P-260 Outcomes of laparoscopic and open gastrectomy for gastric cancer: a comparative analysis

Abstract

Introduction: Laparoscopic gastric resection has increased popularity in western countries as a potentially curative treatment of gastric cancer. The short-term outcomes and technical feasibility are well proved, whereas long-term outcomes and oncological safety are still uncertain. Methods:We performed a comparative analysis based in a prospective database with gastric cancer cases submitted to curative intent surgery, between January 2010 and December 2014, in an Upper GI Surgery Unit. For this analysis, cases of non-resectional surgery were excluded. Results: The 207 cases included in this study were divided in two groups [Laparoscopic (LG) 63 (including 5 conversions) vs Open (OG) gastrectomy 144 cases], that were comparable in demographics (age, gender, comorbidities, ASA score, BMI) and clinico-pathological profile (tumor location and histologic type, staging pTNM and neoadjuvant therapy). In OG group were performed more total gastrectomies (49,3 vs 25,4%; p = 0,002), while LG allow a better lymphadenectomy (D2 in 39,7 vs 16%; p = 0,002), but was associated to a longer operative time (252,3 ± 45,2 vs 207,2 ± 55,9 minutes, p < 0,001). LG was associated with less post-operative morbidity (12,7 vs 24,3%, p = 0,058), mortality (1,6 vs 6,3%, p = 0,289) and re-intervention rate (OR 0,129; CI95% 0,017-0,995; p = 0,049). In OG there was a significant (p = 0,033) need for transfusions (OR 3,127; CI95% 1,125-8,691), while in LG group there were more long-term complications (OR 3,345; CI95% 1,11-10,087; p = 0,034). There weren't significant differences between both groups in LOS, readmission rate nor Clavien classification. Related to oncological outcomes, there weren't significant differences between groups in lymph nodes (LN) retrieved (28,1 ± 11,2 vs 28,4 ± 14,4 LN), R0 resection rate (93,7 vs 92,4%), surgical margins (proximal 5,4 ± 3,1 vs 5,3 ± 3,3 cm; distal 4,6 ± 2,8 vs 4,3 ± 3,3 cm) nor recurrence rate (25,4 vs 22,9%). Median follow-up was 29 (0-72) months. LG was associated with significant (Log rank, p = 0,01) better overall survival (1-year 89 vs 78%, 2-year 78 vs 64%, 3-year 73 vs 54%), but there weren't significant differences (Breslow, p = 0,093) in disease-free survival (1-year 87 vs 69%, 2-year 72 vs 63%, 3-year 67 vs 59%). Conclusion: The results of this study provide further evidence for the feasibility and oncological safety of LG, being associated with reduced morbidity and an impact in overall survival.