Comparison of Surgical and Oncological Outcomes of Laparoscopic and Open Gastrectomy for Pathologically Serosa-Invasive (pT4a) Advanced Gastric Cancer-Retrospective Propensity Score-Matched Analysis.

We aimed to clarify the operative feasibility and oncological efficacy of a laparoscopic gastrectomy (LG) for pT4a gastric cancer through comparison with open gastrectomy (OG). We compared surgical and oncological outcomes in 178 patients with pT4a gastric cancer who underwent LG or OG between 2002 and 2016; the background was adjusted using propensity score matching. After score matching, 45 patients were included in each group. The LG group had a significantly longer operation time (277 minutes versus 175 minutes,  < .001) and lower estimated blood loss (50 mL versus 280 mL,  < .001). The total number of dissected lymph nodes did not differ between groups (46 versus 38,  = .119); however, the number of dissected suprapancreatic lymph nodes was significantly higher in the LG group (11 versus 7.5,  = .011). Postoperative morbidity rates did not differ between groups. Postoperative hospitalization was significantly shorter in the LG group (7 days versus 13 days,  < .01), whereas overall survival, disease-free survival, and cancer recurrence rates and patterns were similar between groups. LG for pT4a gastric cancer has feasible and acceptable outcomes compared with OG.