Laparoscopic versus open gastrectomy for gastric cancer with serous invasion: long-term outcomes.

Background: Laparoscopy-assisted gastrectomy (LAG) has already been introduced for advanced gastric cancer (AGC). However, little is known as to whether LAG is also applicable for AGC with serous invasion given the possibility that malignant cell dissemination and local recurrence incidence might increase. This study was designed to evaluate the technical feasibility and oncological adequacy of LAG in comparison with open gastrectomy (OG) for AGC with serous invasion.

Methods: A retrospective case-matched study was conducted to compare LAG and OG for AGC with serous invasion. For this study, 67 consecutive patients with AGC who underwent LAG between April 2007 and March 2011 were recruited and compared with 67 AGC patients who received OG during the same time period. We analyzed the patient demographics, operative results, pathologic characteristics, and long-term outcomes.

Results: No significant differences were observed in the numbers of harvested lymph nodes (24.0 ± 8.2 versus 25.6 ± 8.8, P = 0.083) or the average distance between the proximal and distal resection margins (4.8 ± 2.5 cm versus 4.6 ± 2.4 cm, P = 0.354; 6.6 ± 4.2 cm versus 7.6 ± 4.7 cm, P = 0.105) in the LAG and OG groups. The complication rate was similar between the LAG and OG groups (6.0% versus 4.5%, P = 0.500). The duration of postoperative analgesic use was significantly shorter in the LAG group than in the OG group (2.9 ± 0.6 d versus 3.9 ± 0.6 d, P < 0.001). The 5-y cumulative survival and recurrence-free survival rates of the two groups were similar (31.3% versus 29.9%, P = 0.949; 29.9% versus 23.9%, P = 0.716).

Conclusions: The findings in this study suggest that LAG is a feasible and safe procedure for patients with seriously invasive AGC and predict acceptable long-term oncologic outcomes. LAG may be an appropriate choice to treat patients with seriously invasive AGC.