In the evolving landscape of surgical oncology, the treatment of advanced gastric cancer remains a formidable challenge, especially following neoadjuvant chemotherapy. A recent multicenter retrospective cohort study published in BMC Cancer delves deep into the comparative efficacy and outcomes of three prevalent surgical approaches: total laparoscopic, laparoscopic-assisted, and traditional open total gastrectomies. This comprehensive study, spanning five medical centers and involving 289 patients, offers fresh insights into how these surgical modalities perform in both short- and long-term contexts, potentially reshaping current clinical preferences and patient management protocols.
Gastric cancer, a malignancy noted for its aggressive nature and complex anatomical considerations, often necessitates radical surgical interventions post neoadjuvant chemotherapy. Neoadjuvant therapy, which aims to reduce tumor burden before surgery, can influence tissue characteristics and subsequent surgical maneuverability. Hence, understanding how different surgical techniques fare under these nuanced conditions is critical. The researchers meticulously stratified patients into three cohorts based on the surgical technique: totally laparoscopic total gastrectomy, laparoscopic-assisted total gastrectomy, and open total gastrectomy, enabling a robust comparative analysis.
One of the noteworthy findings was the paradoxical observation that the totally laparoscopic group exhibited a longer operative time compared to the other two groups. This could initially be perceived as a disadvantage given surgical time often correlates with complications and recovery. However, the increased duration may reflect the inherent complexity and precision required during minimally invasive procedures, which demand advanced technical expertise and cautious dissection in the altered anatomical field post-chemotherapy. This nuanced detail underscores the evolving surgical learning curve associated with robotic and laparoscopic techniques.
Contrastingly, the study also revealed that the totally laparoscopic group experienced greater intraoperative blood loss compared to laparoscopic-assisted and open surgery patients. This finding invites intriguing questions regarding vascular control and tissue management during purely laparoscopic resections. Despite this, the rate of intraoperative blood transfusion did not significantly differ between groups, suggesting that hemodynamic stability was maintained across all surgical approaches, potentially due to effective anesthesiological protocols and surgical expertise.
A decisive advantage of the totally laparoscopic approach emerged in postoperative recovery metrics. Patients undergoing totally laparoscopic total gastrectomy demonstrated accelerated gastrointestinal function recovery—manifested in earlier postoperative bowel movements, defecations, and resumption of oral intake. These parameters are pivotal as they correlate strongly with reduced hospitalization durations, minimized catheter and drain-associated morbidities, and improved overall patient comfort and outcomes. Such benefits hold substantial promise in enhancing patient quality of life and reducing healthcare resource burdens.
Further examination of oncological efficacy revealed that the total number of lymph nodes dissected was significantly higher in the totally laparoscopic group. Lymphadenectomy extent is a critical determinant of accurate pathological staging and prognostication in gastric cancer. The ability of laparoscopy to facilitate meticulous lymph node harvest despite spatial limitations challenges the traditional notion that open surgeries offer superior oncological clearance. This is a vital affirmation for minimally invasive oncologic surgery proponents advocating for laparoscopic modalities.
Interestingly, critical parameters such as tumor staging, maximum tumor diameter, and number of positive lymph nodes harvested were statistically equivalent across all groups, implying comparable surgical radicality and cancer control. Similarly, postoperative complications measured by Clavien-Dindo classifications and readmission rates at both 30 and 90 days post-surgery did not diverge substantially among the surgical strategies, reinforcing the safety profile of minimally invasive techniques in carefully selected cases.
Hospitalization time, a significant economic and emotional factor for patients, also did not differ significantly among the groups. This outcome suggests that while total laparoscopic gastrectomy offers faster functional recovery, other variables—such as institutional practices, patient comorbidities, and rehabilitation protocols—may homogenize length of stay. It highlights the multifaceted nature of postoperative care beyond surgical technique alone.
Survival outcomes, arguably the most critical endpoint, were comparable across the board. There were no significant differences in overall or disease-free survival between the groups, indicating that the choice of surgical method does not compromise long-term oncologic prognosis in advanced gastric cancer patients treated with neoadjuvant therapy. This revelation may grant surgeons and patients greater flexibility in choosing less invasive methods without the fear of diminishing survival chances.
This study’s multicenter design and relatively large sample size bolster its external validity, offering a more generalized reflection of clinical realities across varied clinical settings. Additionally, the retrospective nature allows for real-world outcome analysis, although prospective randomized studies would be invaluable to corroborate these findings and further refine surgical guidelines.
It is important to contextualize these findings within the broader surgical oncology field, where minimally invasive techniques have steadily revolutionized management paradigms. This research illuminates that despite initial challenges such as longer operative times and technical demands, total laparoscopic gastrectomy champions faster postoperative recuperation without sacrificing oncological rigor.
The implications of earlier postoperative recovery extend beyond clinical indices; they resonate deeply with patient-centric care models emphasizing reduced morbidity, quicker return to daily activities, and psychological well-being. Early food intake and bowel function restoration can significantly lessen patient anxiety and improve nutritional statuses, crucial for prolonged recovery and adjuvant treatment tolerance.
Moreover, the higher lymph node yield observed with the fully laparoscopic approach may partially be attributed to enhanced visualization and magnification offered by laparoscopic optics, enabling surgeons to conduct more precise dissections. This technical superiority could redefine surgical expectations in complex gastrectomy cases previously thought to mandate open surgery.
While the surgical landscape continues to embrace robotic assistance and novel instrumentation, this study’s insights underscore the sufficiency of laparoscopy alone as a formidable tool, particularly in resource-limited centers where robotic platforms remain elusive. The study advocates for the inclusion of total laparoscopic techniques in standard surgical armamentaria for advanced gastric cancer when appropriate expertise is available.
It must also be acknowledged that patient selection criteria and surgical expertise inherently influence outcomes. As such, the absence of significant differences in survival and complication rates likely reflects optimal patient stratification and experienced surgical teams across participating centers. These factors highlight the centrality of multidisciplinary collaboration in oncologic care.
To summarize, this pioneering investigation confirms that while total laparoscopic total gastrectomy requires lengthier operative times, it offers incontrovertible benefits in enhanced postoperative recovery without compromising oncological safety or long-term survival. These findings may encourage more widespread adoption of minimally invasive approaches as standard practice following neoadjuvant chemotherapy in advanced gastric cancer care.
As gastric cancer treatment continues to evolve towards precision and personalized strategies, surgical innovation remains paramount. Studies such as this one not only validate emerging techniques but also provide a roadmap for balancing surgical efficiency, patient recovery, and oncologic integrity, fulfilling the overarching goal of improving outcomes in this formidable disease.
Subject of Research: Evaluation of short- and long-term outcomes among different surgical approaches (total laparoscopic, laparoscopic-assisted, and open total gastrectomies) for advanced gastric cancer patients after neoadjuvant chemotherapy.
Article Title: Comparison of short- and long-term outcomes among total laparoscopic, laparoscopic-assisted, and open total gastrectomies for advanced gastric cancer patients after neoadjuvant chemotherapy: a multicenter retrospective cohort study.
Article References:
Gao, X., Li, Z., Yuan, J. et al. Comparison of short- and long-term outcomes among total laparoscopic, laparoscopic-assisted, and open total gastrectomies for advanced gastric cancer patients after neoadjuvant chemotherapy: a multicenter retrospective cohort study. BMC Cancer 25, 1401 (2025). https://doi.org/10.1186/s12885-025-14765-x
Image Credits: Scienmag.com
