Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2026
Comparison of minimally invasive surgery and open surgery following chemotherapy for cStage IVb gastric cancer: a multicenter retrospective cohort study.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Fujii Yusuke, Hisamori Shigeo, Hoshino Nobuaki, Kanaya Seiichiro, Tanaka Eiji, Yamashita Yoshito, Miki Akira, Toda Kosuke, Yamamoto Michihiro, Kinjo Yosuke, Manaka Dai, Hata Hiroaki, Kawada Hironori, Matsuda Shotaro, Itami Atsushi, Hashimoto Kyoichi, Hirai Kenjiro, Nakajima Sanae, Okabe Hiroshi, Sakaguchi Masazumi, Kawamura Yuichiro, Sakamoto Takashi, Okumura Shintaro, Nishigori Tatsuto, Tsunoda Shigeru, Obama Kazutaka
Аннотация
BACKGROUND: The standard treatment for stage IV gastric cancer (GC) is chemotherapy, but advances in systemic therapy have rendered curative surgery a viable option. However, the role of minimally invasive surgery (MIS) in this context remains unclear. This multicenter retrospective cohort study aimed to evaluate safety and effectiveness of MIS post-chemotherapy for patients with cStage IVb GC.
METHODS: Patients with cStage IVb GC who underwent curative-intent MIS or open surgery post-chemotherapy at 19 institutions between 2011 and 2022 were reviewed. Propensity score-matching was performed to adjust for confounding variables. The primary outcome was postoperative complications. Secondary outcomes were perioperative outcomes and long-term survival.
RESULTS: Among 237 eligible patients (MIS, 130; open surgery, 107), 64 matched pairs were analysed. The incidence of Clavien-Dindo grade ≥ II complications was 31.2% in the MIS group and 46.9% in the open group, with no significant difference (risk ratio 0.67, 95% confidence interval [CI] 0.41-1.08). MIS was associated with a longer operative time (mean difference [MD] 98 min, 95% CI 53-143) but reduced blood loss (MD, - 550 g; 95% CI, - 738 to - 362). The MIS group achieved R0 resections more often (92% vs. 78%). The 3-year overall survival rates were 56.5% and 44.6%, respectively (hazard ratio 0.83, 95% CI 0.51-1.36).
CONCLUSIONS: In curative-intent gastrectomy following chemotherapy for cStage IVb gastric cancer, MIS was not associated with worse perioperative outcomes or long-term survival compared with open surgery. Given its less invasive nature, MIS could be considered a feasible option for these patients when performed by experienced surgeons.
METHODS: Patients with cStage IVb GC who underwent curative-intent MIS or open surgery post-chemotherapy at 19 institutions between 2011 and 2022 were reviewed. Propensity score-matching was performed to adjust for confounding variables. The primary outcome was postoperative complications. Secondary outcomes were perioperative outcomes and long-term survival.
RESULTS: Among 237 eligible patients (MIS, 130; open surgery, 107), 64 matched pairs were analysed. The incidence of Clavien-Dindo grade ≥ II complications was 31.2% in the MIS group and 46.9% in the open group, with no significant difference (risk ratio 0.67, 95% confidence interval [CI] 0.41-1.08). MIS was associated with a longer operative time (mean difference [MD] 98 min, 95% CI 53-143) but reduced blood loss (MD, - 550 g; 95% CI, - 738 to - 362). The MIS group achieved R0 resections more often (92% vs. 78%). The 3-year overall survival rates were 56.5% and 44.6%, respectively (hazard ratio 0.83, 95% CI 0.51-1.36).
CONCLUSIONS: In curative-intent gastrectomy following chemotherapy for cStage IVb gastric cancer, MIS was not associated with worse perioperative outcomes or long-term survival compared with open surgery. Given its less invasive nature, MIS could be considered a feasible option for these patients when performed by experienced surgeons.