LAPAROSCOPIC TOTAL OR PARTIAL GASTRECTOMY VERSUS OPEN SURGERY IN GASTRIC CANCER: COMPARISON OF ONCOLOGICAL AND FUNCTIONAL OUTCOMES

• DOI: https://doi.org/10.22533/at.ed.1595125030110

• Palavras-chave: Laparoscopic Gastrectomy, Open Gastrectomy, Surgery for Gastric Cancer, Oncologic Outcomes, Functional Recovery.

• Keywords: Laparoscopic Gastrectomy, Open Gastrectomy, Surgery for Gastric Cancer, Oncologic Outcomes, Functional Recovery.

• Abstract:

  INTRODUCTION: Gastric cancer, predominantly adenocarcinoma, is the fifth most common neoplasm and the third leading cause of cancer death globally, with a higher incidence in regions such as Asia and Latin America due to cultural factors and the high prevalence of Helicobacter pylori [1,2,3]. Gastrectomy, traditionally performed by the open route, is considered the gold standard, but laparoscopy has emerged as an alternative, offering faster recovery and fewer complications, despite technical challenges and a longer learning curve [3,4]. Studies highlight the benefits and limitations of laparoscopy, underscoring the need for an integrative review to consolidate evidence and guide clinical guidelines [6,7,8,9]. METHODS: This integrative review analyzed 45 studies published between 2018 and 2023, comparing laparoscopic and open gastrectomy in the treatment of gastric cancer, focusing on oncological and functional outcomes [9,10]. The search, conducted on databases such as PUBMED and MEDLINE, used specific descriptors and strict filters. The selection process included screening 785 articles, reducing them to 612 after filtering, and a detailed evaluation of 45 full texts, excluding works with insufficient methodology or data [11,12,13]. RESULTS: Safety and efficacy: Laparoscopy is comparable to open surgery in intraoperative and postoperative complications, with a lower rate of wound infections and similar oncological control, including adequate resection margins and lymph node dissection [14,15,16]. Technical aspects: Initially, surgical time may be longer with laparoscopy due to the learning curve, but it improves with experience [17,18,19]. Laparoscopy reduces blood loss and transfusions [20,21,22]. Procedures such as total gastrectomies are more complex than distal ones, requiring a personalized approach [23,24,25]. Quality of Life: Less pain, reduced use of analgesics, accelerated recovery and shorter hospital stays are all advantages of laparoscopy [26,27,28]. In the long term, laparoscopy also reveals less dumping syndrome and better gastrointestinal functionality [29,30,31]. Contextual factors: The laparoscopic technique is effective overall, regardless of demographic differences [32,33,34]. Elderly, obese and patients with comorbidities benefit from less trauma and faster recovery, especially in specialized centers [35,36,37]. DISCUSSION: Open surgery and laparoscopy differ in their approach, invasiveness and recovery [38,39,40]. Open surgery, indicated in complex cases, offers wide visibility and control, but is associated with longer recovery time, pain and risk of infection [41,42]. Laparoscopy, which is minimally invasive, reduces pain, blood loss, length of hospital stay and improves quality of life, but requires specialized training and advanced equipment, and is less indicated in advanced stages of the disease [43,44]. In gastrectomy for gastric cancer, laparoscopy stands out due to less trauma, faster recovery and better functional outcomes, especially in gastrointestinal preservation, reducing complications such as dumping syndrome [44]. Although factors such as age, high BMI and comorbidities influence results, laparoscopy maintains consistent benefits, especially in specialized centers [44]. The choice between techniques should take into account patient characteristics, disease stage and team experience, with further studies needed for clear protocols and individualized decisions. CONCLUSION: The comparison between laparoscopic gastrectomy and open surgery for gastric cancer highlighted the advantages of the laparoscopic technique, such as less tissue trauma, faster recovery, lower risk of infection and superior quality of life [1,2,3,6,7,8,9]. However, it presents challenges such as greater complexity, the need for specialized training and longer surgery times [17,18,19]. Both techniques offer similar oncological outcomes, and the choice must take into account the individual characteristics of each patient [38,39,40,45].