Fabrizio Moisan, MD, Enrique Norero, MD, Milenko Slako, MD, Fernando Crovari, MD, Luis Ibañez, MD, Gustavo Perez, MD, Fernando Pimentel, MD, Sergio Guzmán, MD, Alex Escalona, MD, Nicolás Jarufe, MD, Camilo Boza, MD, Ricardo Funke, MD. Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile
Aim: To compare 3 year survival of laparoscopic versus open curative gastrectomy.
Methods and procedures: retrospective matched cohort study. We included patients between 2002 and 2010 with an R0 resection. A totally laparoscopic technique was used and D2 lymph node dissection was practiced routinely. We performed an intracorporeal hand-sew esophagojejunostomy in all laparoscopic total gastrectomy cases. We matched all laparoscopic cases 1:1 with open cases according to TNM AJCC 7th edition. We used Mann Whitney or t – test and chi square to compare both groups. Kaplan-Meier analysis with log rank test was performed to compare survival.
Results: We included 32 open and 32 laparoscopic cases (mean age 62±14 years; 65% males). Both groups were identical in type of gastrectomy (71% total and 29% subtotal). There was no statistical difference between laparoscopic and open groups in age, sex, N category, tumor location and size, histological differentiation and T category (48% T1, 13% T2, 16% T3 and 23% T4 in both groups), with 48% early and 52% advanced tumors. The median number of resected lymph nodes was similar, 35 (23-53) for laparoscopic and 39 (23-45) for open cases (p=0.73). The median follow up was 46 months. The overall 3 years survival was 75% for laparoscopic surgery and 86% in open group (p=0.25). There was no difference in 3 years survival in laparoscopic versus open group in advanced tumors (64% vs. 75%, p=0.26), N+ tumors (60% vs. 72%, p=0.54) and in the different AJCC stages (stage 1: 92% vs. 100%, stage 2: 86% vs. 82% and stage 3: 40% vs. 50%, p=0.25, 0.89 and 0.67 respectively).
Conclusion: In this preliminary report, with 52% of advanced tumor, the 3 year overall and stage by stage survival was comparable in laparoscopic and open curative gastrectomy.
Program Number: S040