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Background <p>The standard treatment for stage IV gastric cancer (GC) is chemotherapy, but advances in systemic therapy have rendered curative surgery a viable option. However, the role of minimally invasive surgery (MIS) in this context remains unclear. This multicenter retrospective cohort study aimed to evaluate safety and effectiveness of MIS post-chemotherapy for patients with cStage IVb GC.</p> Methods <p>Patients with cStage IVb GC who underwent curative-intent MIS or open surgery post-chemotherapy at 19 institutions between 2011 and 2022 were reviewed. Propensity score-matching was performed to adjust for confounding variables. The primary outcome was postoperative complications. Secondary outcomes were perioperative outcomes and long-term survival.</p> Results <p>Among 237 eligible patients (MIS, 130; open surgery, 107), 64 matched pairs were analysed. The incidence of Clavien–Dindo grade ≥ II complications was 31.2% in the MIS group and 46.9% in the open group, with no significant difference (risk ratio 0.67, 95% confidence interval [CI] 0.41–1.08). MIS was associated with a longer operative time (mean difference [MD] 98&#xa0;min, 95% CI 53–143) but reduced blood loss (MD, − 550&#xa0;g; 95% CI, − 738 to − 362). The MIS group achieved R0 resections more often (92% vs. 78%). The 3-year overall survival rates were 56.5% and 44.6%, respectively (hazard ratio 0.83, 95% CI 0.51–1.36).</p> Conclusions <p>In curative-intent gastrectomy following chemotherapy for cStage IVb gastric cancer, MIS was not associated with worse perioperative outcomes or long-term survival compared with open surgery. Given its less invasive nature, MIS could be considered a feasible option for these patients when performed by experienced surgeons.</p>

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Comparison of minimally invasive surgery and open surgery following chemotherapy for cStage IVb gastric cancer: a multicenter retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月20日

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  • Yusuke Fujii,
  • Shigeo Hisamori,
  • Nobuaki Hoshino,
  • Seiichiro Kanaya,
  • Eiji Tanaka,
  • Yoshito Yamashita,
  • Akira Miki,
  • Kosuke Toda,
  • Michihiro Yamamoto,
  • Yosuke Kinjo,
  • Dai Manaka,
  • Hiroaki Hata,
  • Hironori Kawada,
  • Shotaro Matsuda,
  • Atsushi Itami,
  • Kyoichi Hashimoto,
  • Kenjiro Hirai,
  • Sanae Nakajima,
  • Hiroshi Okabe,
  • Masazumi Sakaguchi,
  • Yuichiro Kawamura,
  • Takashi Sakamoto,
  • Shintaro Okumura,
  • Tatsuto Nishigori,
  • Shigeru Tsunoda,
  • Kazutaka Obama

摘要

Background

The standard treatment for stage IV gastric cancer (GC) is chemotherapy, but advances in systemic therapy have rendered curative surgery a viable option. However, the role of minimally invasive surgery (MIS) in this context remains unclear. This multicenter retrospective cohort study aimed to evaluate safety and effectiveness of MIS post-chemotherapy for patients with cStage IVb GC.

Methods

Patients with cStage IVb GC who underwent curative-intent MIS or open surgery post-chemotherapy at 19 institutions between 2011 and 2022 were reviewed. Propensity score-matching was performed to adjust for confounding variables. The primary outcome was postoperative complications. Secondary outcomes were perioperative outcomes and long-term survival.

Results

Among 237 eligible patients (MIS, 130; open surgery, 107), 64 matched pairs were analysed. The incidence of Clavien–Dindo grade ≥ II complications was 31.2% in the MIS group and 46.9% in the open group, with no significant difference (risk ratio 0.67, 95% confidence interval [CI] 0.41–1.08). MIS was associated with a longer operative time (mean difference [MD] 98 min, 95% CI 53–143) but reduced blood loss (MD, − 550 g; 95% CI, − 738 to − 362). The MIS group achieved R0 resections more often (92% vs. 78%). The 3-year overall survival rates were 56.5% and 44.6%, respectively (hazard ratio 0.83, 95% CI 0.51–1.36).

Conclusions

In curative-intent gastrectomy following chemotherapy for cStage IVb gastric cancer, MIS was not associated with worse perioperative outcomes or long-term survival compared with open surgery. Given its less invasive nature, MIS could be considered a feasible option for these patients when performed by experienced surgeons.