Laparoscopic versus open gastrectomy for locally advanced gastric cancer: a comparative analysis of survival and prognostic factors

INTRODUCTION: This retrospective study aimed to compare the outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) in patients undergoing gastrectomy with D2 lymph node dissection for locally advanced gastric adenocarcinoma.
METHODS: A total of 159 patients who underwent surgery between 2014 and 2022 were analyzed. Patients were divided into two groups according to the surgical approach: LG (60%) and OG. Data on patient demographics, tumor characteristics, perioperative outcomes, and survival were collected. Overall survival (OS) was analyzed using the Kaplan–Meier method and Cox proportional hazards models.
RESULTS: The LG group was significantly younger and had earlier tumor-node-metastasis (TNM) stages and N stages than the OG group (p<0.001). The median hospital stay was shorter in the LG group (8 vs. 8 days, p=0.042); however, postoperative morbidity was higher (29.2% vs. 6.3%, p<0.001). In the univariate analysis, LG was associated with improved OS compared with OG (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.41–0.90, p=0.014). However, in the multivariable analysis adjusted for age and TNM stage, age <65 years (HR 0.57, 95% CI 0.38–0.86, p=0.007) and stage II disease (HR 0.32, 95% CI 0.19–0.54, p<0.001) were identified as independent prognostic factors for better survival, whereas the surgical approach was no longer independently significant (HR 0.68, 95% CI 0.45–1.02, p=0.062).
DISCUSSION AND CONCLUSION: Laparoscopic gastrectomy is a feasible approach for selected patients with locally advanced gastric cancer. Although it is associated with a shorter hospital stay, careful attention should be paid to postoperative morbidity. The observed survival benefit associated with laparoscopy appears to be influenced by patient age and tumor stage rather than by the surgical technique itself. Larger prospective studies are needed to evaluate the independent long-term survival impact of the laparoscopic approach.

Keywords: Gastric cancer, laparoscopic gastrectomy, open gastrectomy, prognostic factors, survival