Jiyang Li, Hongqing Xi, Jianxin Cui, Aizhen Cai, Kecheng Zhang, Yunhe Gao, Bo Wei, Lin Chen. Chinese People’s Liberation Army of General Hospital
INTRODUCTION Minimally invasive surgery (MIS) has become the standard care of early gastric cancer worldwide. As the treatment of late-stage cancer going forward, MIS has emerged as an alternative modality for treating advanced gastric cancer. Liver is the most frequent site to which gastric cancer hematogenously metastasizes. With advances in minimally invasive techniques and devices and the accumulating experience of surgeons, MIS for gastric cancer with liver metastasis (GCLM) is the wave of the future. Accordingly, we conducted a nonrandomized, controlled trial to compare the short-term and long-term surgical outcomes of MIS with conventional open surgery for GCLM, evaluating its safety and effectiveness.
METHODS AND PROCEDURES A review of a prospectively designed database at our institute from January 2006 to December 2015 revealed a series of 97 consecutive GCLM patients who received gastrectomy with extended lymphadenectomy (open surgery, n=87 and MIS, n=10). All these patients accepted local treatments of liver metastases (MIS group: laparoscopic/robotic hepatectomy or laparoscopic/robotic gastrectomy combined with radiofrequency ablation or transarterial chemoembolization for liver metastases). Demographic, clinicopathologic characteristics and short-term and long-term outcomes were analyzed.
RESULTS There was no difference of demographic characteristics between the open surgery group and the MIS group. And all other clinicopathological factors are equally comparable between groups except for histologic differentiation. MIS showed significantly less blood loss, shorter time to first sips of water and soft diet. However, total retrieved lymph nodes from open surgery was similar to MIS (mean 14.3 vs 19.0, respectively). Postoperative complication (19.5% vs 30.0%, P=0.321) between the two groups was not significantly different. The overall survival time between the two groups was also comparative (P=0.105 by log-rank test), with 1-year, 3-year and 5-year survival rate 85%, 37% and 25% in the open surgery group, respectively; and 70%, 40% and 10% in the MIS group, respectively. Stratified analysis demonstrated that the difference of two survival curves increased in the stratum of well and moderately differentiation, indicating MIS may benefit the patients with high degree of histologic differentiation more. But this finding is still not statistically different (P=0.107 by log-rank test).
CONCLUSIONS Minimally invasive surgery could be a safe and effective alternative to conventional open surgery in treating gastric cancer patients with liver metastasis. Furthermore, MIS maintains its advantages as minimal invasiveness in the multidisciplinary synthetic therapy of GCLM.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79409
Program Number: S037
Presentation Session: Gastric
Presentation Type: Podium