Short- and long-term outcomes after laparoscopic versus open total gastrectomy for stage 0–I gastric cancer: a multicenter, retrospective analysis

BACKGROUND: Laparoscopic surgery has been increasingly adopted in the treatment of gastric cancer. Although the safety and efficacy of laparoscopic distal gastrectomy have been well established, evidence regarding laparoscopic total gastrectomy (LTG) remains limited, especially for early-stage disease. This study aimed to compare the short-term surgical outcomes and long-term survival between LTG and open total gastrectomy (OTG) in patients with stage 0-I gastric cancer. METHODS: A retrospective analysis was conducted on the clinicopathological data of 122 patients with stage 0-I gastric cancer underwent radical LTG or OTG from January 2010 to December 2013. Multivariate regression with a generalized estimation equation (GEE) was used to analyze the differences in total complications, LTG-related complications and OTG-related complications between the laparoscopic and open groups. The inverse probability of treatment weighting (IPTW) Kaplan-Meier survival curve was used to compare the long-term survival of the two groups. The primary outcome was the short-term outcomes and long-term survival of LTG with traditional OTG for stage 0-I gastric cancer. RESULTS: The incidence of postoperative complications was 16.4% in the LTG group and 18.4% in the OTG group, with no statistically significant difference between the two groups (P>0.05). In the adjusted multivariate GEE regression for OTG-related complications, the risk of OTG-related complications in the laparoscopic group was 0.111 (95% confidence interval: 0.016-0.771, P=0.03). Before and after IPTW adjustment, there was no statistically significant difference in survival between the LTG group and the OTG group (P=0.28 and P=0.34). CONCLUSIONS: LTG is safe and feasible to apply in stage 0-I gastric cancer. Comparing OTG, LTG with a similar overall complication rate and long-term survival, but reduce the incidence of OTG-related complications and does not increase the risk of LTG-related complications in stage 0-I gastric cancer. However, these findings still need to be confirmed in a large clinical trial.