Could neoadjuvant chemotherapy increase postoperative complication risk of laparoscopic total gastrectomy? A monoinstitutional propensity score-matched study in China

The potential survival benefit of neoadjuvant chemotherapy(NC)in patients with advanced gastric cancer has been widely recognized.With the development of minimally invasive surgery,which is represented by laparoscopy,the effect of NC on the safety of laparoscopic gastrectomy remains to be further explored.AIM To compare the short-term outcomes of laparoscopic total gastrectomy(LTG)after NC(NC-LTG)with LTG alone.METHODS A total of 92 patients who underwent NC-LTG and 381 patients who received LTG alone at the Chinese PLA General Hospital between September 2015 and September 2020 were retrospectively included in our study.We used propensityscore matching(PSM)to balance baseline bias.After 1:1 PSM,73 patients were included in each group with no statistically significant difference in baseline characteristics.RESULTS The NC-LTG group exhibited a longer operation time(244.10±48.13 min vs 225.74±45.33 min,P=0.019)and increased intraoperative blood loss[150(100-300)mL vs 100(100-200)mL,P=0.011]compared to the LTG group.The 30-d postoperative morbidity of the NC-LTG group was 20.5%(15/73),and that of the LTG group was 13.7%(10/73).There were no significant differences in 30-d severe complication rates or anastomotic leakage rates.Subgroup analysis showed that the patients with pTNM(pathological tumor-node-metastasis classification)T0N0-II in the NC-LTG group underwent a longer operation than the LTG group,while no significant difference was found in any perioperative index for the pTNM III patients.A multivariate analysis showed that an operation time longer than 240 min was an independent risk factor(odds ratio=3.021,95%confidence interval:1.160-7.868,P=0.024),while NC was not an independent risk factor for postoperative complications in LTG.CONCLUSION Despite a longer operation time and more blood loss after NC-LTG,which indicate surgical difficulty,NC-LTG exhibits acceptable short-term outcomes compared to LTG,suggesting the safety and feasibility of NC-LTG.