The impact of time on the efficacy of advanced distal gastric cancer (ADGC) remains unclear. At 3 years postoperatively, the efficacy of oncologic surgery for ADGC needs to be confirmed.
A total of 1256 patients with ADGC at two teaching institutions in China from April 2007 to December 2014 were enrolled. The general data of the two groups were matched using propensity scores. Restricted mean survival time (RMST) was used to compare survival.
After matching, 461 patients each in the open distal gastrectomy (ODG) and laparoscopic distal gastrectomy (LDG) groups were analyzed. The 3- and 5-year overall survival (OS) and disease-free survival in ODG group were comparable to those in LDG group. RMST-stratified analysis showed that the 3-year RMST of ODG group was similar to that of LDG group (-1.38 years, P=0.163) in cT4a patients, whereas the 5-year RMST had significant differences between groups (-8.36 years, P=0.005). In further stratified analysis, when patients with cT4a and tumor was >5 cm, the 3-year RMST of ODG group was similar to that of LDG group (0.98 year, P=0.480); however, the 5-year RMST was significantly longer in ODG group (4.67 years, P=0.042). Multivariate regression analysis showed that ODG is a protective factor for 5-year OS in patients with cT4a and tumors >5 cm.
Beyond 3 years, ODG can improve the survival of patients with serous infiltration and tumors >5 cm by reducing the risk of recurrence. The present findings can serve as a reference for the preoperative selection of GC surgery options and the setting of follow-up time for clinical studies.
The authors.
Scientific and Technological Innovation Joint Capital Projects of Fujian Province.
All authors have declared no conflicts of interest.