Surgical and oncological outcomes of laparoscopic versus open gastrectomy after neoadjuvant chemotherapy in patients with locally advanced gastric cancer: A multicenter analysis

Background: Evidence based on large-scale samples comparing the efficacy of laparoscopic gastrectomy (LG) and open gastrectomy (OG) in patients with locally advanced gastric cancer (LAGC) after neoadjuvant chemotherapy (NACT) remains limited. This multicenter study aimed to evaluate the short -term and oncological outcomes of LG and OG after NACT. Methods: Data from a multicenter database of LAGC patients undergoing radical gastrectomy after NACT across 12 centers in China. Propensity score matching (PSM 3:1) was used to balance baseline characteristics. Shortterm outcomes, 5-year overall survival (OS), disease-free survival (DFS), and recurrence patterns were compared. Results: In total, 962 patients fulfilled the inclusion criteria, of whom 753 underwent LG and 209 underwent OG. After PSM, 627 LG and 209 OG patients were analyzed. Both groups had comparable clinical and pathological characteristics (SMD <= 0.100). Intraoperative blood loss was lower in the LG group, with earlier ambulation and diet initiation than that in the OG group (P < 0.05). The number of lymph nodes retrieved was higher in LG group (P < 0.001). Although no significant differences were shown in 5-year OS (LG vs. OG: 51.7vs.43.4 %) and 5-year DFS (LG vs. OG, 48.8 vs. 41.4 %; P > 0.05), landmark analysis revealed improved OS (77.6vs. 65.9 %; P = 0.024) and DFS (84.1vs.71.4 %; P = 0.031) after a landmark time of 28 months in the LG group. Most recurrences occurred within 3 years postoperatively, with similar recurrence patterns in both groups (P > 0.05). Conclusions: In LAGC patients after NACT, LG yielded faster recovery while demonstrating comparable surgical efficacy and oncological outcomes to OG, with potential long-term survival benefits.