Gastric Cancer

, Volume 22, Issue 1, pp 214–222 | Cite as

A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03

  • Woo Jin Hyung
  • Han-Kwang Yang
  • Sang-Uk Han
  • Young-Jun Lee
  • Joong-Min Park
  • Jin Jo Kim
  • Oh Kyung Kwon
  • Seong Ho Kong
  • Hyoung-Il Kim
  • Hyuk-Joon Lee
  • Wook Kim
  • Seung Wan Ryu
  • Sung-Ho Jin
  • Sung Jin Oh
  • Keun Won Ryu
  • Min-Chan Kim
  • Hye-Seong Ahn
  • Young Kyu Park
  • Young-Ho Kim
  • Sun-Hwi Hwang
  • Jong Won Kim
  • Gyu Seok ChoEmail author
Original Article



With improved short-term surgical outcomes, laparoscopic distal gastrectomy has rapidly gained popularity. However, the safety and feasibility of laparoscopic total gastrectomy (LTG) has not yet been proven due to the difficulty of the technique. This single-arm prospective multi-center study was conducted to evaluate the use of LTG for clinical stage I gastric cancer.


Between October 2012 and January 2014, 170 patients with pathologically proven, clinical stage I gastric adenocarcinoma located at the proximal stomach were enrolled. Twenty-two experienced surgeons from 19 institutions participated in this clinical trial. The primary end point was the incidence of postoperative morbidity and mortality at postoperative 30 days. The severity of postoperative complications was categorized according to Clavien–Dindo classification, and the incidence of postoperative morbidity and mortality was compared with that in a historical control.


Of the enrolled patients, 160 met criteria for inclusion in the full analysis set. Postoperative morbidity and mortality rates reached 20.6% (33/160) and 0.6% (1/160), respectively. Fifteen patients (9.4%) had grade III or higher complications, and three reoperations (1.9%) were performed. The incidence of morbidity after LTG in this trial did not significantly differ from that reported in a previous study for open total gastrectomy (18%).


LTG performed by experienced surgeons showed acceptable postoperative morbidity and mortality for patients with clinical stage I gastric cancer.


Gastric cancer Laparoscopy Total gastrectomy 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical standards

Each centre’s institutional review board or independent ethics committee approved the study. All procedures followed the guiding principles of the Declaration of Helsinki and the Good Clinical Practice Guidelines of the International Conference on Harmonization. All patients provided written informed consent.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Woo Jin Hyung
    • 1
  • Han-Kwang Yang
    • 2
  • Sang-Uk Han
    • 3
  • Young-Jun Lee
    • 4
  • Joong-Min Park
    • 5
  • Jin Jo Kim
    • 6
  • Oh Kyung Kwon
    • 7
  • Seong Ho Kong
    • 2
  • Hyoung-Il Kim
    • 1
  • Hyuk-Joon Lee
    • 2
  • Wook Kim
    • 8
  • Seung Wan Ryu
    • 9
  • Sung-Ho Jin
    • 10
  • Sung Jin Oh
    • 11
  • Keun Won Ryu
    • 12
  • Min-Chan Kim
    • 13
  • Hye-Seong Ahn
    • 14
  • Young Kyu Park
    • 15
  • Young-Ho Kim
    • 16
  • Sun-Hwi Hwang
    • 17
  • Jong Won Kim
    • 5
  • Gyu Seok Cho
    • 18
    Email author
  1. 1.Department of SurgeryYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of Surgery and Cancer Research InstituteSeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of SurgeryAjou University School of MedicineSuwonSouth Korea
  4. 4.Department of Surgery, Institute of Health SciencesGyeongsang National University School of MedicineJinjuSouth Korea
  5. 5.Department of SurgeryChung-Ang University College of MedicineSeoulSouth Korea
  6. 6.Department of SurgeryIncheon St. Mary’s Hospital, The Catholic University of Korea College of MedicineIncheonSouth Korea
  7. 7.Department of SurgeryKyungpook National University Medical CenterDaeguSouth Korea
  8. 8.Department of SurgeryYeouido St. Mary’s Hospital, The Catholic University of Korea College of MedicineSeoulSouth Korea
  9. 9.Department of SurgeryKeimyung University School of MedicineDaeguSouth Korea
  10. 10.Department of SurgeryKorea Cancer Center Hospital, Korea Institute of Radiological and Medical SciencesSeoulSouth Korea
  11. 11.Department of SurgeryHaeundae Paik Hospital, Inje University College of MedicineBusanSouth Korea
  12. 12.Center for Gastric Cancer, Research Institute and HospitalNational Cancer CenterGoyangSouth Korea
  13. 13.Department of SurgeryDong-A University College of MedicineBusanSouth Korea
  14. 14.Department of SurgerySeoul National University Boramae Medical CenterSeoulSouth Korea
  15. 15.Department of SurgeryChonnam National University Hwasoon HospitalHwasunSouth Korea
  16. 16.Department of SurgeryKyung Hee University School of MedicineSeoulSouth Korea
  17. 17.Department of SurgeryPusan National University Yangsan HospitalYangsanSouth Korea
  18. 18.Department of SurgerySoonchunhyang University College of MedicineBucheon-siSouth Korea

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