Feasibility of laparoscopic/robot-assisted surgery for Borrmann type 4 gastric cancer: a comparison study with conventional open surgery

Eigo Akimoto; Takahiro Kinoshita; Masahiro Yura; Mitsumasa Yoshida; Takafumi Okayama; Takumi Habu; Masaru Komatsu; Hiromi Nagata; Daiki Terajima

doi:10.1007/s00464-024-10857-0

Feasibility of laparoscopic/robot-assisted surgery for Borrmann type 4 gastric cancer: a comparison study with conventional open surgery

Surg Endosc. 2024 Apr 30. doi: 10.1007/s00464-024-10857-0. Online ahead of print.

Authors

Eigo Akimoto¹, Takahiro Kinoshita², Masahiro Yura¹, Mitsumasa Yoshida¹, Takafumi Okayama¹, Takumi Habu¹, Masaru Komatsu¹, Hiromi Nagata¹, Daiki Terajima¹

Affiliations

¹ Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
² Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. takkinos@east.ncc.go.jp.

PMID: 38691134
DOI: 10.1007/s00464-024-10857-0

Abstract

Background: Laparoscopic surgery for early gastric cancer is regarded as a standard of care because of robust evidences obtained by several phase-III trials. Furthermore, the efficacy of laparoscopic radical surgery for advanced gastric cancer has been also reported. Meanwhile, the feasibility of laparoscopic surgery for Bormann type 4 gastric cancer, special type with unfavorable prognosis, remains unclear since excluded from eligibility of these trials.

Methods: This study included 100 patients with type 4 gastric cancer who underwent laparoscopic/robot-assisted (minimally invasive surgery (MIS) group; n = 32) or open (Open group; n = 68) curative surgery between 2008 and 2021. After propensity score matching, 30 patients in each group were extracted for analysis. Clinical data, including surgical and midterm survival outcomes, were retrospectively compared between the two groups.

Results: Incidences of postoperative complication (≥ Clavien-Dindo grade III) were recorded in 23.3% in the MIS group and 13.3% in the Open group, but no statistical significance was demonstrated (P = 0.50). The 3-year overall survival rate in the MIS group was better than that in the Open group (80.2% vs. 53.5%, log-rank, P = 0.03). The trend of recurrence site was similar. Multivariate analysis showed that adjuvant chemotherapy was an independent favorable prognostic factor (hazard ratio, 0.33, 95% confidence interval 0.11-0.93) for overall survival. MIS was indicated as a favorable prognostic factor (hazard ratio, 0.39, 95% confidence interval 0.39-1.07), but without statistical difference.

Conclusion: While multidisciplinary treatment is mainstay of treatment because of the poor prognosis of this disease, minimally invasive surgery may play an important role in treatment if appropriate patient selection is done. Further analyses with larger sample size are necessary to reach a final conclusion regarding oncological efficacy.

Keywords: Laparoscopic gastrectomy; Minimally invasive gastrectomy; Robot-assisted gastrectomy; Type 4 gastric cancer.