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Improved survival after laparoscopic compared to open gastrectomy for advanced gastric cancer: a Swedish population-based cohort study.
Tsekrekos, Andrianos; Vossen, Laura E; Lundell, Lars; Jeremiasen, Martin; Johnsson, Erik; Hedberg, Jakob; Edholm, David; Klevebro, Fredrik; Nilsson, Magnus; Rouvelas, Ioannis.
Afiliación
  • Tsekrekos A; Department of Upper Abdominal Surgery, Karolinska University Hospital, C1:77, Stockholm, Sweden. andrianos.tsekrekos@ki.se.
  • Vossen LE; Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden. andrianos.tsekrekos@ki.se.
  • Lundell L; Department of Upper Abdominal Surgery, Karolinska University Hospital, C1:77, Stockholm, Sweden.
  • Jeremiasen M; Centre for Bioinformatics and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
  • Johnsson E; Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 141 57, Huddinge, Stockholm, Sweden.
  • Hedberg J; Department of Surgery, Odense University Hospital, Odense, Denmark.
  • Edholm D; Department of Surgery, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden.
  • Klevebro F; Department of Surgery, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
  • Nilsson M; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
  • Rouvelas I; Department of Surgery, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Gastric Cancer ; 26(3): 467-477, 2023 05.
Article en En | MEDLINE | ID: mdl-36808262
BACKGROUND: Laparoscopic gastrectomy is increasingly used for the treatment of locally advanced gastric cancer but concerns remain whether similar results can be obtained compared to open gastrectomy, especially in Western populations. This study compared the short-term postoperative, oncological and survival outcomes following laparoscopic versus open gastrectomy based on data from the Swedish National Register for Esophageal and Gastric Cancer. METHODS: Patients who underwent surgery with curative intent for adenocarcinoma of the stomach or gastroesophageal junction Siewert type III from 2015 to 2020 were identified, and 622 patients with cT2-4aN0-3M0 tumors were included. The impact of surgical approach on short-term outcomes was assessed using multivariable logistic regression. Long-term survival was compared using multivariable Cox regression. RESULTS: In total, 350 patients underwent open and 272 laparoscopic gastrectomy, of which 12.9% were converted to open surgery. The groups were similar regarding distribution of clinical disease stage (27.6% stage I, 46.0% stage II, and 26.4% stage III). Neoadjuvant chemotherapy was administered to 52.7% of the patients. There was no difference in the rate of postoperative complications, but laparoscopic approach was associated with lower 90 day mortality (1.8 vs 4.9%, p = 0.043). The median number of resected lymph nodes was higher after laparoscopic surgery (32 vs 26, p < 0.001), while no difference was found in the rate of tumor-free resection margins. Better overall survival was observed after laparoscopic gastrectomy (HR 0.63, p < 0.001). CONCLUSIONS: Laparoscopic gastrectomy can be safely preformed for advanced gastric cancer and is associated with improved overall survival compared to open surgery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Gástricas / Neoplasias Esofágicas / Laparoscopía Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Gastric Cancer Asunto de la revista: GASTROENTEROLOGIA / NEOPLASIAS Año: 2023 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Japón
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Gástricas / Neoplasias Esofágicas / Laparoscopía Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Gastric Cancer Asunto de la revista: GASTROENTEROLOGIA / NEOPLASIAS Año: 2023 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Japón