Comparison of laparoscopic and open gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer: a propensity score matching analysis.

[BACKGROUND] We investigated the safety and efficacy of laparoscopic gastrectomy (LG) in patients with locally advanced gastric cancer who underwent neoadjuvant chemotherapy (NAC).

[METHODS] This study included 247 consecutive patients with advanced gastric cancer who underwent NAC followed by gastrectomy between 2007 and 2017 at one of six institutions. The patients were divided into the open gastrectomy (OG) and LG groups. The short- and long-term outcomes in both groups were investigated after propensity score matching.

[RESULTS] After propensity score matching, 72 pairs of patients were selected. The baseline characteristics were not significantly different after matching. Compared with the OG group, the LG group had a significantly longer operative time (360 vs. 305 min, P = 0.002) and less intraoperative blood loss (271 vs. 652 mL, P < 0.001). The LG group had more harvested lymph nodes than the OG group (57.4 vs. 45.1, P < 0.001). The frequency of Clavien-Dindo grade ≥ 2 postoperative complications was not significantly different (26% vs. 22%, P = 0.698). The interval between surgery and postoperative chemotherapy was significantly shorter in the LG group (48.7 vs. 68.6 days, P = 0.048). The 5-year overall survival rates in the OG and LG groups were 54.4% and 53.5%, respectively. The overall survival was similar between the two groups (P = 0.773). No significant differences were observed between the two groups in terms of the type of recurrence, including lymph node, hematogenous, and peritoneal recurrences (P = 1.000, P = 1.000, and P = 0.686, respectively).

[CONCLUSIONS] Based on both short- and long-term results, LG is a potential therapeutic option for patients with gastric cancer who undergo NAC.