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A matched cohort study of the failure pattern after laparoscopic and open gastrectomy for locally advanced gastric cancer: does the operative approach matter?

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Abstract

Background

Due to lacking evidence for confirming the efficacy of performing laparoscopic surgery for locally advanced gastric cancer (LAGC). Therefore, this study aimed to compare the static and dynamic failure patterns after laparoscopic gastrectomy (LG) and open gastrectomy (OG) in LAGC.

Methods

A total of 1792 LAGC patients who underwent radical resection between January 2010 and January 2017 were divided into the LG group (n = 1557) and the OG group (n = 235). Propensity score matching was performed to balance the two groups. Dynamic hazard rates of failure were calculated using the hazard function. Early and late failure were defined as failure occurring before and after 2 years since surgery, respectively.

Results

A total of 1175 patients with LAGC were included after matching (LG group, n = 940; OG, n = 235). The failure rate of the whole cohort was 43.2% (508/1175), accounting for 41.4% (389/940) and 50.6% (119/235) in the LG and OG groups, respectively. Although the two groups showed no significant differences in failure rate for any failure type, landmark analysis showed a lower early distant recurrence rate in the stage IIa–IIIb subgroup of the LG group (OG versus LG: 30.3% versus 21.1%, P = 0.004). The dynamic hazard rate peaked at 9.4 months (peak rate = 0.0186) before gradually declining. In stage IIa–IIIb patients, the hazard rate of the OG group remained significantly higher than that of the LG group within the first 2 years in terms of distant recurrence (peak rate: OG versus LG, 0.0091 versus 0.0055).

Conclusion

Given the differences in early failure between LG and OG, more intensive surveillance for distant recurrence within the first 2 years should be considered for patients with stage IIa–IIIb after OG.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We wish to thank all colleagues and nurses who provided care to the patients in this study.

Funding

This study was funded by Joint Funds for the innovation of science and technology, Fujian Province (Grant Numbers: 2017Y9011, 2017Y9004, 2018Y9041); the second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013); Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171), Natural Science Foundation of Fujian Province (2019J01155), Fujian provincial science and technology innovation joint fund project plan (2018Y9005), and Fujian provincial health technology project (2019-ZQN-37).

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Author notes

  1. Jun Lu, Dong Wu, and Bin-Bin Xu contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China

    Jun Lu, Dong Wu, Bin-Bin Xu, Zhen Xue, Hua-Long Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Ping Li, Chao-Hui Zheng & Chang-Ming Huang

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Jun Lu, Dong Wu, Bin-Bin Xu, Zhen Xue, Hua-Long Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Ping Li, Chao-Hui Zheng & Chang-Ming Huang

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Jun Lu, Dong Wu, Bin-Bin Xu, Zhen Xue, Hua-Long Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Ping Li, Chao-Hui Zheng & Chang-Ming Huang

  4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China

    Jun Lu, Dong Wu, Bin-Bin Xu, Zhen Xue, Hua-Long Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Ping Li, Chao-Hui Zheng & Chang-Ming Huang

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Contributions

Conception/Design: CMH, CH Z, PL, JL, and DW. Collection and/or assembly of data: JL, DW, BBX, ZX, HLZ, JWX, JBW, JXL, PL, CHZ, and CMH. Data analysis and interpretation: JL, DW, BBX, ZX, HLZ, PL, CHZ, and CMH. Manuscript writing: JL, DW, BBX, PL, CHZ, and CMH. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Ping Li, Chao-Hui Zheng or Chang-Ming Huang.

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Jun Lu, Dong Wu, Bin-bin Xu, Zhen Xue, Hua-Long Zheng, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Ping Li, Chao-Hui Zheng, and Chang-Ming Huang have no conflicts of interest or financial ties to disclose.

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Lu, J., Wu, D., Xu, BB. et al. A matched cohort study of the failure pattern after laparoscopic and open gastrectomy for locally advanced gastric cancer: does the operative approach matter?. Surg Endosc 36, 689–700 (2022). https://doi.org/10.1007/s00464-021-08337-w

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