Surgical Endoscopy

, Volume 27, Issue 11, pp 4267–4276 | Cite as

Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301)

  • Young-Woo Kim
  • Hong Man Yoon
  • Young Ho Yun
  • Byung Ho Nam
  • Bang Wool Eom
  • Yong Hae Baik
  • Sang Eok Lee
  • Yeji Lee
  • Young-ae Kim
  • Ji Yeon Park
  • Keun Won Ryu



The purpose of this study was to evaluate laparoscopy-assisted distal gastrectomy (LADG) compared to open distal gastrectomy (ODG) in the treatment of early gastric cancer with respect to survival, surgical outcomes, complications, and quality of life (QOL).


One hundred sixty-four patients with cT1N0M0 and cT1N1M0 distal gastric cancer were randomly assigned to either the LADG group or the ODG group. The primary end point was the 5-year disease-free survival (DFS) rate. Complications were classified using the accordion severity classification of postoperative complications scheme. QOL was measured using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-STO22 preoperatively and postoperatively during regular follow-up visits. This trial is registered at (NCT00546468).


The median (range) follow-up period was 74.3 (24.8–90.8) months. The LADG and ODG groups showed similar survival [5-year DFS rate: 98.8 % vs. 97.6 %, respectively (P = 0.514), 5-year overall survival (OS) rate: 97.6 vs. 96.3 %, respectively (P = 0.721)] or overall complication rate (29.3 vs. 42.7 %, respectively; P = 0.073). Mild complications were significantly less frequent in the LADG group than in the ODG group (23.2 vs. 41.5 %; P = 0.012). The rates of moderate, severe, and long-term complications (i.e., 31 days to 5 years after surgery) did not differ significantly between groups. No clinically meaningful differences were detected between the two groups in long-term QOL.


LADG showed similar DFS and OS compared to ODG in treating early gastric cancer. Marginal benefits in mild complications were observed with LADG. LADG did not show advantages over ODG regarding other complications and long-term QOL.


Gastric cancer Survival Quality of life Laparoscopy 



This work was supported by a Grant (NCC 0310060-1,2,3) from the National Cancer Center, South Korea. We thank Jae Gahb Park, MD, Jin Soo Lee, MD, Jae-Moon Bae, MD, Seung Hoon Lee, MD, previous and present staff members of the Center for Gastric Cancer (Myeong-Cherl Kook, MD, Jong Seok Lee, MD, Sang-Gyun Kim, MD, Ho Joon Song, MD, Il Ju Choi, MD, Chan Gyu Kim, MD, Jong Yeul Lee, M.D., Soo Jeong Cho, MD, Ji Yoon Rho, M.D.), scrub nurses in the operating room, and nurses in the ward for their support during this clinical study. We also thank Hyun-Jung Park, RN, Eun Ju Yoo, RN, Yura Kim, RN, Seonhui Park, RN, Seonmi Kim, RN, Jaehyeun Lee, RN, Iyeong Kim, RN, Miae Park, RN, and Jiyeong Jang, RN, for collecting the data.


Young-Woo Kim, Hong Man Yoon, Young Ho Yun, Byung Ho Nam, Bang Wool Eom, Yong Hae Baik, Sang Eok Lee, Yeji Lee, Young-ae Kim, Ji Yeon Park, and Keun Won Ryu have no conflicts of interest or financial ties to disclose.


