Feasibility of Minimally Invasive Surgery for Locally Advanced Gastric Cancer After Neoadjuvant Chemotherapy: A Four-arm Comparative Study.

[BACKGROUND/AIM] Previous studies demonstrated the safety of laparoscopic gastrectomy in patients with locally advanced gastric cancer. However, the feasibility of minimally invasive surgery (MIS) following neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer remains unclear. To our knowledge, no previous study has conducted a comprehensive analysis that evaluated NAC and surgical approach simultaneously. This study aimed to assess the feasibility of MIS for locally advanced gastric cancer after NAC using a four-arm comparison.

[PATIENTS AND METHODS] This study retrospectively analyzed 174 patients who underwent gastrectomy at Kobe University Hospital between January 2011 and July 2024. The patients were categorized into four groups based on NAC and surgical approaches: No NAC/open surgery (n=63), no NAC/MIS (n=49), NAC/open surgery (n=20), and NAC/MIS (n=42). We compared surgical and survival outcomes among the four groups.

[RESULTS] Patients in the group treated with NAC/MIS experienced less blood loss, fewer transfusions, and a shorter hospital stay. Additionally, compared with the NAC/open (20%) and no NAC/MIS (6.1%) groups, the rate of severe postoperative complications (grade ≥III) was lowest in the group treated with NAC/MIS, with no incidence of pancreatic fistula. The R0 resection rate was highest (97.6%) in the group treated with NAC/MIS. Although 5-year relapse-free survival and overall survival were higher in the group treated with NAC/MIS, the differences were not statistically significant.

[CONCLUSION] This four-arm study suggests that minimally invasive surgery after NAC for locally advanced gastric cancer may be technically and oncologically safe.