Feasibility of laparoscopic gastrectomy for patients with Siewert-type II/III adenocarcinoma of the esophagogastric junction: A propensity score matching analysis

Abstract

Background/AimThe feasibility of using laparoscopic gastrectomy for the treatment of Siewert-type II/III adenocarcinoma of the esophagogastric junction (AEG) has not been addressed. This study aimed to comparatively evaluate the short- and long-term effects on laparoscopic versus open surgery using (propensity score matching) PSM for Siewert-type II/III AEG.MethodsWe retrospectively collected data from the patients with Siewert-type II/III AEG who were treated in our cancer center between January 2013 and December 2015. Patients undergoing laparoscopic gastrectomy and open gastrectomy were matched via PSM. The cumulative 2-year Overall survival (OS) rate of patients in the two cohorts was estimated by Kaplan-Meier plots. Multi-variable analysis using a Cox regression model was conducted to identify independent risk factors.ResultsA total of 963 patients with Siewert-type II/III AEG were included, of which 132 cases were in the laparoscopic gastrectomy group, and 831 cases were in the open gastrectomy group. After regrouping with PSM, 132 patients in the laparoscopic gastrectomy group were balanced with 264 similar patients in the open gastrectomy group. As expected, the laparoscopic gastrectomy group had significantly longer operation times, but less blood loss. Furthermore, the two groups showed similar results for post-operative complications, duration of hospital stay and 2-year OS rate. Combined organ resection was an independent risk factor for 2-year OS rate.ConclusionThis study suggests that laparoscopic gastrectomy may serve as a safe and feasible treatment for Siewert-type II/III AEG and achieve similar oncologic outcomes as open gastrectomy.

Laparoscopic versus open gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a meta-analysis

“…After screening the title and abstract, 36 studies were assessed via full-text articles that we obtained. Finally, seven articles with a total of 1915 patients were included [13][14][15][16][17][18][19]. Approximately 1042 patients were in the LG group, while 873 patients were in the OG group.…”

“…All selected studies reported the duration of surgery [13][14][15][16][17][18][19]. Four studies [15,16,18,19] showed that operative time was significantly longer in the LG group than in the OG group.…”

“…All selected studies reported the duration of surgery [13][14][15][16][17][18][19]. Four studies [15,16,18,19] showed that operative time was significantly longer in the LG group than in the OG group. One study [14] showed the opposite outcome, and other two studies [13,17] showed no significant difference between the LG group and OG group.…”

“…Seven studies [13][14][15][16][17][18][19] for inclusion provided the estimated blood loss. Six studies [14][15][16][17][18][19] of them showed that the estimated blood loss was significantly less in the LG group than in the OG group, and only one study [13] showed no significant difference between the two groups.…”

“…Seven studies [13][14][15][16][17][18][19] for inclusion provided the estimated blood loss. Six studies [14][15][16][17][18][19] of them showed that the estimated blood loss was significantly less in the LG group than in the OG group, and only one study [13] showed no significant difference between the two groups. The meta-analysis revealed that the estimated blood loss was significantly less in the LG group than in OG group (WMD = − 77.49 ml, 95%CI − 111.84 to − 43.15; P < 0.00001).…”