A comparison of short-term outcomes of total laparoscopic, laparoscopic-assisted, and open total gastrectomies for patients with advanced gastric cancer after neoadjuvant chemotherapy: a multicenter retrospective cohort study

Objective To evaluate the short-term safety and efficacy of total laparoscopic, laparoscopic-assisted, and open total gastrectomies for patients with gastric cancer after neoadjuvant therapy. Methods This multicenter retrospective cohort study was conducted to collect clinical data from 289 patients who underwent total radical gastrectomy after neoadjuvant therapy at six centers. The patients were divided into three groups according to the surgical method they received: total laparoscopic, laparoscopic-assisted, and open groups. The general baseline data, intraoperative and postoperative conditions, postoperative histopathological results, and related complications of the three groups were compared. Results The total laparoscopic group had a longer operation time and more intraoperative blood loss than the laparoscopic-assisted and open groups. However, the first postoperative bowel movement, first postoperative defecation, first postoperative meal, and removal of the postoperative drainage tube occurred earlier, and the total number of lymph node dissections was higher in total laparoscopic group. The intraoperative blood transfusion rate, postoperative intensive care unit admission rate, maximum tumor diameter, positive lymph node dissection number, TNM staging, and hospitalization time did not differ significantly among the three groups, nor did the total incidence of postoperative complications, Clavien-Dindo classification, and 30- and 90-day readmission rates (all p > 0.05). Conclusion For patients with gastric cancer treated with neoadjuvant therapy, there is no significant difference in overall safety and short-term effectiveness among the three surgical methods employed. Although total laparoscopic total gastrectomy has a longer operation time, it has the advantages of faster postoperative recovery and earlier food intake.