Abstract 466P
Background
For remnant gastric cancer (RGC), the efficacy of laparoscopic completion total gastrectomy (LCTG) remains controversial. This prospective study aims to investigate the safety, feasibility, and long-term oncological efficacy of LCTG in the treatment of RGC.
Methods
This prospective single-arm study (FUGES-004) enrolled 50 RGC patients (ClinicalTrials.gov identifier: NCT02792881) who underwent LCTG at the Fujian Medical University Union Hospital between June 2016 and June 2020. The historic control group sourced from patients who underwent open completion total gastrectomy (OCTG) in the six tertiary teaching hospitals from CRGC-01 study. Inverse probability treatment weighted (IPTW) was used to balance the baseline between LCTG and OCTG. The primary outcome was 30-day postoperative morbidity. Secondary outcomes included 3-year disease-free survival (DFS), 3-year overall survival (OS), and recurrence patterns.
Results
Finally, 46 eligible participants who underwent LCTG and 160 patients who underwent OCTG were included in the analysis. After IPTW, no significant difference was found between the LCTG and OCTG groups in the incidence (LCTG vs. OCTG: 28.0% vs. 35.0%, P = 0.379) or severity of complications within 30 days after surgery. Compared with OCTG, LCTG resulted in better short-term outcomes and faster postoperative recovery, such as less estimated blood loss, shorter operation time, more harvested lymph nodes, and reduced hospital stay. However, the textbook outcome rate was comparable between the two groups (45.9% vs. 32.8%, P=0.107). In addition, After IPTW, LCTG had the comparable 3-year DFS and 3-year OS with OCTG (DFS: log-rank P = 0.173; OS: log-rank P = 0.319). There were no significant differences between the two groups in the recurrence types, mean recurrence time, or 3-year cumulative hazard of recurrence (all p>0.05). Subgroup analysis and concurrent comparison demonstrated the same trends.
Conclusions
With strictly adjusted for confounding factors, this prospective study suggested that LCTG is not inferior to OCTG in short- and long-term outcomes. In experienced centers, LCTG can be a treatment option for RGC on the premise of strict indications.
Clinical trial identification
NCT02792881.
Legal entity responsible for the study
Fujian Medical University Union Hospital.
Funding
"Dual High" Medical Services in Fujian Province (Min Wei Yi Zheng [2021] No. 76).
Disclosure
All authors have declared no conflicts of interest.