Laparoscopic vs open total gastrectomy for advanced gastric cancer following neoadjuvant therapy:A propensity score matching analysis

BACKGROUND Laparoscopic total gastrectomy(LTG)has drawn increasing attention over the years.Although LTG has shown surgical benefits compared to open TG(OTG)in early stage gastric cancer(GC),little is known about the surgical and oncological outcomes of LTG for advanced GC following neoadjuvant therapy(NAT).AIM To compare the long-and short-term outcomes of advanced GC patients who underwent LTG vs OTG following NAT.METHODS Advanced GC patients who underwent TG following NAT between April 2011 and May 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences were enrolled and stratified into two groups:LTG and OTG.Propensity score matching analysis was performed at a 1:1 ratio to overcome possible bias.RESULTS In total,185 patients were enrolled(LTG:78;OTG:109).Of these,138 were paired after propensity score matching.After adjustment for propensity score matching,baseline parameters were similar between the two groups.Compared to OTG,LTG was associated with a significantly shorter length of hospital stay(P=0.012).The rates of R0 resection,lymph node harvest,and postoperative morbidity did not significantly differ between the two groups.Overall survival(OS)outcomes were comparable between the two groups.Pathological T and N stages were found to be independent risk factors for OS.CONCLUSION LTG can be a feasible method for advanced GC patients following NAT,as it appears to be associated with better short-and comparable long-term outcomes compared to OTG.

Robotic-assisted versus open total pancreatectomy: a propensity score-matched study

Background:Total pancreatectomy(TP)is a complex surgical procedure with significant postoperative morbidity.Despite the narrowed range of indications for TP,the introduction of neoadjuvant chemotherapy and the increasing complexity of surgical resections performed in high-volume centers has increased the number of annually performed TPs,especially regarding malignant disease.The introduction of robotic-assisted pancreatic surgery has provided a novel and minimally invasive approach for TP,yet the feasibility of this technique is still unknown.This study assessed the safety and efficacy of robotic-assisted total pancreatectomy(RTP)compared to conventional open total pancreatectomy(OTP).Methods:All patients who underwent TP between March 2015 and July 2019 in a high-volume institution for pancreatic surgery were included in this retrospective study.Clinical data and perioperative outcomes were derived from the prospectively maintained institutional database.A 1:1 propensity score matching(PSM)method was utilized to compare the RTP and OTP cohorts to minimize bias.Results:A standardized surgical protocol was utilized for RTP following a learning curve of RPD and RDP.The median operative time for patients who underwent RTP was significantly decreased compared to those who underwent OTP[300(IQR,250-360)vs.360 min(IQR,300-525),P=0.031].Additionally,en bloc resection and spleen-preserving rates were also higher in the RTP cohort.Major 30-day morbidity(Clavien-Dindo>IIIa)and 90-day mortality were similar between the two cohorts.After a median follow-up time of 15(IQR,8-24)months,both the RTP and OTP cohorts had a comparable quality of life regarding exocrine and endocrine insufficiency.Conclusions:RTP appears to be safe and feasible when utilized in high-volume centers for the indicated management of benign and highly selected malignant pancreatic disease.However,further prospective randomized studies are needed to assess the feasibility of this approach.