A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasion

Background Little is known about the feasibility and safety of laparoscopy-assisted total gastrectomy (LATG) with extended lymphadenectomy in patients with advanced gastric cancer (AGO). This study compared the technical feasibility, safety, and oncologic efficacy of LATG with open total gastrectomy (OTG) for AGO without serosa invasion. Methods From January 2009 to December 2011, 235 patients underwent LATG and 153 patients underwent OTG for AGO without serosa invasion. Age, gender, and depth of invasion (pT2 and pT3) were matched by propensity scoring, and 116 patients (58 LATG and 58 OTG) were selected for analysis. Their clinicopathologic characteristics, postoperative outcomes, and survival were compared. Results There was no significant difference in clinicopathologic characteristics between the two propensity-matched groups. Median number of lymph nodes per patient was 29, and the mean number of retrieved lymph nodes was similar in the LATG and OTG groups (30.8 +/- 10.2 vs. 29.0 +/- 8.3). Pen-operative characteristics, operation time, number of transfused units per patient, and time to resumption of activities were similar in the two groups; while blood loss, times to first flatus and resumption of soft diet, and post-operative stay were significantly lower in the LATG group (P<0.05, respectively). Rates of post-operative complications (12.1% vs. 15.5%) and postoperative mortality (0% vs. 1.7%), as well as cumulative survival rates, were similar. Conclusions LATG with D2 lymphadenectomy is a safe and feasible procedure for AGO patients without serosa invasion. Prospective, multicenter, randomized trials are needed to confirm the efficacy of LATG in this patient population.