ± 17	0.86
Before surgery	Physical functioning1	71 ± 14	70 ± 15	0.79
	Role functioning1	68 ± 17	67 ± 18	0.83
	Emotional functioning1	64 ± 16	63 ± 17	0.88
	Cognitive functioning1	66 ± 15	65 ± 16	0.81
	Social functioning1	67 ± 18	66 ± 19	0.86
Six mo after surgery	Physical functioning1	81 ± 13	72 ± 16	0.01
	Role functioning1	78 ± 16	69 ± 19	0.02
	Emotional functioning1	74 ± 15	67 ± 18	0.07
	Cognitive functioning1	76 ± 14	71 ± 16	0.11
	Social functioning1	77 ± 17	71 ± 19	0.12

¹Higher scores indicate better functioning or global health status.

Higher scores indicated more severe symptoms. LG: Laparoscopic gastrectomy; OG: Open gastrectomy.