  1. 1.
    Reddick EJ, Olsen DO (1989) Laparoscopic laser cholecystectomy. A comparison with mini-lap cholecystectomy. Surg Endosc 3:131–133PubMedCrossRefGoogle Scholar
  2. 2.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  3. 3.
    Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52PubMedCrossRefGoogle Scholar
  4. 4.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AMH, Heath RM, Brown JM (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRefGoogle Scholar
  5. 5.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  6. 6.
    Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727PubMedCrossRefGoogle Scholar
  7. 7.
    Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176PubMedCrossRefGoogle Scholar
  8. 8.
    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report: a phase III multicenter, prospective, randomized trial (KLASS Trial). Ann Surg 251:417–420PubMedCrossRefGoogle Scholar
  9. 9.
    Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311PubMedCrossRefGoogle Scholar
  10. 10.
    Lee JH, Han HS (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173PubMedCrossRefGoogle Scholar
  11. 11.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237PubMedCrossRefGoogle Scholar
  12. 12.
    Japanese Gastric Cancer Association (1998) Japanese Classification of Gastric Carcinoma—2nd English Edition. Gastric Cancer 1:10–24PubMedCrossRefGoogle Scholar
  13. 13.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  14. 14.
    Fayers P, Bottomley A (2002) Quality of life research within the EORTC—the EORTC QLQ-C30. European Organisation for Research and Treatment of Cancer. Eur J Cancer 38(4):S125–S133PubMedCrossRefGoogle Scholar
  15. 15.
    Blazeby JM, Conroy T, Bottomley A, Vickery C, Arraras J, Sezer O, Moore J, Koller M, Turhal NS, Stuart R, van Cutsem E, D’haese S, Coens C (2004) Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-STO 22, to assess quality of life in patients with gastric cancer. Eur J Cancer 40:2260–2268PubMedCrossRefGoogle Scholar
  16. 16.
    Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144PubMedGoogle Scholar
  17. 17.
    Littell RC, Milliken GA, Stroup WW, Wolfinger RD, Schabenberber O (2006) SAS for mixed models, 2nd edn. SAS Publishing, CaryGoogle Scholar
  18. 18.
    Greene FL, Kercher KW, Nelson H, Teigland CM, Boller AM (2007) Minimal access cancer management. CA Cancer J Clin 57:130–146PubMedCrossRefGoogle Scholar
  19. 19.
    Wente MN, Seiler CM, Uhl W, Buchler MW (2003) Perspectives of evidence-based surgery. Dig Surg 20:263–269PubMedCrossRefGoogle Scholar
  20. 20.
    Braga M, Frasson M, Vignali A, Zuliani W, Civelli V, Di Carlo V (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48:2217–2223PubMedCrossRefGoogle Scholar
  21. 21.
    Pugliese R, Maggioni D, Sansonna F, Ferrari GC, Forgione A, Costanzi A, Magistro C, Pauna J, Di Lernia S, Citterio D, Brambilla C (2009) Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures. Eur J Surg Oncol 35:281–288PubMedCrossRefGoogle Scholar
  22. 22.
    Lee SW, Nomura E, Bouras G, Tokuhara T, Tsunemi S, Tanigawa N (2010) Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. J Am Coll Surg 211:33–40PubMedCrossRefGoogle Scholar
  23. 23.
    Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, Bae JM (2008) Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 15:1625–1631PubMedCrossRefGoogle Scholar
  24. 24.
    Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K, JCOG Gastric Cancer Surgical Study Group (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244PubMedCrossRefGoogle Scholar
  25. 25.
    Jiang X, Hiki N, Nunobe S, Kumagai K, Nohara K, Sano T, Yamaguchi T (2012) Postoperative pancreatic fistula and the risk factors of laparoscopy-assisted distal gastrectomy for early gastric cancer. Ann Surg Oncol 19:115–121PubMedCrossRefGoogle Scholar
  26. 26.
    Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135:806–810PubMedCrossRefGoogle Scholar
  27. 27.
    Strong V, Devaud N, Allen P, Gonen M, Brennan M, Coit D (2009) Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case–control study. Ann Surg Oncol 16:1507–1513PubMedCrossRefGoogle Scholar
  28. 28.
    Watson DI, Devitt PG, Game PA (1995) Laparoscopic Billroth II gastrectomy for early gastric cancer. Br J Surg 82:661–662PubMedCrossRefGoogle Scholar
  29. 29.
    Ohtani H, Tamamori Y, Noguchi K, Azuma T, Fujimoto S, Oba H, Aoki T, Minami M, Hirakawa K (2010) A meta-analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer. J Gastrointest Surg 14:958–964PubMedCrossRefGoogle Scholar
  30. 30.
    Ding J, Liao GQ, Liu HL, Liu S, Tang J (2011) Meta-analysis of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer. J Surg Oncol 105(3):297–303PubMedCrossRefGoogle Scholar
  31. 31.
    Guzman E, Pigazzi A, Lee B, Soriano P, Nelson R, Benjamin Paz I, Trisal V, Kim J, Ellenhorn J (2009) Totally laparoscopic gastric resection with extended lymphadenectomy for gastric adenocarcinoma. Ann Surg Oncol 16:2218–2223PubMedCrossRefGoogle Scholar
  32. 32.
    Varela JE, Hiyashi M, Nguyen T, Sabio A, Wilson SE, Nguyen NT (2006) Comparison of laparoscopic and open gastrectomy for gastric cancer. Am J Surg 192:837–842PubMedCrossRefGoogle Scholar
  33. 33.
    Shehzad K, Mohiuddin K, Nizami S, Sharma H, Khan IM, Memon B, Memon MA (2007) Current status of minimal access surgery for gastric cancer. Surg Oncol 16:85–98PubMedCrossRefGoogle Scholar
  34. 34.
    Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS (2008) The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 248:793–799PubMedCrossRefGoogle Scholar
  35. 35.
    Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Ann Surg 238:680–685PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Young-Woo Kim
    • 1
  • Hong Man Yoon
    • 1
  • Young Ho Yun
    • 2
    • 4
  • Byung Ho Nam
    • 3
  • Bang Wool Eom
    • 1
  • Yong Hae Baik
    • 1
    • 5
  • Sang Eok Lee
    • 1
    • 6
  • Yeji Lee
    • 2
  • Young-ae Kim
    • 1
    • 2
  • Ji Yeon Park
    • 1
    • 7
  • Keun Won Ryu
    • 1
  1. 1.Gastric Cancer BranchResearch Institute & Hospital, National Cancer CenterGoyang-siRepublic of Korea
  2. 2.Cancer Management BranchResearch Institute & Hospital, National Cancer CenterGoyang-siRepublic of Korea
  3. 3.Center for Clinical TrialsNational Cancer CenterGoyangRepublic of Korea
  4. 4.Seoul National University College of MedicineSeoulRepublic of Korea
  5. 5.Department of General SurgeryDongguk University International HospitalGoyangRepublic of Korea
  6. 6.Department of General SurgeryKonyang Universtiy HospitalDaejeonRepublic of Korea
  7. 7.Department of General SurgerySoonchunhyang University HospitalSeoulRepublic of Korea

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