Laparoscopic surgery after neoadjuvant chemotherapy for locally advanced gastric cancer: comparative clinical results and prospects for implementation

Abstract

Background. Gastric cancer in Uzbekistan ranks first in incidence among men and fifth among women, with a stable mortality rate (3.8-4.0 per 100,000). Stages II-III account for 73-75% of cases, resulting in a high one-year mortality rate (27%) and low five-year survival rates (≈32%). Limited coverage of combination treatment (35.7%) and insufficient use of high-tech interventions require the development of screening, improved diagnostics, and the introduction of modern methods. Laparoscopic surgery after neoadjuvant polychemotherapy (NAPCT) reduces morbidity, complication rates, and accelerates recovery. Study objective. To compare the short-term outcomes of laparoscopic surgery after NAPCT and traditional open surgery for locally advanced gastric cancer. Materials and methods. Data from 165 patients were analyzed, divided into three groups: Group 1 – open surgery without NAPCT; Group 2 – NAPCT + open surgery; Group 3 – NAPCT + laparoscopic surgery. The following were assessed: blood loss, operative time, need for narcotic analgesics, hospital stay, complications (Clavien-Dindo), anastomotic complication rate, quality of life, rehabilitation time, and return to work. Results and discussion. Blood loss was minimal in Group 3 (150 ml) versus 250–350 ml in Groups 1 and 2. Surgery duration was 120 min. (Group 1), 135 min. (Group 2), and 165 min. (Group 3). The postoperative period in patients in Group 3 was characterized by a lower need for analgesics (2 days versus 3.5 and 3), a shorter hospital stay (6.5 versus 8 and 7.5 days), and a lower number of complications ≤class II (6 versus 15 and 12). There were no anastomotic leaks. There was no one-year mortality, and three-year survival is being assessed. Group 3 demonstrated better quality of life indicators, with rehabilitation lasting 10 days (versus 3 weeks), and return to work lasting 2 weeks (versus 3-4 weeks). Conclusion: Laparoscopic surgery after NAPCT for breast cancer is superior to open surgery in reducing morbidity, complications, and hospitalization time, while accelerating rehabilitation and improving quality of life. Despite the longer duration of the procedure, this method holds promise for implementation in oncosurgical practice.

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