Long-term oncological outcomes of minimally invasive versus open gastrectomy for cancer

Background: Although laparoscopy is widely used in oncologic digestive surgery, many centers are still reluctant to replace open surgery for gastric cancer treatment, especially in advanced disease. The aim of this study was to assess long-term survival and recurrence in patients after laparoscopic (LG) versus open (OG) oncological gastrectomy, in a tertiary reference center.

Methods: All consecutive patients with gastric adenocarcinoma undergoing curative gastrectomy between December 2007 and December 2021 were retrospectively analyzed. Clinico-pathological characteristics, survival and recurrence were compared among LG, OG or converted (CoG) patients. The ×2 test was used for categorical variables and the Mann-Whitney U test for continuous ones. Survival was assessed with the Kaplan-Meier method and log-rank test, as well as a multivariable Cox regression analysis.

Results: Among 156 included patients, 49 (31.4 ​%) were in the LG group, 93 (59.6 ​%) in the OG group, and 14 (9 ​%) in the CoG group. Baseline demographics were similar among the groups. R0 resection rates were 75.5 ​% in LG, 80.6 ​% in OG, and 64.3 ​% in CoG (p ​= ​0.489). Open surgery was associated with a higher mean lymph node yield (28.4 ​± ​11.6) compared to LG (22.8 ​± ​9.7) and CoG (26.5 ​± ​12.3, p ​= ​0.036). Severe postoperative complications were higher in the CoG group (64.3 ​% CoG versus 29 ​% OG, 32.7 ​% LG, p ​= ​0.035). The CoG group had a significantly inferior disease-free survival (p ​= ​0.012 vs OG, p ​= ​0.003 vs LG; 53.3 ​% OG, 62.7 ​% LG and 28.1 ​% CoG) although overall survival was similar (57.1 ​% OG, 62.7 ​% LG and 32.7 ​% CoG, all p ​> ​0.005).

Conclusions: Laparoscopic gastrectomy, while associated with a lower lymph node yield, provides similar overall survival rates compared to open surgery. Conversion to open surgery was associated with higher major postoperative morbidity and inferior disease-free survival.